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Cardiovascular > Endocarditis and other infections > Flashcards

Endocarditis and other infections Flashcards

1
Q

What is the likely focus of infection for Streptococcus pneumoniae?

A

Pneumonia or meningitis

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2
Q

What is the likely focus of infection for E. Coli/Klebsiella/other coliforms?

A

Urinary tract or gut

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3
Q

What is the likely focus of infection for staphylococcus aureus?

A

Skin or wound infection
Bone/joint infection
Endocarditis

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4
Q

Describe the characteristics of the staphylococcus genus

A

Gram-positive
Round (coccus)
Found in cells, pairs or most commonly in clusters (name derived from Greek for ‘a bunch of grapes’

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5
Q

How is the staphylococcus genus divided?

A

There ability to produce the blood clotting enzyme, coagulase
Coagulase positive and negative

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6
Q

Is staphylococcus aureus coagulase positive or negative?

A

Coagulase positive

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7
Q

Is staphylococcus epidermis coagulase positive or negative?

A

Coagulase negative

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8
Q

What bacteria is associated with prosthetic material?

A

Staphylococcus epidermis

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9
Q

What is infective endocarditis?

A

It is an infection of the endothelium of the heart valves

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10
Q

Give predisposing factors for infective endocarditis

A

Heart valve abnormality (calcification/stenosis, congenital heart disease or post rheumatic fever), prosthetic heart valve, intravenous drug user or intravenous lines

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11
Q

What is the pathogenesis of endocarditis?

A

Damaged heart valve
Turbulent blood flow over rough endothelium
Platelet/fibrin attachment
Bacteraemia (may be very transient)
Organisms settle in platelet/fibrin thrombi, forming a microbial vegetation
This affects the function of the heart valves and bits can break off and travel in circulation, lodging in capillary beds

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12
Q

What side of the heart is usually affected by endocarditis?

A

The left side - aortic and mitral valves

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13
Q

What valve tends to be affected in intravenous drug users?

A

Tricuspid

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14
Q

What organisms cause endocarditis?

A 
Staphylococcus aureus (38%)
Viridians streptococci (31%)
Enterococcus sp. (8%)
Staphlycoccus epidermidis (6%)
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15
Q

What are the atypical bacteria that can cause endocarditis?

A

Bartonella, coxiella burnetii, chlamydia, legionella, mycoplasma and brucella

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16
Q

What are the presenting symptoms of acute endocarditis?

A

Overwhelming sepsis and cardiac failure

17
Q

What are the symptoms for subacute endocarditis?

A

Fever, malaise, weight loss, tiredness and breathlessness

18
Q

What are the signs of subacute endocarditis?

A

Fever, new or changing heart murmurs, finger clubbing, splinter haemorrahages, Osler nodes, Janeway lesion, Roth spot, splenomegaly and microscopic haematuria.

19
Q

How many blood cultures do you do for a diagnosis of endocarditis?

A

3

20
Q

What is the second method of diagnosis?

A

Echocardiogram

21
Q

What bacteria tend to cause early presentations of prosthetic valve endocarditis?

A

Staphylococcus aureus and staphylococcus epidermis

22
Q

What bacteria tends to cause endocarditis in intravenous drug users?

A

Staphylococcus aureus

23
Q

How does endocarditis often present in intravenous drug users?

A

Staphylococcus aureus pneumonia

24
Q

Describe the general treatment for all types of endocarditis

A

IV antibiotics at a high dose and high frequency

25
Q

What drugs would be given for native endocarditis?

A

Amoxicillin and gentamicin IV

26
Q

What drugs would be given for prosthetic valve endocarditis?

A

Vancomycin and gentamicin IV and rifampicin PO

usually need valve replacement

27
Q

What drugs would be given for drug user endocarditis?

A

Flucloxacillin IV

28
Q

What drug is given for o Staphylococcus aureus (not MRSA)?

A

Flucloxacillin IV

29
Q

What drugs are given for MRSA?

A

Vanconycin IV and rifampicin PO

30
Q

What drugs are given for o Viridians streptococci?

A

Benzylpenicillin and gentamicin IV

31
Q

What drugs are given for o Enterocossus sp.?

A

Amoxicillin/Vancomycin & gentamicin IV

32
Q

What drugs are given for o Staphylococcus epidermidis?

A

Vancomycin and gentamicin IV and rifampicin PO

33
Q

What is monitored during therapy?

A

Cardiac function, temperature and serum C-reactive protein

34
Q

How is endocardisi prevented?

A

Prophylaxis use of antibiotics in high risk patients during gastrointestinal or genitourinary tract procedures if infection in this area is suspected

35
Q

What is myocarditis?

A

Inflammation of the cardiac muscle

36
Q

What are the symptoms of myocarditis?

A

Fever, chest pain, shortness of breath and palpitations

37
Q

What are the signs of myocarditis?

A

Arrythmia and cardiac failure

38
Q

What is the main cause of myocarditis?

A

Enteroviruses

39
Q

What is pericarditis?

A

Inflammation of the pericardium

Cardiovascular (17 decks)

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