IE and ARF (UTD) Flashcards
Define infective endocarditis
infection of the endocardium and/or heart valves that involves thrombus formation (vegetation), which may damage the endocardial tissue and/or valves
Estimated annual incidence of IE in USA among infants?
3.3 per 100,000 per year among infants <1 year old
Estimated annual incidence of IE in USA among older children/adolescents?
0.3 to 0.8 per 100,000 per year in older children and adolescents
Risk factors for developing IE?
CHD (especially cyanotic HD), central venous catheters, RHD
Rate of underlying CHD in children with IE?
35-60%
Risk of IE is highest in patients with?
complex cyanotic heart disease, especially in those who have had surgical intervention
Reported incidence rates of IE in children with CHD range from…
40 to 60 per 100,000 person-years, which is several orders of magnitude higher than in the general pediatric population
CHD lesions at highest risk for IE include…
cyanotic lesions, endocardial cushion defect, left-sided lesions, and ventricular septal defects (VSD). Other risk factors include cardiac surgery within six months and age <3 years.
What devices may be a factor in IE development in kids?
Indwelling CVCs, intracardiac devices (ventriculoatrial shunts, pacemakers, implantable cardioverter-defibrillators, and prosthetic and bioprosthetic valves). As use of these devices becomes more common, the relative proportion of device-related IE increases
In developed countries, the incidence of rheumatic heart disease has […] dramatically since the 1960s
declined
in the modern era, rheumatic heart disease is an […] predisposing condition for IE in children
uncommon
In resource-limited settings, rheumatic heart disease remains […] IE
an important risk factor for developing
Other risk factors for IE (other than CHD/RHD/central access devices)?
IVDU, degenerative heart disease –> not commonly seen in children
Overall pathogenesis of IE?
interactions among blood-borne pathogens, damaged endothelium, fibrin, and platelets
3 steps in pathogenesis of IE?
- Endocardial surface is injured by shear forces associated with turbulent blood flow 2. fibrin, platelets and sometimes RBCs deposit and form a non-infected thrombus 3. bacteraemia or fungaemia –> adherence of pathogens to injured endothelium and thrombus. Subsequent fibrin and platelet deposition –> protective sheath isolating from host defences and allows rapid proliferation of infection
1st step in pathogenesis of IE?
The endocardial surface is initially injured by shear forces associated with turbulent blood flow in children with congenital heart disease (CHD), or indwelling central venous catheters in children without CHD.
2nd step in pathogenesis of IE?
At the site of endothelial damage, fibrin, platelets, and occasionally red blood cells are deposited and initially form a noninfected thrombus.
3rd step in pathogenesis of IE?
Transient bacteremia (which occurs in normal children) or fungemia results in adherence of microbial pathogens to the injured endocardium and thrombus. Subsequent fibrin and platelet deposition over the infected vegetation result in a protective sheath that isolates the organisms from host defenses and permits rapid proliferation of the infectious agent.
Most common microorganisms causing IE?
Staphlococci and Streptococci species
Among children with underlying heart disease, what are the most common causes of IE?
- Viridans streptococci – 33 percent
- Staphylococcus aureus – 28 percent
- Other streptococci – 17 percent
- Other Staphylococcus species – 7 percent
- Polymicrobial – 11 percent
- Gram-negative bacilli – 5 percent
Among children without underlying heart disease, what are the most common causes of IE?
- S. aureus – 47 percent
- Viridans streptococci – 18 percent
- Polymicrobial – 12 percent
- Other streptococci – 10 percent
- Gram-negative bacilli – 8 percent
- Other Staphylococcus species – 6 percent
Overall presentation of S.aureus IE?
acute fulminant process with a high mortality rate, as compared with IE due to most other pathogens
Patient with in-dwelling catheters are at risk for bacteremia with […] in infective endocarditis?
Gram-negative organisms
Gram-negative bacterial endocarditis is rare or common?
rare










