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Infective Endocarditis

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description of IE
etiology, epidemiology, clinical signs and symptoms, pathophysiology, and treatment

Published in: Health & Medicine

Infective Endocarditis

  1. 1. Infective Endocarditis Presented by: Daren Nicole N. Perez BSPH-5A
  2. 2. Anatomy and Physiology of Endocardium
  3. 3. Endocarditis
  4. 4. Infective Endocarditis • A microbial infection of a cardiac valve or the endocardium caused by bacteria, fungi, or chlamydia • Pathological findings include the presence of friable valvular vegetations containing bacteria, fibrin and inflammatory cells. There is often valvular destruction with extension to adjacent structures. – Embolic lesions may demonstrate similar findings
  5. 5. Etiology The normal heart is relatively resistant to infection. Bacteria and fungi do not easily adhere to the endocardial surface, and constant blood flow helps prevent them from settling on endocardial structures. 2 factors are typically required for endocarditis: •A predisposing abnormality of the endocardium •Microorganisms in the bloodstream (bacteremia) Rarely, massive bacteremia or particularly virulent microorganisms cause endocarditis on normal valves
  6. 6. Etiology
  7. 7. Etiology • Usually Bacterial •Staphylococcus aureus Endocarditis •Streptococcus viridans Endocarditis •Actinobacillus actinomycetemcomitans Endocarditis • Sometimes Fungal •Candida albicans Endocarditis
  8. 8. Etiology
  9. 9. Etiology HACEK organisms The HACEK group of organisms – Haemophilus parainfluenza, Haemophilus aphrophilus, Actinobacillus (Haemophilus) actinomycetemcomitans Cardiobacterium hominis, Eikenella Kingella species – also commonly cause IE and can be difficult to diagnose.
  10. 10. Epidemiology Population Groups At Greater Risk: •Rheumatic Fever History •Hemodialysis •Previous History Of Endocarditis •Patients With Prosthetic Valves •IV Drug Users (30% Risk Within 2 Years)
  11. 11. •More Common In Men •Median Age 50 Years •Acute Cases Increasing •Streptococcal Cases ↓ Slightly; Fungal And Gram Negative Cases Increasing Epidemiology
  12. 12. •Incidence Increases With Age, Probably Due To Increased Cardiac Disease And Decreased Immunity •Prosthetic Heart Valve Infections Are Increasing Epidemiology
  13. 13. Mortality •Overall Rate About 40% •Death Usually Due To Heart Failure Resulting From Valve Dysfunction •Highest Death Rate Is In Early Prosthetic Valve Endocarditis
  14. 14. Pathophysiology
  15. 15. Clinical Features
  16. 16. Janeway Lesions
  17. 17. Splinter Hemorrhage – tiny blood clots that tend to run vertically under the nails.
  18. 18. Osler’s Nodes
  19. 19. Subconjunctival Hemorrhages
  20. 20. Roth’s Spots
  21. 21. Investigations
  22. 22. Investigations • Blood cultures •Echocardiography • key investigation as it can assess underlying cardiac function as well as: • identify the presence and size of vegetations. • Detect intracardiac complications • pre-existing rheumatic disease • valve apparatus can be examined and the degree of valve incompetence assessed. Transthoracic echocardiography is noninvasive and has high specificity for visualising vegetations. Transoesophageal echocardiography is more sensitive than TTE.It can detect small vegetations,prosthetic endocarditis and intra cardiac complications.
  23. 23. Investigations Other investigations include the following: •Blood count – normochromic normocytic anemia is usual, while neutrophil leucocytosis is common •ESR – this may be raised •renal and liver function test – levels of creatinine may be raised; levels of liver enzymes may be raised in a hepatocellular (nonobstructive) pattern •CRP – increases acutely in bacterial infection •Urine Microscopy – microscopic hematuria is common in early disease •Culture – culture any skin lesion, drip site, or other focus of infectio
  24. 24. Investigations Major criteria •Two positive blood cultures for organisms typical of endocarditis •Three positive blood cultures for organisms consistent with endocarditis •Serologic evidence of Coxiella burnetii (or one positive blood culture) Echocardiographic evidence of endocardial involvement: •Oscillating intracardiac mass on a heart valve, on supporting structures, in the path of regurgitant jets, or on implanted material without another anatomic explanation •Cardiac abscess •New dehiscence of prosthetic valve •New valvular regurgitation Revised Duke Clinical Diagnostic Criteria for Infective Endocarditis
  25. 25. Natural History Further Classification •Acute • Affects normal heart valves • Rapidly destructive • Metastatic foci • Commonly Staph. • If not treated, usually fatal within 6 weeks •Subacute • Often affects damaged heart valves • Indolent nature • If not treated, usually fatal by one year
  26. 26. Treatment
  27. 27. Prognosis • With effective treatment, patients with IE have a 70% survival rate. • The prognosis is worse if there is no identifiable organism or if there is a resistant organism. • Fungal infections are associated with increased mortality, as is prosthetic valve endocarditis. • Overall death rates are: • 20% for native valve endocarditis • 30% for staphylococcal infections • 20%–30% for late prosthetic valve infection . The most common cause of death is intractable heart failure.
  28. 28. Reference • http://www.clevelandclinicmeded.com/medicalpubs/disea semanagement/infectious-disease/infective-endocarditis/ • https://www.merckmanuals.com/professional/cardiovascu lar-disorders/endocarditis/infective-endocarditis • http://www.ncbi.nlm.nih.gov/books/NBK2208/ • http://www.columbia.edu/itc/hs/medical/pathophys/id/2 005/MID-LowyEndoColor.pdf • http://www.ncbi.nlm.nih.gov/pubmed/9658947 • Pharmacotherapy Handbook, 7th edition. Barbara G. Wells et.al.

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