Infective endocarditis

848 views

Published on

infective endocarditis

Published in: Health & Medicine
0 Comments
5 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total views
848
On SlideShare
0
From Embeds
0
Number of Embeds
2
Actions
Shares
0
Downloads
42
Comments
0
Likes
5
Embeds 0
No embeds

No notes for slide

Infective endocarditis

  1. 1. INFECTIVE ENDOCARDITIS
  2. 2. CLASSIFICATION OLD •Subacute bacterial endocarditis •Acute bacterial endocarditis NEW •Native valve endocarditis •Prosthetic valve endocarditis •Endocarditis in injection drug users •Nosocromial endocarditis(not includued everywhere)
  3. 3. PATHOGENESIS • Alteration of the valvular endothelium leading to deposition of platelets and fibrin •Bacteremia with seeding of non-bacterial thrombotic vegetation(NBTE) •Adherence and growth, further platelet and fibrin deposition •Extension to other structures - Papillary muscle, aortic valve ring abscess, conduction system
  4. 4. •Intravenous drug abuse •Artificial heart valves and pacemakers •Acquired heart defects •Calcific aortic stenosis •Mitral valve prolapse with regurgitation •Congenital heart defects •Intravascular catheters RISK FACTORS
  5. 5. •Staphylococcus aureus(30-40%) •Viridans group streptococci(18%) •Enterococci (11%) •Coagulase-negative staphylococci (11%) •Streptococcus bovis(7%) •Other streptococci (5%) •Non-HACEK Gram negatives(2%) •HACEK organisms(2%) •Fungi(2%) •Culture negative(2-20%) MICROBIOLOGY
  6. 6. •Fever •Heart murmur •Nonspecific signs – petechiae, subungal or “splinter” hemorrhages, clubbing, splenomegaly, neurologic changes •More specific signs - Osler’s Nodes, Janeway lesions, and Roth Spots SIGNS
  7. 7. Petechiae Photo credit, Josh Fierer, M.D. medicine.ucsd.edu/clinicalimg/ Eye-Petechiae.html Harden Library for the Health Sciences www.lib.uiowa.edu/ hardin/ md/cdc/3184.html 1. Nonspecific 2. Often located on extremities or mucous membranes dermatology.about.com/.../ blpetechiaephoto.htm
  8. 8. Splinter Hemorrhages 1. Nonspecific 2. Nonblanching 3. Linear reddish-brown lesions found under the nail bed 4. Usually do NOT extend the entire length of the nail
  9. 9. Osler’s Nodes 1. More specific 2. Painful and erythematous nodules 3. Located on pulp of fingers and toes 4. More common in subacute IE American College of Rheumatology webrheum.bham.ac.uk/.../ default/pages/3b5.htm www.meddean.luc.edu/.../ Hand10/Hand10dx.html
  10. 10. Janeway Lesions 1. More specific 2. Erythematous, blanching macules 3. Nonpainful 4. Located on palms and soles
  11. 11. DIAGNOSIS
  12. 12. Blood Cultures Minimum of three blood cultures1 Three separate venipuncture sites Obtain 10-20mL in adults and 0.5-5mL in children2 Positive Result Typical organisms present in at least 2 separate samples Persistently positive blood culture (atypical organisms) Two positive blood cultures obtained at least 12 hours apart Three or a more positive blood cultures in which the first and last samples were collected at least one hour apart BLOOD CULTURE
  13. 13. Chest x-ray Look for multiple focal infiltrates and calcification of heart valves EKG Rarely diagnostic Look for evidence of ischemia, conduction delay, and arrhythmias Echocardiography IMAGING
  14. 14. Transthoracic echocardiography (TTE) First line if suspected IE Native valves Transesophageal echocardiography (TEE) Prosthetic valves Intracardiac complications Inadequate TTE Fungal or S. aureus or bacteremia INDICATIONS FOR ECHOCARDIOGRAPHY
  15. 15. CARDIAC COMPLICATIONS •Vegetations on valve closure lines •Destruction and perforation of valve leaflets •Rupture of chordae tendinae, intraventricular septum, papillary muscles •Valve ring abscess •Myocardial abscess •Conduction abnormalities •Congestive heart failure
  16. 16. EXTRA CARDIAC COMPLICATIONS KIDNEY •Immune complex glomerulonephritis •Emboli with infarction, abcess AORTIC MYCOTIC ANEURYSM CEREBRAL EMBOLISM •Infarction, abcess, mycotic aneurysm •Purulent/aseptic meningitis •Hemorrhage
  17. 17. SPLENIC ENLARGEMENT, INFARCTION SEPTIC OR BLAND PULMONARY EMBOLISM SKIN BOWEL AND OTHER ORGAN EMBOLI’S

×