This document discusses infective endocarditis, including its epidemiology, classification, predisposing factors, microbiology, pathogenesis, diagnosis, management, treatment, and prophylaxis. It notes that infective endocarditis is an infection of the endocardial lining of the heart, usually caused by bacteria. It can be either acute or subacute and most commonly affects patients with pre-existing heart disease. Common causative organisms include streptococci and staphylococci. Diagnosis is based on the modified Duke criteria and involves blood cultures, echocardiography, and clinical signs. Treatment involves prolonged antibiotic therapy based on culture results, often for 6 weeks. Prophylaxis with antibiotics is recommended for certain medical

1. INFECTIVE
ENDOCARDITIS

2. • Infection of the endocardeal lining of the heart
• Caused by infectious pathogens. The agents are usually
bacterial, but other organisms can also be responsible.

3. Incidence of endocarditis
estimated as 2-6 cases every
100,000 person years
90% of endocarditis
occurs in patients with
pre-existing heart
disease
Worldwide, condition that most
predisposes individuals to endocarditis
is rheumatic heart disease
Greatest morbidity occurs
among those with recent
cardiac prostheses, status-
post heart transplant, or
prior endocarditis
EPIDEMIOLOGY

4. 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

5. PREDISPOSING FACTOR
Heart Disease Bactremia InterventionIV Drug Abuse
Dental Procedures
Cardiac Surgery or Presence of prosthetic valve
ENT Procedures
Cardiac Catheterization
GIT GUT Procedures
Intravascular Catheter
Poor Dental Hygiene
ImmunodeficiencyInfection (teeth,ear,UT)

6. MICROBIOLOGY
• S. Viridans
• Most common causative organism
• Gram negative bacilli
• Neonates and immunocompromised patients
• Prosthetic valves
• Within first year of surgery: Coag-negative staph
• Staph.epidermidis
• After first year: similar to native valve endocarditis
• HACEK organisms
• Hemophilus, Actinobacillus, Cardiobacterium, Eikenella,
Kingella
• Frequently affect damaged valves and can cause emboli
Candida
6 -10 % culture negative.

8. PATHOGENESIS

11. Infection
Involvement Of
Cardiovascular
System
Immunological
Reaction
• Fevers
• Chills n rigor
• night sweats
• General malaise
• Weakness
• Loss of appetite
• Weight loss
• Amenorrhea in females
• Appearance of left and right failure
• Development of new murmur
• Presence of embolic episodes (strokes, hematuria)
• Arthralgia
• Myalgia
• Clubbing
• Splenomegaly
• Microscopic Hematuria
• Splinter Haemorrhage
• Petechiae Over Body
• Roth Spots
• Osler Nodes
• Janeway Lesion

13. DIAGNOSIS : DukeCriteria
• Based on pathological and clinical criteria.
• Utilizes microbiological data, evidence of endocardial
involvement, and other phenomenon associated with
infective endocarditis to estimate the probability of
infective endocarditis in a given patient.
• Has been shown to be valid and reproducible in
children

14. Modified DukeCriteria
• Definite IE
• Pathological
• Microorganism (via culture or
histology) in a valvular
vegetation, embolized
vegetation, or intracardiac
abscess
• Histologic evidence of
vegetation or intracardiac
abscess
• Clinical
• 2 major
• 1 major and 3 minor
• 5 minor
• Possible IE
• At least 1 major and 1 minor,
• 3 minor
• Rejected IE
• Firm alternative diagnosis, or
• Resolution of manifestations of
endocarditis with antibiotic
therapy of 4 days or less, or
• No pathological
endocarditis at
evidence of
surgery or
autopsy with antibiotic therapy
of 4 days or less

15. Duke criteria: Majorcriteria
• Positive blood culture
• Typical microorganism consistent with IE, from two separate blood
cultures
• S. viridans, S. bovis, HACEK
• community-acquired S. aureus or enterococci (no primary focus)
• Persistently positive cultures
• at least two positive cultures, drawn 12 hours apart
• all of three, or a majority of four or more cultures (with first and last
sample drawn at least one hour apart
• Evidence of endocardial involvement
• Positive echocardiogram
• oscillating intracardiac mass on valve or supporting structures, or
• myocardial abscess, or
• new partial dehiscence of prosthetic valve
• New valvular regurgitation

16. The echocardiogram inIE

17. Duke criteria: Minorcriteria
• Predisposition
• Predisposing heart condition or IV
drug abuser
• Fever
• > 38.0º C
• Vascular phenomena
• arterial emboli, septic pulmonary
infarct, mycotic aneurysm,
intracranial hemorrhage,
conjunctival hemorrhage, Janeway’s
lesion
• Immunologic phenomena
• glomerulonephritis, Osler’s nodes,
Roth’s spots, rheumatoid factors
• Microbiologic evidence
• positive blood culture but does not
meet major criteria as noted
• Echocardiographic evidence
• consistent with IE but does not meet
major criteria as noted

18. MANAGEMENT & TREATMENT
• Principle of management consist of :
• If blood culture results :
• If the patient is very ill, antibiotic can be initiated empirically after the
cultures are taken. However, in all the other cases, we should await the
results of blood culture
1. Identification of organism and its antibiotic
sensitivity
2. prompt, appropriate and prolonged antimicrobial
treatment to cure and prevent prolapse
Positive : choice of Ab is
dictated by antibiotic
sensitivity
Negative : empirical therapy

19. • Usually, penicillin and
gentamicin are the
preferred antibiotics
that are administered
parenterally
• Total duration of therapy
: 6 weeks
• Following the
completion of the
therapy, blood culture
should be obtained to
verify eradication of the
infection
Fungal endocarditis ?
• Difficult to treat
• May require surgery
along with antifungals
(ampothericin B) for a
duration of 6-8 weeks
• Followed by oral
antifungals (
fluconazole) for
prolonged duration

22. PROPHYLAXIS
• Antibiotics are recommend for the prevention of
IE prior to certain medical and dental procedures.
• Presently it is recommended for all dental
procedures that involve treatment of gingival
tissue or periapical region of the teeth or oral
mucosa perforation, for invasive procedures that
involve incision or biopsy of respi mucosa
• No longer recommended for genitourinary or GIT
procedures solely for bacterial endocarditis
prophylaxis
The drugs recommended :
- Oral amoxicillin ( 50mg/kg)
- IV ampicillin
- Those allergic to penicillin : cefazolin,
ceftriaxone, clindamycin, cephalexin,
azithromycin or clarithromycin
 given before the procedure and up to 2 hours
after the procedures ( for those who did not
take it earlier)

23. References :
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