Despite the decline in rheumatic heart disease worldwide and the use of antibiotic prophylaxis, there is no evidence that the incidence of infective endocarditis (EI) is decreasing. In fact, some data suggestit may be increasing. The classical fever of unknown origin presentation represents a minority of EI cases today; thus, clinicians need to be vigilant about keeping EI in mind with some of these more unusual presentations

The aim was to study various presentations of EI, which are organized into three groups of presenting symptoms and signs: nonspecific, cardiac, and embolic

This was a descriptive retrospective study of 62 patients hospitalized in Charles Nicolle hospital and treated for definite EI from 2011 to 2019.

The mean age of patients was 50.12±16.66 years ranging from the age of 19 and 88 years. The study population consisted of 35 men (57.1%) and 27 women (42.9%). 44 (89.9%) of the patients had been admitted due to fever. Peripheral signs like Janeway lesion and Osler's node were not seen, arthralgia was seen in 9 patients. Heart failure was observed in 30.6% of the cases. Embolic events were common: stroke (18.3%), pulmonary emboli (9%), peripheral vascular emboli (10.2%) and spleen infarction (14.2%). After instauration of the treatment most complication were cerebral (6%), spleenic (7%), cardiac (10%), thirty two of the patients improved and were discharged in good general condition. Seven patients died, and in hospital mortality of 14.3%.

EI is a disease in which the presentation are various and acute than previously described and remains a serious and deadly disease despite recent advances in diagnosis and treatment.