Infrctive Endocarditis

Infective Endocarditis
DR HAMISI SEMBE
DR NURU LETARA
OUTLINE
• Introduction
• Epidemiology
• Etiology
• Risk factors
• Pathogenesis
• Clinical features
• Management
• Complications
• Prognosis
Introduction
• Infection of the endocardial lining of the heart
• May involve
The endocardium of the valves
The mural endocardium
Endothelium of blood vessels
• The commonest site of infection is a diseased valve from where

the infection can spread along the endothelium.
Epidemiology
• Estimated annual incidence of approximately 0.5 per 100,
000 per year
• Significant cause of morbidity and mortality in children and

adolescents despite
advances in management and
Prophylaxis of the disease with antimicrobial agents.

Etiology
• Bacterial causes
• Non bacterial causes

Viruses
Fungi
Other microbial agents
Etiology
• Streptococcus viridans (alpha hemolytic) and Staphylococcus
aureus are the leading causative agent in pediatric patients.
• Viridans group streptococcal infection is more common after
dental procedures
• Group D enterococci are seen more often after lower bowel
or genital urinary manipulation
• Pseudomonas aeruginosa is seen more frequently in
intravenous drug users
Etiology
• Fungal endocarditis
Candida commonest
others : Aspergillus, Histoplasma etc.

Risk factor
• Survivors of cardiac surgery
Especially those with mechanical prosthesis
• RHD
• Unrepaired CHD
• Intravenous drug users
• Patients taking immunosuppressant medications
• Patients require chronic intravascular catheters
Pathogenesis
Pathogenesis
• Congenital or acquired heart lesion
• Turbulent blood flow because of hole or stenotic orifice
• Turbulent flow traumatizes the vascular endothelium, creating a
substrate for deposition of fibrin and platelets leading to the
formation of a nonbacterial thrombotic embolus (NBTE)
• Biofilms form on the surface of implanted mechanical devices such as
valves, catheters, or pacemaker wires that also serve as the adhesive
substrate for infection
• The development of transient bacteremia then colonizes this (NBTE)
or biofilm leading to proliferation of bacteria within the lesion.
Pathogenesis
• Bacteria surface proteins act as adhesion factors to the (NBTE ) or
biofilm after which bacteria can rapidly proliferate within the
vegetation
• Given the heavy colonization of mucosal surface ( the oropharynx, or
gastrointestinal, vaginal or urinary tracts) by potentially pathogenic
bacteria, these surfaces are thought to be the origin of this transient
bacteremia.
Clinical features
• Grouped into 3
Indicating presence of an infection
Indicating involvement of the cardiovascular system
Indicating the presence of an immunological reaction
to infection
Features indicating the presence of infection
• Fever
• Chills
• Rigors
• Night sweats
• General malaise and weakness
• Loss of appetite
• Weight loss
Features indicative of the involvement of the
CVS
• Appearance of left or right failure
• Development of a new murmur or change in a preexisting
murmur
• Presence of embolic episodes
Stroke from CNS embolism
Hematuria from renal infarct
Left flank pain from splenic infarct
Gastrointestinal hemorrhage from mesenteric embolism
Features of immunological response
presenting as vasculitis
• Arthralgia
• Mayalgia
• Clubbing
• Splenomegaly and microscopic hematuria
• Splinter hemorrhage
• Petechiae over skin
• Roth spots
• Osler nodes
• Janeway lesions
• Erythematous patches
Modified Duke criteria
• Major criteria
Positive blood culture for IE ( 1 of the following)
• Typical microorganism consistent with IE from 2 separate blood cultures
• Persistently positive blood culture
• Single positive blood culture for Coxiella burnetii
Evidence of endocardial involvement

• Echocardiography positive for IE
• New valvular regurgitation
• Minor criteria
Predisposition
• Iv drug users
• Presence of a predisposing heart condition
Fever-Temperature more or equal 38.0C
Vascular phenomena
Immunological phenomena
Microbiological evidence- positive blood cultures that do not meet
major criteria
• Definitive IE is established in the presence of the following
Pathological criteria
• Pathological lesions –vegetation or intracardiac abscess
• Microorganism- demonstrated by culture or histology of vegetation or
intrathoracic abscess
Clinical criteria
• 2 major clinical criteria
• 1 major and 3 minor criteria
• 5 minor clinical criteria
• Possible IE
Presence of 1 major and 1 minor clinical criteria or
Presence of 3 minor clinical criteria
• Rejected IE
A firm alternative diagnosis is made
Resolution of clinical manifestations occurs after less than 4 days of antibiotic
therapy
No pathological evidence of IE
Clinical criteria for possible or definitive IE not met.
Management
Investigations
• Blood culture- confirmatory
• Supportive
FBP
ESR
CRP
Urinalysis
• Echocardiogram
• CXR
Treatment
• Antibiotic therapy
• Surgical
IE associated valve dysfunction with CCF
Patients with persistent fevers and bacteremia despite appropriate antibiotic
therapy
• Empiric treatment
IE without acute symptoms (wait for B/C results 1 to 3 Days)
IE with symptoms; empiric treatment (Patients with hemodynamic instability,
clinical presentation suggestive of IE, fever, new murmur etc.)
Treatment
• Antibiotic for 6 weeks
• Penicillin and aminoglycosides
• MRRSA vancomycin for 6 weeks
• Antifungal for fungal infection

Complications
• Cardiac complications
 HF, perivalvular abscess, pericarditis.
• Forms of metastic infection
Septic embolization, metastatic abscess
• Neurologic complications
Stroke, brain abscess, meningitis
• Renal complications
Renal infarction or abscess following septic embolization, glomerulonephritis.
• Musculoskeletal complications
Vertebral osteomyelitis and septic athritis
Prognosis
• Six month mortality rate among patients with IE ranges up to 27%.
• Factors associated with increased risk of mortality

Microbiology
Heart failure
Embolization
Candidate for cardiac surgery
Prevention
• Oral hygiene for prevention of oral disease
• Antimicrobial prophylaxis for high risk patients when undergoing
invasive procedures
• Thank you for listening

Infrctive Endocarditis

Uploaded by

Copyright:

Available Formats

Infrctive Endocarditis

Uploaded by

Document Information

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Infrctive Endocarditis

Uploaded by

Copyright:

Available Formats

Infective Endocarditis

• The commonest site of infection is a diseased valve from where

• Significant cause of morbidity and mortality in children and

Prophylaxis of the disease with antimicrobial agents.

• Non bacterial causes

others : Aspergillus, Histoplasma etc.

Evidence of endocardial involvement

Presence of 3 minor clinical criteria

• Penicillin and aminoglycosides

• MRRSA vancomycin for 6 weeks

• Antifungal for fungal infection

• Factors associated with increased risk of mortality

You might also like