infection

Question 1

Pathophysiology of endocarditis

Answer 1

Question 2

causative organisms

Answer 2

Bacterial:

• Streptococci>> Viridian (50% of episodes)
• Staphylococcus aureus (20%).
• enterococcol (bovis and feacalis)

2 - 10% fungi

• Candida or Aspergillus

other:

• ‘HACEK’ organisms, (fastidious)

Question 3

commonost in IV drug users

Answer 3

Staphylococcus aureus

Question 4

fungal is most common in?

Answer 4

immunosuppression, IV drug use, cardiac surgery, prolonged exposure to anmicrobial drugs and IV feeding

Question 5

Ix

(if bc was negative?)

Answer 5

BLOOD CULTURES & ECHOCARDIOGRAM

bC>> prefered X3 at 3 diff sites or 6 even!

Echo: TOE & TTE but toe is the goals one!cuz good for detectionof mitral valve and prosthetic valve vegetations.

If cultures are negative despite a high level of suspicion of IE , samples can be taken in special media that allows the growth of fastidious organisms

Question 6

Diagnostic criteria

Answer 6

Question 7

Management

Answer 7

1. Viridans streptococci: benzylpenicillin IV (or vancomycin if penicillin-allergic) + low-dose gentamicin
2. Enterococcus faecalis: amoxicillin IV (or vancomycin if penicillin-allergic) + low-dose gentamicin IV
3. staphylococcis: Flucloxacillin + low-dose gentamicin IV

or benzylpenicillin if penicillin-sensitive

or vancomycin if penicillin allergic or MRSA) plus gentamicin (or fusidic acid).

Question 8

monitor response to therapy?

Answer 8

 ECHO (x1 weekly) - to assess vegetaon size and look for complicaons (e.g. valve destrucon, intracardiac abscesses)

 ECG (x2 weekly) - to detect conductionon disturbances, which may indicate development of an aortic root abscess in aortic valve infection

 Blood tests (x2 weekly) - ESR, CRP, full blood count and U&Es

Question 9

Referral for considerationson of surgery?

Answer 9

 Moderate to severe cardiac failure due to valve compromise

 Valve dehiscence

 Uncontrolled infecon despite appropriate anmicrobial therapy

 Relapse after good medical therapy

 Threatened or actual systemic embolism

 Coxiella burneti and fungal infectioons

 Paravalvar infection (e.g. aortic root abscess)

 Sinus of Valsalva aneurysm

 Valve obstruction

Question 10

gnereal symptoms

Answer 10

Question 11

signs

Answer 11

Question 12

prognosis

Answer 12

30% mortality - Staphylococcus

6% mortality - Streptococci