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Not good for the
WWhhaatt iiss BBaacctteerriiaall 
EEnnddooccaarrddiittiiss?????? 
EENNDDOOCCAARRDD -- EENNDDOOCCAARRDDIIUU 
-- TThheeMM iinnnneerr llaayyeerr ooff tthhee 
hheeaarrtt 
IITTIISS -- IInnffllaammmmaattiioonn 
ooff
Definition of Bacterial Endocarditis 
Bacterial endocarditis, a serious infection of the 
endocardium of the heart, 
particularly the heart valves, 
is associated with a high 
degree of illness and death. 
It generally occurs in patients 
with altered and abnormal 
heart architecture, in 
combination with exposure 
to bacteria through trauma 
and other potentially high-risk 
activities involving transient bacteraemia.
DDiiffffeerreenntt ttyyppeess ooff BBaacctteerriiaall 
EEnnddooccaarrddiittiiss 
• Acute 
– Toxic presentation 
– Progressive valve destruction & 
metastatic infection developing in 
days to weeks 
– Most commonly caused by S. aureus 
• SSuubb aaccuuttee 
– Mild toxicity 
– Presentation over weeks to months 
– Rarely leads to metastatic infection 
– Most commonly S. viridans or enterococcus
SSuubb AAccuuttee SSyymmppoottoommss -- 
-- FFeevveerr 
-- GGeenneerraall WWeeaakknneessss 
-- HHeeaarrtt MMuurrmmuurr 
CCaauusseedd bbyy tthhee PPrreesseennccee ooff -- 
-- AAllpphhaa--hheemmoollyyttiicc ssttrreeppttooccooccccii 
((ccoommmmoonn iinn oorraall ccaavviittyy)) 
-- eenntteerrooccooccccii oorr ssttaapphhyyllooccooccccii 
aarree oofftteenn iinnvvoollvveedd aass wweellll
CCaauusseess -- 
TTyyppiiccaallllyy ccaauusseedd bbyy aann iinnffeeccttiioonn 
eellssee wwhheerree.. 
LLiikkee iinn tthhee tteeeetthh,, oorr ttoonnssiillss 
 PPuulllliinngg iinnffeecctteedd tteeeetthh oorr 
ssuurrggeerryy ccaann ccaauussee bbaacctteerriiaa 
ttoo eenntteerr bblloooodd ssttrreeaamm.. 
OOtthheerr iinnssttaanncceess iinncclluuddee -- 
BBooddyy ppiieerrcciinnggss,, eessppiiccaallllyy ooff tthhee 
ttoouunnggee,, nnoossee aanndd eevveenn nniipppplleess.. 
CCoommmmoonn ccoorreellllaattiioonn wwiitthh 
ooppppeerrttuunniissttiicc iinnffeeccttiioonnss oorr 
PPrree--eexxiissttiinngg lleessiioonnss oorr aaccbboonnnnooggrreemmnnaaiittllii aahhllee hhaaeerrttaa rrvvttaa ddllvveeeeffeessccttss 
BBaacctteerriiaa llooddggee tthheemmsseellvveess iinn pprree--eexxiissttiinngg lleessiioonnss 
IItt iiss iinn hheerree wwhheerree tthheeyy mmuullttiippllyy iinn bblloooodd cclloottss wwhhiicchh eennccaassee 
tthheemm aanndd pprrootteecctt tthheemm ffrroomm tthhee bbooddyy’’ss iimmmmuunnee ssyysstteemm 
BBlloooodd cclloottss ggrrooww,, aanndd ppiieecceess ccaann ttrraavveell ttoo kkiiddnneeyyss.. 
EEvveennttuuaallllyy lleeaaddss ttoo hheeaarrtt ffaaiilluurree iiff uunnttrreeaatteedd..
Signs 
- 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

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Not good for the endocardium

  • 2. WWhhaatt iiss BBaacctteerriiaall EEnnddooccaarrddiittiiss?????? EENNDDOOCCAARRDD -- EENNDDOOCCAARRDDIIUU -- TThheeMM iinnnneerr llaayyeerr ooff tthhee hheeaarrtt IITTIISS -- IInnffllaammmmaattiioonn ooff
  • 3. Definition of Bacterial Endocarditis Bacterial endocarditis, a serious infection of the endocardium of the heart, particularly the heart valves, is associated with a high degree of illness and death. It generally occurs in patients with altered and abnormal heart architecture, in combination with exposure to bacteria through trauma and other potentially high-risk activities involving transient bacteraemia.
  • 4. DDiiffffeerreenntt ttyyppeess ooff BBaacctteerriiaall EEnnddooccaarrddiittiiss • Acute – Toxic presentation – Progressive valve destruction & metastatic infection developing in days to weeks – Most commonly caused by S. aureus • SSuubb aaccuuttee – Mild toxicity – Presentation over weeks to months – Rarely leads to metastatic infection – Most commonly S. viridans or enterococcus
  • 5. SSuubb AAccuuttee SSyymmppoottoommss -- -- FFeevveerr -- GGeenneerraall WWeeaakknneessss -- HHeeaarrtt MMuurrmmuurr CCaauusseedd bbyy tthhee PPrreesseennccee ooff -- -- AAllpphhaa--hheemmoollyyttiicc ssttrreeppttooccooccccii ((ccoommmmoonn iinn oorraall ccaavviittyy)) -- eenntteerrooccooccccii oorr ssttaapphhyyllooccooccccii aarree oofftteenn iinnvvoollvveedd aass wweellll
  • 6. CCaauusseess -- TTyyppiiccaallllyy ccaauusseedd bbyy aann iinnffeeccttiioonn eellssee wwhheerree.. LLiikkee iinn tthhee tteeeetthh,, oorr ttoonnssiillss  PPuulllliinngg iinnffeecctteedd tteeeetthh oorr ssuurrggeerryy ccaann ccaauussee bbaacctteerriiaa ttoo eenntteerr bblloooodd ssttrreeaamm.. OOtthheerr iinnssttaanncceess iinncclluuddee -- BBooddyy ppiieerrcciinnggss,, eessppiiccaallllyy ooff tthhee ttoouunnggee,, nnoossee aanndd eevveenn nniipppplleess.. CCoommmmoonn ccoorreellllaattiioonn wwiitthh ooppppeerrttuunniissttiicc iinnffeeccttiioonnss oorr PPrree--eexxiissttiinngg lleessiioonnss oorr aaccbboonnnnooggrreemmnnaaiittllii aahhllee hhaaeerrttaa rrvvttaa ddllvveeeeffeessccttss BBaacctteerriiaa llooddggee tthheemmsseellvveess iinn pprree--eexxiissttiinngg lleessiioonnss IItt iiss iinn hheerree wwhheerree tthheeyy mmuullttiippllyy iinn bblloooodd cclloottss wwhhiicchh eennccaassee tthheemm aanndd pprrootteecctt tthheemm ffrroomm tthhee bbooddyy’’ss iimmmmuunnee ssyysstteemm BBlloooodd cclloottss ggrrooww,, aanndd ppiieecceess ccaann ttrraavveell ttoo kkiiddnneeyyss.. EEvveennttuuaallllyy lleeaaddss ttoo hheeaarrtt ffaaiilluurree iiff uunnttrreeaatteedd..
  • 7. Signs - 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