Bacterial Endocarditis

Question 1

Next step of management for anyone with staph aureus bacteremia?

Answer 1

TTE first regardless of signs of bacterial endocarditis.

need to rule out metastatic infection

Question 2

Who gets a colonoscopy after having bacteremia?

Answer 2

anyone who has streptococcus gallolyticus due to strong association to colonic malignancy.

Question 3

Cardiac complications (33-50%) of bacterial endocarditis?

Answer 3

heart failure
perivavular abscess - seen more commoly in aortic
pericarditis
intracardiac fistula

Question 4

neurological complications of bacterial endocarditis?

Answer 4

stroke
brain abscess
meningitis

Question 5

Renal complications of bacterial endocarditis?

Answer 5

renal infarction or abscess

glomerulonephritis

Question 6

MSK complications of bacterial endocarditis?

Answer 6

septic arthritis

vertebral osteomyelitis

Question 7

other complications of bacterial endocarditis?

Answer 7

mycotic aneurysm,

septic emboli: pulmonary splenic or soft tissues

Question 8

Indications for surgery for infected valve?

Answer 8

refractory CHF due to mitral or aortic valvular insufficiency

Question 9

right sided infective endocarditis

Answer 9

see septic emboli and PNA (70%)
due to IVDA
see tricuspid valve infected
no heart murmurs on PE
Staph aureus is most common.  

see cocomittent HIV and hepatitis B and C

Question 10

periodontal infection and abscess can lead to infective endocarditis via

Answer 10

strepococcus species.

Question 11

causes of culture negative endocarditis

Answer 11

fastidious bacteria (Coxiella and Bartonella)
streptococcus species if antibiotics already given
-fungal organisms
non infectious causes (NBTE rheumatological dx or malignancy)

Question 12

clinical presentation of culture negative endocarditis

Answer 12

usually subacute with low grade fevers, fatigue

no growth on 3 sets of blood cultures for >5 days

Question 13

Diagnostic workup for culture negative endocarditis

Answer 13

modified duke criteria apply with endocarditis
q fever serology (IgG antibody titer >1:800, RF and UA

PET in some cases

Question 14

HACEK organisms for subacute infective endocarditis

Answer 14

H haemophilus spp
A aggregatibacter spp
C cardiobacterium hominis
E eikenella corrodens
K kingella spp

Question 15

Q fever

Answer 15

from C burnetti - droplet exposure from infected livestok. See pneumonia with flu like symptoms and hepatitis and can be asymptomatic.

can have endocarditis months after exposure and acute infection and seen with men >40 yrs, pregnant women and pts with prior valvular disorder

Question 16

how often do we see embolization with endocarditis and how do they manifest?

Answer 16

embolization 15-45%

CNS (stroke, blindness)
Extremities (ischemia, gangrene, arthralgias)
Pulmonary emboli (right sided endocarditis)
splenic or renal infarction

Question 17

which valve is most likely to develop an abscess formation in bacterial endocarditis?

Answer 17

seen with aortic valve and its annulus

can extend from arotic valve to adjacent conduction tissue near AV node and cause heart blocks. It can also go down to the ventricular septum and cause interventricular conduction delays.

Question 18

how to confirm a perivalvular abscess from endocarditis?

Answer 18

EKG shows 1st degree AV block which is suspicious

Confrimation: TEE

Question 19

Treatment for a perivalvular abscess from endocarditis

Answer 19

surgery is needed for:
a perivalvular abscess or fistula
valvular stenosis or regurg resulting in heart failure
fungal infective endocarditis
vegetations with or without embolic events

Question 20

how to treat fungal infective endocarditis?

Answer 20

needs surgery.

Question 21

Modified Duke’s criteria is:

Answer 21

major criteria: blood culture typical microorganism or TTE showing valvular vegetation

minor criteria: predisposing cardiac lesion, IVDA, fever, embolic phenomena, immunologic phenomena, positive blood culture not meeting above criteria.

Definite IE: 2 major OR 1 major +3 minor

Possible IE: 1 major + 1 minor or 3 minor

Question 22

clinical findings of duke criteria?

Answer 22

fever, heart murmur, petechiae, subungal splinter hemorrhages, Osler nodes, Janeway lesions, neurological phenomena, splenomegaly, Roth Spots

Question 23

what is seen on labs with infective endocarditis?

Answer 23

Elevated ESR and decreased complement (C3 C4 and CH50) and can have positive RF due to circulating immune complexes

Question 24

if patient is having abdominal pain and has infective endocarditis

Answer 24

needs imaging of spine for vertebral myelitis or abdomen for splenic infarcts

Question 25

indications for early surgical management of native valve infective endocarditis:

Answer 25

valvular or conduction failure _ acute heart failure due to valvular regurgitation, valve leaflet fistula formation, new heart block

uncontrolled infection _ paravalvular abscess formation, infection with difficult to treat pathogen (fungi), persistent fever or bacteremia >7 days on abx

embolic complications_ systemic emboli despite being on appropriate abx, left sided mobile vegetation >10 mm and prior embolic event.

Question 26

indications for early surgical management of native valve infective endocarditis: for valvular conduction failure

Answer 26

valvular or conduction failure _ acute heart failure due to valvular regurgitation, valve leaflet fistula formation, new heart block

Question 27

indications for early surgical management of native valve infective endocarditis: for uncontrolled infection

Answer 27

uncontrolled infection _ paravalvular abscess formation, infection with difficult to treat pathogen (fungi), persistent fever or bacteremia >7 days on abx

Question 28

indications for early surgical management of native valve infective endocarditis: for embolic complications

Answer 28

embolic complications_ systemic emboli despite being on appropriate abx, left sided mobile vegetation >10 mm and prior embolic event.

Question 29

What is considered early surgical management of infective endocarditis?

Answer 29

This is valvular repair or replacement prior ot completion of a full antibiotic course

Question 30

Why do we do early surgical intervention with pts ho present with infective endocarditis and acute heart failure?

Answer 30

because >90% mortality rate. See vegetations prevent coaptation of the valves and leas to valvular regurgitation.

Question 31

if someone has a non typhoidal salmonella bacteremia what do you test for too

Answer 31

Check HIV

Question 32

If there’s an infection strep bovis with this in the blood what else do you check?

Answer 32

colonoscopy
associated with GI malignancy

also if has clostridium septicum also get colonoscopy