The diagnosis of infective endocarditis may be particularly difficult in the elderly. Often, presenting signs and symptoms are nonspecific, and development of weakness, malaise, weight loss, confusion, and so on may be the only evidence of infection. A recent study noted that Osler’s nodes are less common in the elderly than in younger patients.130 In one study, more than two thirds of cases of endocarditis in elderly patients were misdiagnosed at the time of admission.131 Musculoskeletal manifestations are often mistakenly ascribed to primary rheumatologic disorders, and heart murmurs are considered benign or believed to result from calcific lesions associated with aging.

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