Infective endocarditis: when an infection attacks a heart valve, and the case of a 24-year-old patient operated on in Tangier
A badly treated sore throat, a dental procedure, a small wound: a bacterium enters the blood and settles on a heart valve. Endocarditis is rare, but it can destroy a valve in a few weeks. The warning signs, the treatment, and a case we published.
Written by Dr Mohamed el Amine Tber, cardiovascular surgeon in Tangier
A badly treated sore throat, a dental procedure, a small wound: a bacterium enters the blood and settles on a heart valve. This is infective endocarditis. It is rare, but it can destroy a valve in a few weeks. Here is how to recognise it, how it is treated, and why surgery is sometimes the only way out, through a case we published.
The signs that should alert you
- A lingering fever with no cause found, especially in someone who already has a damaged valve, an artificial valve or a known heart murmur.
- Deep fatigue, new breathlessness, night sweats, weight loss.
- Sometimes small red spots on the skin, under the nails or in the white of the eye.
- More rarely, a sudden sign: weakness on one side of the body, difficulty speaking, which means a fragment has travelled to the brain.
Faced with an unexplained fever of more than a week in a heart patient, the reflex is simple: a blood test with blood cultures, meaning a search for the germ in the blood, and an echocardiogram. These two tests make the diagnosis in the great majority of cases.
Who is at risk
Anyone can develop endocarditis, but the bacterium settles mainly where the valve is already damaged: a bicuspid valve from birth, a valve affected by childhood rheumatic fever, an artificial valve, a pacemaker, or a previous endocarditis. Intravenous injections and dental work without precautions are the most frequent entry points.
Read also: rheumatic heart disease, when a badly treated sore throat damages the valves
How it is treated
Treatment relies first on antibiotics matched to the germ found in the blood, given intravenously for four to six weeks. Surgery becomes necessary in three situations: when the valve leaks massively and the heart can no longer cope, when the infection does not respond despite antibiotics, or when vegetations, those infected clumps attached to the valve, threaten to break off towards the brain. In these cases the valve is replaced, often without waiting for the end of the antibiotics.
The case we published
A 24-year-old woman, born with an aortic valve with two leaflets instead of three, arrived exhausted, breathless at rest, with severe anaemia. The valve was leaking massively, the heart was already weakened, and blood tests found a bacterium, a staphylococcus, as well as a rare immune disease, cryoglobulinaemia, in which certain blood proteins solidify in the cold.
That last point changed everything for the operation. Cardiac surgery is usually done by cooling the body, which, here, could trigger a serious reaction. After a meeting between surgeon, anaesthetist-intensivist, cardiologists and internist, we operated on the seventh day while keeping the body at 37 °C throughout the procedure, with targeted antibiotics and treatment of the immune disease before and after.
The valve was replaced. Two days in intensive care, no complications, discharge on the seventh day, and a young woman who returned to a normal life. This case was published in November 2025 in an international journal of clinical cases, because the combination of these two diseases is rare and the solution, an operation at normal temperature decided as a team, may help other teams.
What this case shows
- 7 days
- Between admission and surgery, the time to confirm the germ, prepare the heart and bring all the specialties together.
- 37 °C
- Body temperature maintained throughout cardiopulmonary bypass, instead of the usual cooling.
- 48 h
- Of intensive care, with no infectious, haemodynamic or immunological complication.
- 5
- Specialists around a single patient: surgeon, anaesthetist-intensivist, two cardiologists, internist.
What to remember
- An unexplained fever in a patient with a known murmur or valve does not wait: blood test and echocardiogram.
- Endocarditis can be cured, but the valve sometimes has to be replaced quickly, before the heart wears out.
- Complex cases are decided by several people: surgeon, intensivist, cardiologist, internist. The patient gains an operation adapted to them, not to a protocol.
Read also: heart valve replacement, duration, biological or mechanical valve, success and cost
When to consult
If you have a heart murmur, a damaged or artificial valve and a fever that lasts, do not take an antibiotic at random: it would mask the germ. See a doctor quickly for a blood test and an echocardiogram. Dr Tber, cardiovascular surgeon in Tangier, treats these infected valves with the team at the Riad Marshan Clinic, from diagnosis to surgery when it is needed.
Frequently asked questions
What are the first signs of endocarditis?
How do you get endocarditis?
Can endocarditis be treated without surgery?
How do you prevent endocarditis when you have a fragile valve?
Sources and references
External resources, opened in a new tab.
- Managing Aortic Valve Endocarditis with Cryoglobulinemia: A Multidisciplinary Case in a Young Patient Tber M. et al., American Journal of Case Reports and Clinical Images, 3(1), novembre 2025, DOI 10.51521/AJCRCI.2025.e31.149
- 2023 ESC Guidelines for the management of endocarditis Société européenne de cardiologie, European Heart Journal 2023
- Endocarditis, information patient NHS, 2022
- Infective endocarditis, fiche patient American Heart Association
Readable also
On the blog
Severe aortic stenosis: symptoms, life expectancy and when to operate
Narrowing of the aortic valve progresses silently for years, then everything changes once the first symptoms appear. Understanding that turning point is understanding why the timing of the operation counts as much as the operation itself.
Read
Aortic aneurysm: understanding a silent disease, and getting screened for it in Tangier
An aortic aneurysm often develops without a single sign, until it becomes dangerous. Understanding what causes it, how it is screened for and how it is treated is what lets you act in time, and calmly.
Read