Infective endocarditis continues to be a medically challenging disease despite modern medical advances. In fact, modern medical therapy, such as intracardiac catheters and devices, may contribute to the underlying predisposition of some individuals. In many cases careful clinical assessment and blood cultures remains important to determine the infecting organism. The anatomical pathologist, cardiologist, cardiac surgeon, infectious disease consultant, and microbiologist all play an important role in diagnosis and treatment. Many of the classically described clinical and pathological manifestations are no longer commonly encountered because of timely and effective antimicrobial treatment. In addition to the well-recognized local valvular complications, spread of the infection to perivalvular structures is clinically relevant and contributes to the therapeutic challenge. Patients with culture-negative fungal and prosthetic IE have a poor prognosis and pose a major clinical challenge.

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