Endocarditis

Question 1

Drugs for Endocarditis

Answer 1

Beta lactams
Daptomycin
Rifampin
Vancomycin

Question 2

Endocarditis pathogenesis

Answer 2

Endothelial lining of heart valves is naturally resistant to infection.
If lining is injured - increased adherence of platelets and fibrin = site for bacteria to adhere and colonize
Bacteria came from bloodstream
Proliferation = more coagulation = macroscopic vegetations

Question 3

Most causative agents of Endocarditis

Answer 3

Streptococci

Staphylococci

Question 4

Bacterial sources of Endocarditis

Answer 4

Infected needle (IV drug abuse) 
Open wound
Cardiac device
Dental procedure
Surgery
Intravascular catheter

Question 5

Other causes

Answer 5

Preexisting heart conditions

Prosthetic valve

Question 6

Viridans strep in endocarditis

Answer 6

Viridans streptococci = normal flora in oral cavity

– goes to blood via dental procedures breaching oral mucosa

Question 7

Viridans strep vs staph aureus in Endocarditis

Answer 7

Viridans strep (most common)
Virulence
--Low
Found
--Mouth 
Valves attacked
--Previously damaged
Vegetations
--Small 
Valves destroyed
--No

Staph aureus
Virulence
--High
Found
--Skin
Valves attacked
--Damaged+healthy
Vegetations
--Large
Valves destroyed
--Yes

Question 8

Staph epidermidis

Answer 8

Likes prosthetic valves
Can enter via : 
-valve surgery
-intravenous catheter
-----Nosocomial infection

Question 9

Enterococcus fecalis + Streptococcus bovis

Answer 9

These bacteria normally live in gut
Can move into bloodstream if
-colorectal cancer
-ulcerative colitis

Question 10

Coxiella burnetti

Answer 10

• Via infected animal
• Q fever develops (flu like symptoms) leads to endocarditis in immunocompromised/
  pregnant

Difficult to diagnose

Question 11

Infective endocarditis - Duke’s criteria

Answer 11

It is used to determine if a patient needs to be treated right away

Question 12

Pathologic criteria

Answer 12

• Definitive,
• Based on histology+micro b
  (1) –All about vegetation
  (2) –Growth of microorganism in culture

Question 13

Major criteria

Answer 13

(1)--Micro/culture 
Staph A, Strep viridans, strep bovis, HACEK > 12 hrs apart
Persistently +ve culture >4
Coxiella +ve culture 
(2)--Radiographical - evidence of heart disease 
Vegetation
Abscess
New regurgitation

Question 14

Minor criteria

Answer 14

(1) –Jaenway lesions - immunological evidence - fingers
(2) – IV drug use - elbow joints infected
(3) –Cultures
(4) –Heart - predisposition, emboli,
(5) –Fever - >38C -head

Question 15

Definitive endocarditis is treated right away (T/F)

Answer 15

True

Question 16

Duke’s criteria

Answer 16

Definitive
1 pathological
2 major
3 minor+1 major
4 minor+1 major
5 minor

Possible
1 major+1mior
3 minor

Question 17

Point value system

Answer 17

Point values to determine
Definitive (>/=10)
Possible (>/=6)

1 pathologic = 10 pts
1 major = 5 pts
1 minor = 2 pts