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Why does infective endocarditis from injection drug use bite the tricuspid valve?

2019; Elsevier BV; Volume: 294; Linguagem: Inglês

10.1016/j.ijcard.2019.08.006

1874-1754

Bobby Yanagawa, Corey Adams, Richard Whitlock, Rakesh C. Arora,

Antimicrobial Resistance in Staphylococcus

To date, why the tricuspid valve is preferentially infected in injection drug users is still an unanswered question in medicine [ [1] Frontera J.A. Gradon J.D. Right-side endocarditis in injection drug users: review of proposed mechanisms of pathogenesis. Clin. Infect. Dis. 2000; 30: 374-379 Crossref PubMed Scopus (196) Google Scholar ]. We thank Bassareo et al. [ [2] Bassareo P.P Calcaterra G. Mercuro G. Correspondence relating to the paper “Right-sided infective endocarditis: insights into the forgotten valve.”. Int J Cardiol. 2019; 294: 53 Abstract Full Text Full Text PDF Scopus (2) Google Scholar ] for their proposed conceptualization of right-sided IE secondary to IDVU as a perfect storm of modulating, triggering and anatomical factors. The modulating factor is immunosuppression in injection drug users. Indeed, many but not all IV drug users are immunosuppressed by concurrent infection by HIV, Hep C and other infections [ [3] Yanagawa B. Bahji A. Lamba W. Tan D.H. Cheema A. Syed I. Verma S. Endocarditis in the setting of IDU: multidisciplinary management. Curr. Opin. Cardiol. 2018; 33: 140-147 Crossref PubMed Scopus (25) Google Scholar ]. It is not clear how this explains right- versus left-sided valve involvement.