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STEP Pathology > deck_5071927 > Flashcards

deck_5071927 Flashcards

1
Q

What is infective endocarditis?

A

microbial infection of the heart valves or mural endocardium leading to vegetations composed of thrombotic debris and organisms, often associated with destruction of underlying cardiac tissue

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2
Q

What else can be infected besides the heart in infective endocarditis?

A

-aorta-existing aneurysms-prosthetic devices

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3
Q

What kinds of bugs caused infective endocarditis?

A

mostly bacteria, some fungi

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4
Q

What is acute IE caused by?

A

infection of a previously normal heart valve by a highly virulent organism

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5
Q

What is the most common cause of acute IE?

A

Staph aureus (31% of all)

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6
Q

What does Staph aureus infection result in?

A

rapid production of necrotizing and destructive lesions

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7
Q

What is subacute IE caused by?

A

due to insidious infection of deformed valves by organisms of lower virulence

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8
Q

What is the most common cause of subacute IE?

A

viridans strep (17% of all cases) (less destructive)viridans can affect normal valves and aureus can affect abnormal valves as well

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9
Q

What are some species of strep viridans?

A

S. mitis, mutans, oralis, sanguinis, sobrinus, milleri

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10
Q

What are some other causes of IE?

A

-Enterococcus (11%)-Coag neg staph (staph epi.) (11%)-HACEK (2%)-Fungi (2%)

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11
Q

What are the HACEKs?

A

Haemophilus aphrophilus(subsequently calledAggregatibacter aphrophilusandAggregatibacter paraphrophilus);Actinobacillus actinomycetemcomitans (subsequently calledAggregatibacter actinomycetemcomitans);Cardiobacterium hominis;Eikenella corrodens; andKingella kingae.

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12
Q

Describe the HACEKs.

A

all gram negative and all commensals in the oral cavityused to be a cause of culture neg IE but can be easily isolated now

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13
Q

What are some causes of culture-negative endocarditis?

A

-bartonella (causes cat-stratch fever)-Coxiella burnetii (causes Q fever)

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14
Q

T or F. Gram negative bacteria adhere less readily to heart valves

A

T. Every cause except the HACEKs are gram+

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15
Q

What are some common causes of IE in IV drug users?

A

-S. aureus (gram+ cocci in clusters)-Pseduomonas (needle infected)- (gram - rods)-Candida albicans (no gram stain results)- huge vegetations

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16
Q

What are some common causes of IE in patients with prosthetic valves?

A

S. epi (creates a biofilm)gram + of clusters

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17
Q

What are some common causes of IE in patients with colon cancer?

A

Strep. gallolyticus (formerly S. bovis)will see blood in the stool in age over 50, gram+ cocci in pairs and chains

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18
Q

How does IE look grossly?

A

friable, bulky lesions containing fibrin, inflammatory cells, and bacteriacan be single or multiple lesions that can erode into the myocardium or develop abscesses

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19
Q

What is a common progression of IE lesions?

A

they are prone to embolize and abscesses frequently develop where they lodge, leading to sequelae such as septic infarcts

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20
Q

What are the most common valves affected in IE?

A

MITRAL and aortic

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21
Q

What are the most common valves affected in IE in drug users?

A

right side valves (especially tricuspid)

22
Q

What are some risk factors for IE?

A

-IVDU-male sex-Age 60+-poor dentition (viridians mediated)

23
Q

Heart related risk factors for IE?

A

-structural, valvular, congenital, or prosthetic heart disease-HIV-chronic hemodialysis (catheters, immunosuppression)-IV device (central line)

24
Q

What kind of valvular heart disease puts a patient at risk for IE?

A

-mitral valve prolapse-degenerative calcific valvular stenosis-bicuspid aortic valve

25
Q

How does acute endocarditis present?

A

-rapid fever development, chills, weight loss, B symptoms-dyspnea, cough, night sweats, arthalgias

26
Q

How does subacute endocarditis present?

A

gradual onset of low-grade fever, night sweats, weight loss, fatiguecan be sick for several weeks before coming in

27
Q

Other signs of IE?

A

-cardiac murmur (85-90%)-splenomegaly-petechiae (very common)-splinter hemorrhages

28
Q

Where are petechiae common in IE?

A

lower legs, conjunctiva, and palate

29
Q

What is splinter hemorrhages?

A

nonblanching linear reddish-brown lesions under the nail bed- might be a micro-abscess

30
Q

Uncommon signs of IE?

A

-Janeway lesions-Osler nodes-Roth spots

31
Q

What are Janeway lesions?

A

nontender erythematous violaceous modules mostly on the palms and soles- flat, not raised (cant feel them)micro-abscesses with neutrophils infiltration of capillaries

32
Q

What are Osler lesions?

A

tender, subcutaneous violaceous nodules mostly on the pads of the fingers and toes (can appear white)raised so you can feel them

33
Q

T or F. Janeway lesions are more common in acute IE

A

T. Although not very common at all

34
Q

Note about Osler lesions and Roth spots.

A

sequelae of vascular-occlusion by micro-thrombi leading to localized immune-mediated vasculitis

35
Q

When should IE be suspected?

A

In patients with fever (with /without bacteremia) and relevant cardiac risk factors or non cardiac risk factors (IVDU, recent dental procedure)

36
Q

How is diagnosis of IE made?

A

based on clinical symptoms, blood cultures, and ECG

37
Q

T or F. At least 3 sets of blood cultures should be obtained from separate sites prior to giving antibiotics

A

T.

38
Q

What are some other hints leaning toward IE?

A

-elevated inflammatory markers (ESR, CRP)-anemia-positive rheumatoid factor-UA with hematuria, pyre, proteinuria

39
Q

What is the Duke criteria?

A

guidelines for IE diagnosis

40
Q

What are the pathologic Duke criteria for definite IE?

A

pathologic lesions: vegetation or intracardiac abscess demonstrating active endocarditis on histologymicroorganisms: culture or histology of a vegetation or intracardiac abscess

41
Q

What are the clinical Duke criteria for definite IE?

A

-2 major criteria -1 major and 3 minor criteria-5 minor criteria

42
Q

What are the major Duke criteria for diagnosis of IE?

A

-positive blood culture for a characteristic organisms or persistently + for an unusual organism -ECG ID of a valve-related or implant-related mass or abscess, or partial separation of artificial valve -new valvular regurg

43
Q

What are the minor Duke criteria for diagnosis of IE?

A

-predisposing heart lesion or IVDU-fever-vascular lesions (petechiae, splinters, emboli, Janeway, etc)-Immunological phenomena (glomerulonephritis, Osler noders, Roth spots)- a single + culture for an unusual bacteria -worsening or changing of a murmur

44
Q

How is IE treated?

A

vancomycin (assuming gram +!!). Adjust for gram negative

45
Q

What are some cardiac complications of IE?

A

-valvular insufficiency, -heart failure, -chord rupture, -suppurative pericarditis

46
Q

What are some neurologic complications of IE?

A

-embolic stroke, -brain abscesses, -intracerebral hemorrhage

47
Q

What is a complication of right-sided IE?

A

septic pulmonary emboli

48
Q

What are some possible metastatic infections caused by IE?

A

-vertebral osteomyelitis-septic arthritis-psoas abscess

49
Q

What is a systemic immune reaction caused by IE?

A

glomuleronephritis

50
Q

Prognosis of IE?

A

In hospital mortality: 18-23%six-month mortality rate: 22-27%

STEP Pathology (80 decks)

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