CBL - Infective/Bacterial Endocarditis Flashcards
List the important predisposing risk factors for infective endocarditis [5]
-
age >60 years
- more likely to develop degenerative valve disease & require valve replacement
- more common in males
- IV drug users
- Poor dentition or dental infection
- Structural heart disease/Valvular heart disease/Congenital heart disease
What are the common clinical signs and symptoms of infective endocarditis? [13]
- Fever
- often associated with chills, anorexia & weight loss
- Malaise, myalgias, arthralgias, night sweats
- Dyspnoea
- Cardiac murmurs
- Common supportive signs also include:
- splenomegaly
- cutaneous manifestations such as:
- petechiae
- splinter haemorrhages
What are the relatively uncommon clinical manifestations that are highly suggestive of infective endocarditis? [3]
- Janeway lesions
- Osler nodes
- Roth spots
What are Janeway lesions? [1]
Nontender erythematous macules on the palms and soles
What are Osler’s nodes? [1]
Tender subcutaneous nodules typically on the pads of the fingers and toes, which may also occur on the thenar and hypothenar eminences
What are Roth spots? [1]
Exudative, oedematous haemorrhagic retinal lesions
There are several systemic complications associated with infective endocarditis. What can septic emboli lead to? [3]
infarction of kidneys, spleen and other organs
There are several systemic complications associated with infective endocarditis. Which patients tend to get pulmonary emboli? [1]
occurs in patients with concomitant right-sided endocarditis
There are several systemic complications associated with infective endocarditis. What are the cardiac complications of IE? [2]
- valvular insufficency
- heart failure
There are several systemic complications associated with infective endocarditis. What are the neurological complications of IE? [3]
- embolic stroke
- intracerebral haemorrhage
- brain abscess
There are several systemic complications associated with infective endocarditis. What kinds of metastatic infection can occur as a result of IE? [4]
- osteomyelitis
- septic arthritis
- splenic abscess
- psoas abscess
What is the criteria used to diagnose IE called? [1]
Duke’s Criteria
What is the accepted criteria for diagnosing definite IE? [5]
- Pathologic lesions:
- vegetation or intracardiac abscess demonstrating active endocarditis on histology OR
- 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
Define the criteria for possible IE [2]
the presence of one major and one minor clinical criteria
OR
the presence of three minor clinical criteria
What are the major clinical criteria for diagnosing a patient with IE? [9]
- 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)