BACKGROUND: This observational study was to decide the culprit microorganisms and clinical profile of infective endocarditis in rheumatic heart disease patients in local population of Jharkhand, the response of clinical treatment and to assess the prognosis of the cases. METHODS: 25 cases of Rheumatic heart disease, fulfilling the diagnostic criteria for infective endocarditis were studied prospectively with baseline investigations, blood culture and echocardiography and were treated with appropriate antibiotics. RESULTS: In our study the mean age observed was 26year and male patient to female patient ratio was 3.16:1.Aortic valve was the commonest valve to be involved. Cardiac murmurs were present in all patients, splenomegaly was present in 56% of patients but peripheral signs of infective endocarditis were rare. Blood culture was positive in 28% of cases and staphylococcus aureus was the main organism isolated. 23 cases out of 25 cases studied showed vegetations on echocardiography mostly on aortic or mitral valve.In majority of patients (80%) injection Penicillin G and Gentamicin were started in standard recommended dose first on empirical basis but later on suitable antibiotics were started according to sensitivity pattern. Mortality was significantly high (20%). CONCLUSIONS: Fever and constitutional symptoms were the most common presentation. Mild to moderate anemia, leucocytosis, high ESR were very common but, peripheral signs were rarely observed in our study. Staphylococcus was the predominant etiological agent and treatment of endocarditis was more successful when suitable antibiotics were started after culture and sensitivity.