Bacterial Endocarditis Flashcards
Next step of management for anyone with staph aureus bacteremia?
TTE first regardless of signs of bacterial endocarditis.
need to rule out metastatic infection
Who gets a colonoscopy after having bacteremia?
anyone who has streptococcus gallolyticus due to strong association to colonic malignancy.
Cardiac complications (33-50%) of bacterial endocarditis?
heart failure
perivavular abscess - seen more commoly in aortic
pericarditis
intracardiac fistula
neurological complications of bacterial endocarditis?
stroke
brain abscess
meningitis
Renal complications of bacterial endocarditis?
renal infarction or abscess
glomerulonephritis
MSK complications of bacterial endocarditis?
septic arthritis
vertebral osteomyelitis
other complications of bacterial endocarditis?
mycotic aneurysm,
septic emboli: pulmonary splenic or soft tissues
Indications for surgery for infected valve?
refractory CHF due to mitral or aortic valvular insufficiency
right sided infective endocarditis
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
periodontal infection and abscess can lead to infective endocarditis via
strepococcus species.
causes of culture negative endocarditis
fastidious bacteria (Coxiella and Bartonella)
streptococcus species if antibiotics already given
-fungal organisms
non infectious causes (NBTE rheumatological dx or malignancy)
clinical presentation of culture negative endocarditis
usually subacute with low grade fevers, fatigue
no growth on 3 sets of blood cultures for >5 days
Diagnostic workup for culture negative endocarditis
modified duke criteria apply with endocarditis
q fever serology (IgG antibody titer >1:800, RF and UA
PET in some cases
HACEK organisms for subacute infective endocarditis
H haemophilus spp A aggregatibacter spp C cardiobacterium hominis E eikenella corrodens K kingella spp
Q fever
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
how often do we see embolization with endocarditis and how do they manifest?
embolization 15-45%
CNS (stroke, blindness)
Extremities (ischemia, gangrene, arthralgias)
Pulmonary emboli (right sided endocarditis)
splenic or renal infarction
which valve is most likely to develop an abscess formation in bacterial endocarditis?
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.
how to confirm a perivalvular abscess from endocarditis?
EKG shows 1st degree AV block which is suspicious
Confrimation: TEE
Treatment for a perivalvular abscess from endocarditis
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
how to treat fungal infective endocarditis?
needs surgery.
Modified Duke’s criteria is:
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
clinical findings of duke criteria?
fever, heart murmur, petechiae, subungal splinter hemorrhages, Osler nodes, Janeway lesions, neurological phenomena, splenomegaly, Roth Spots
what is seen on labs with infective endocarditis?
Elevated ESR and decreased complement (C3 C4 and CH50) and can have positive RF due to circulating immune complexes
if patient is having abdominal pain and has infective endocarditis
needs imaging of spine for vertebral myelitis or abdomen for splenic infarcts
indications for early surgical management of native valve infective endocarditis:
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.
indications for early surgical management of native valve infective endocarditis: for valvular conduction failure
valvular or conduction failure _ acute heart failure due to valvular regurgitation, valve leaflet fistula formation, new heart block
indications for early surgical management of native valve infective endocarditis: for uncontrolled infection
uncontrolled infection _ paravalvular abscess formation, infection with difficult to treat pathogen (fungi), persistent fever or bacteremia >7 days on abx
indications for early surgical management of native valve infective endocarditis: for embolic complications
embolic complications_ systemic emboli despite being on appropriate abx, left sided mobile vegetation >10 mm and prior embolic event.
What is considered early surgical management of infective endocarditis?
This is valvular repair or replacement prior ot completion of a full antibiotic course
Why do we do early surgical intervention with pts ho present with infective endocarditis and acute heart failure?
because >90% mortality rate. See vegetations prevent coaptation of the valves and leas to valvular regurgitation.
if someone has a non typhoidal salmonella bacteremia what do you test for too
Check HIV
If there’s an infection strep bovis with this in the blood what else do you check?
colonoscopy
associated with GI malignancy
also if has clostridium septicum also get colonoscopy
