Endocarditis Flashcards
Normally, blood is ________
Sterile
What is bacteraemia?
The presence of bacteria in the blood
What is septicaemia?
The presence and multiplication of bacteria in the blood
What is infective endocarditis?
Infection of the heart valve endothelium
This cause valve irregularities which leads to turbulent blood flow
Valve irregularities may break free and pass into the blood
What are the risk factors for infective endocarditis?
- Any heart valve abnormality - calcification/sclerosis, congenital, post rhematic fever
- Prosthetic heart valaves
- IV drug users
- Intravascular lines
How does endocarditis come about?
There is damage to the heart valve causing turbulent blood flow
This causes deposition of platelets and fibrin
In infcetive endocarditis, microbial vegetations can settle within the platelet/fibrin thrombi
These can break off and form blockages in capillary beds
Bacteraemia can come about after ________ treatment
Dental
Which side of the heart is most often affected by endocarditis?
Left side
Which organisms are most likely to cause infective endocarditis?
- Staph aureus (38%)
- Step viridans (31%)
- Enterococcus sp (8%)
- Staph epidermidis (6%)
What are some more unusual examples of organisms that can cause endoarditis?
- Atypical organisms
- Bartonella, Coxiella burnetii (Q-fever), Chlamydia, Legionella, Mycoplasma, Brucella
- Gram-negatives
- HACEK organisms
- Haemophilus spp. , Aggregatibacter spp**, Cardiobacterium, Eikenella sp., Kingella sp.
- Non-HACEK gram negatives
- HACEK organisms
- Fungi
Why are atypical organisms hard to diagnose as the cause of endocarditis?
They are hard to culture, and are slow to grow
How often should blood cultures be taken during treatment of endocarditis?
Every 2-3 days until the results are negative
How is endocarditis diagnosed?
- Firstly a transoesophageal echo is taken
- The result (positive or negative) from this is confirmed by the more accurate transthoracic echo
What is the coagulase test?
Coagulase is an enzyme produced by S.aureus which converts soluble fibrinogen to insoluble fibrin
If fibrin is produced in this test S.aureus is present, and if it is not another form of staphylococcus is present
What is the most common coagulase negative test result for?
Staphylococcus epidermidis
Where is S.epidermidis likely to come from?
It can infect metal and plastic (prosthetic material) such as IV lines, prosthetic heart valves and joints.
What is MALDI TOF?
A machine that can identify the species of microorganism and most relevant treatment
How does acute endocarditis present clinically?
Cardiac failure and overwhelming sepsis
There is poor organ functiondue to lower blood pressure
Aggressive and virulent pathogens such as S.aureus cause this
How does subacute endocarditis differ from acute endocarditis?
It has a slower onset