Infective Endocarditis
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Infective Endocarditis

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Infective Endocarditis

Infective Endocarditis

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Infective Endocarditis Infective Endocarditis Presentation Transcript

  • Infective endocarditis
  • Overview
    • Infection of the endocardium
    • Incidence :1/1000 hospital addmisions
    • Risks :Structural heart disease,immunosupression,PPMs,prologed cardiac surgery,redos,catheter based infections,sternal wound infection.
    • Mortality still 20 %
  • Clinical presentation
    • Acute with toxicity metastatic infection and progress over days to weeks .Subacute with progression over weeks to months with less toxicity and metastatic infection.
    • Fever and new murmur(85 %)
    • CHF 55%( more in AV 75 %)
    • Neurological (embolic 20 %),encephalopathy10 %,myctic aneurysm 5 %
    • Petechia 20-40%,splinter haemmg.10-30 %,Osler nodes 10-25 %,Janeway lesions 5 %
    • Clubbing 10-20 %,splenomegaly 30-50 %,Roth spots<5 %
    • Systemic embolisation 25 -50 % depends on the respective organs
  • Complications of IE
    • Heart failure (60%)
    • Abscesses (30%)
    • Embolism (30%)
    • Mortality (1O-20%)
  • Etiology
    • 70-75 % have valvular abnormalities
    • Source of infection cannot always be identified
  • Infective Endocarditis: a changing disease
    • new high-risk subgroups
    • IVDA
    • elderly
    • intracardiac devices
    • nosocomial diseases
    • more difficult to prevent
    • more difficult to treat
  • Native valve endocarditis
    • Step.(60%),S.aures(25 %),Strep.Bovis( GI cansers),Enterococcus,HACEK(3%)
    • Drug abusers ,usually S.aureus 60 %,less severe disease ,usualyy TV
    • Pseudomonas endocarditis is usually destructive and needs surgery.
    • Strep pneumoniae ,1-3 % and in the setting of alcaholism
    • Congenital lesions:commoly Bicuspid AV,PDA,VSD,Coarct. and TOF
  • Prothetic valve endocarditis
    • 10-20 % of all cases
    • Risk highest in the first 6/12
    • Similar incidence in mechanical and bioprothetic
    • Equal in AV and MV
    • Less 2/12 post op is early,usualyy coagulase –ve staph.and S.aureus
    • Late has similar organisms to native IE,but there is 10-15 % fungal endocarditis.
  • PPM endocarditis
    • 0.2-7 % ,mainly staph.
  • CS negative endocarditis
    • 10 %
    • Usually due to prior antibiotic therapy
    • Also fastiduous organisms HACEK,Legionella,Coxiella,Bartonella,Brucella
    • Non bacterial endocarditis
  • Pathophysiology
    • Non bacterial thrombotic endocarditis then with bacteraemia becomes septic
    • Impairement of valve function
    • Conduction defects
    • emboli
  • Labs
    • Basic- mainly an acute inflamatory response
    • Blood C/S
    • Histology and C/S of resected specimens
    • Urinalysis
    • ECG
    • CXR
  • Imaging
    • TTE
    • TEE
    • CT brain scan
    • angiogram
  • Aortic Valve Brucella Endocarditis
  • Aortic Valve Brucella Endocarditis
  • Treatment
    • Multidisciplinary
    • Patient and organism specific RX needed
  • Fungal endocarditis
    • Use ampho B and flucytosine ( toxic to B. marrow and kidneys
    • Almost always needs surgery .
    • Long term oral prophylaxis is often given to prevent relapse
  • New guidelines 2009: timing of surgery
  • Vikram– JAMA 2003 ; 290 : 3207
    • 513 patients with complicated IE , 230 (40%) surgical therapy
    • 6 month mortality
    Impact of surgery on mortality