CBL - Infective/Bacterial Endocarditis Flashcards

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1
Q

List the important predisposing risk factors for infective endocarditis [5]

A
  1. age >60 years
    • more likely to develop degenerative valve disease & require valve replacement
  2. more common in males
  3. IV drug users
  4. Poor dentition or dental infection
  5. Structural heart disease/Valvular heart disease/Congenital heart disease
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2
Q

What are the common clinical signs and symptoms of infective endocarditis? [13]

A
  1. Fever
    • often associated with chills, anorexia & weight loss
  2. Malaise, myalgias, arthralgias, night sweats
  3. Dyspnoea
  4. Cardiac murmurs
  5. Common supportive signs also include:
    • splenomegaly
    • cutaneous manifestations such as:
      • petechiae
      • splinter haemorrhages
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3
Q

What are the relatively uncommon clinical manifestations that are highly suggestive of infective endocarditis? [3]

A
  1. Janeway lesions
  2. Osler nodes
  3. Roth spots
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4
Q

What are Janeway lesions? [1]

A

Nontender erythematous macules on the palms and soles

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5
Q

What are Osler’s nodes? [1]

A

Tender subcutaneous nodules typically on the pads of the fingers and toes, which may also occur on the thenar and hypothenar eminences

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6
Q

What are Roth spots? [1]

A

Exudative, oedematous haemorrhagic retinal lesions

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7
Q

There are several systemic complications associated with infective endocarditis. What can septic emboli lead to? [3]

A

infarction of kidneys, spleen and other organs

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8
Q

There are several systemic complications associated with infective endocarditis. Which patients tend to get pulmonary emboli? [1]

A

occurs in patients with concomitant right-sided endocarditis

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9
Q

There are several systemic complications associated with infective endocarditis. What are the cardiac complications of IE? [2]

A
  1. valvular insufficency
  2. heart failure
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10
Q

There are several systemic complications associated with infective endocarditis. What are the neurological complications of IE? [3]

A
  1. embolic stroke
  2. intracerebral haemorrhage
  3. brain abscess
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11
Q

There are several systemic complications associated with infective endocarditis. What kinds of metastatic infection can occur as a result of IE? [4]

A
  1. osteomyelitis
  2. septic arthritis
  3. splenic abscess
  4. psoas abscess
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12
Q

What is the criteria used to diagnose IE called? [1]

A

Duke’s Criteria

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13
Q

What is the accepted criteria for diagnosing definite IE? [5]

A
  1. Pathologic lesions:
    • vegetation or intracardiac abscess demonstrating active endocarditis on histology OR
  2. Microorganism:
    • demonstrated by culture or histology of a vegetation or intracardiac abscess

OR

  • Clinical criteria
    • 2 major clinical criteria OR
    • 1 major and 3 minor clinical criteria OR
    • 5 minor clinical criteria
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14
Q

Define the criteria for possible IE [2]

A

the presence of one major and one minor clinical criteria

OR

the presence of three minor clinical criteria

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15
Q

What are the major clinical criteria for diagnosing a patient with IE? [9]

A
  • Positive blood cultures:
    • typical microorganisms consistent with IE from two separate blood cultures OR
    • persistently positive blood cultures
  • For organisms that are typical causes of endocarditis:
    • At least 2 positive blood cultures from blood samples drawn >12 hours apart
  • For organisms that are more commonly skin contaminants:
    • 3 or a majority of ≥4 separate blood cultures (with first and last drawn at least one hour apart), OR
    • Single positive blood culture for Coxiella burnetii or phase I IgG antibody titer >1:800
  • Evidence of endocardial involvement:
    • Echocardiography positive for IE (vegetation) OR
    • Abscess, OR
    • New partial dehiscence of prosthetic valve
    • New valvular regurgitation (increase or change in preexisting murmur is not sufficient)
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16
Q

What is a vegatation? [1]

A

oscillating intracardiac mass on a valve or on supporting structures

17
Q

What are the minor clinical criteria for diagnosing a patient with IE? [5]

A
  1. presence of risk factors
  2. fever (temp. ≥38°C)
  3. Vascular phenomena:
    • major arterial emboli
    • septic pulmonary infarcts
    • mycotic aneurysm
    • intracranial hemorrhage
    • conjunctival hemorrhages
    • Janeway lesions
  4. Immunologic phenomena:
    • glomerulonephritis
    • Osler nodes
    • Roth spots
    • rheumatoid factor
  5. Microbiologic evidence
    • positive blood cultures that do not meet major criteria OR
    • serologic evidence of active infection with organism consistent with IE
18
Q

What are common bacterial pathogens/microorganisms associated with infective endocarditis? [4]

A
  1. Staphylococcus aureus
  2. Streptococcus viridans
  3. Streptococcus gallolyticus/S. bovis
  4. HACEK Enterococci [Haemophilus, Aggregatibacter, Cardiobacterium, Eikenella, Kingella]
19
Q

Fill in the following diagram on classification of bacteria:

A
  1. gram positive (staining blue/purple)
  2. gram +ve cocci
  3. staphylococci
    • staph. aureus (MRSA/MSSA)
    • Coagulase negative staphylcocci (CoNS)
  4. streptococci
    • strep. viridans
    • enterococci
  5. gram +ve rods
  6. listeria
  7. gram negative (staining pink)
  8. gram -ve cocci
  9. neisseria
  10. gram -ve rods
  11. E. coli & Pseudomonas
20
Q

Fill in the following diagram on the classification of streptococci:

A
  1. β-haemolytic
    • causes complete haemolysis
    • see that it has changed colour (green) but no gaps around it on ajar plate
  2. Group A = bacitracin sensitive
  3. Group B = bacitracin resistant
  4. α-haemolytic
    • causes partial haemolysis
    • see that it has changed colour (green) & gaps around it on ajar plate
  5. pseudomonas = bile soluble
  6. viridans = not bile soluble
  7. Group D
  8. Enterococcus
    • shows no haemolytic reaction at all
    • i.e. no change in colour and no gaps