endocarditis Flashcards
what is it
endovascular infection of cardiovascular structures including cardiac valves, atrial and ventricular endocardium, large intrathoracic vessels and intracardiac foreign bodies
consequence of what 2 things
- presence of organism in blood stream
- abnormal cardiac endothelium
what can bacteraemia arise
- poor dental hygiene
- IV drug ise
- soft tissue infections
- dental treatment
- cardiac surgery
- pacemakers
does bacteraemia always result in endocarditis
no
what does damaged endocardium promote
platelet and fibrin deposition
what does increase platelet and fibrin deposition allow
organisms to adhere and grow, leading to an infected vegetation
what valves are most commonly involved
aortic and mitral
what valves are usually affected in drug users
right sided
what organisms affect the mouth
- alpha haemolytic viridian’s streptococci
what organisms are caused by vascular catheters and antibiotic use
staph aureus
what organisms affect the gut and perineum
enterococci
what organism affect bowel malignancy
strep. bovis
what organism affect early disease of native valve replacements
- staph aureus
- staph epidermis
what organism affect late occurring endocarditis due to valve replacements
- strep viridian’s
- staph aureus
who is most likely to get soft tissue infections
- diabetics
- IVDUs
- catheters
what organism affects soft tissue infections
staphylococci
what are rare causes of endocarditis
HACEK groups of organism
how bad are the HACEK group
very insidious
what criteria is used
Duke
what is usual cause of culture-negative endocarditis
prior antibiotic therapy
some duet to variety of fastidious organisms that fail to grow
what are examples of organism that cause gram-negative
- coxiella brunetti
- chlamydia
- bartonella
- legionella
symptoms
- malaise (95%)
- clubbing (10%)
- murmurs (90%)
- cardiac failure (50%)
- arthralgia (25%)
- pyrexia (90%)
- osler nodes (15%)
- splinter haemorrhages (10%)
- janeway lesion (5%)
- petechiae (50%)
- Roth spots (5%)
- splenomegaly (40%)
- cerebral emboli (20%)
- ## haematuria (70%)
what symptoms give high clinical suspicion
- new valve lesion/murmur
- embolic events of unknown origin
- sepsis of unknown cause
- haematuria and suspected renal infarction
- fever plus prosthetic material in heart, IV drug user, positive blood culture
what is major criteria for diagnosis
- positive blood culture
- positive serological test for Q fever
- echo
- new valvular regurgitation
