Ribeyrolles et al reviewed the clinical features of infective endocarditis without biological markers of an inflammatory response. This can be challenging to diagnose and may be associated with a delayed diagnosis. The authors are from Henri-Mondor University Hospital.
Typical patient:
(1) age > 60 years
(2) afebrile (85%)
(3) immunocompetent with no immunosuppression
Clinical features:
(1) low serum CRP concentrations (< 20 mg/L)
(2) normal WBC count
(3) new onset of heart failure, valvular regurgitation and/or embolic stroke
The diagnosis may be delayed further if blood cultures are negative.
Transesophageal echocardiography is recommended if transthoracic endocarditis is indeterminate.
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