We studied clinical presentations on admission in Infectious Disease Wards of 1053 patients (308 i.v. drug abusers and 745 non drug abusers) with IE validated according to the Duke Hospitals' criteria, from a total of 1164 patients observed from 1984 to 1999. We divided the patients in three five-year span groups (1984-89, 1990-94 and 1995-99) and we examined signs and symptoms on presentation that led us to suspect I.E. (sepsis, valvulopathy, peripheric vascular damage and predisposing conditions including i.v. drug abuse). Our study confirms that clinical diagnosis of I-E. nowadays is reliable if history and physical examination are carried out correctly.