Infectious Disease

Question 1

What is endocarditis?

Answer 1

an inflammation of the endocardium; infection of the heart valves by various organisms characterized by valvular vegetations and fibrin deposits

Question 2

What are some common signs and sxs of IE?

Answer 2

Fever, chills, weakness, night sweats, weight loss

heart murmur, splenomegaly, skin manifestations (Osler’s nodes & Janeway’s lesions)

Question 3

Difference between Janeway lesion

Answer 3

Janeway: located on soles, palms, thenar/hypothenar eminences, plantar of toes; nontender macules variable and irregular (acute)

Osler: finger and toe tips, thenar/hypothenar eminences; tender nodules of 1mm to >1cm

Question 4

What 3 groups of organisms cause a majority of infective endocarditis?

Answer 4

Staphylococci
Streptococci
Enterococci

Question 5

Describe the treatment approach to IE?

Answer 5

• isolation of infecting pathogen
• determine antimicrobial susceptibilities
• high dose, parenteral, bactericidal abx’s for extended period (to achieve bactericidal concentrations w/in vegetations)
• surgery (valvectomy and valve replacement)

Question 6

Why has Staphylococcal endocarditis become more prevalent?

Answer 6

Mainly bc of increased IVDA

Also, more frequent peripheral/central catheters and valve replacment surgeries

Question 7

Which organism is the most common organism causing IE among those w/ IVDA and persons w/ venous catheters?

Answer 7

Staph aureus

Question 8

What is the tx for a pt w/a native valve?

Answer 8

Nafcillin OR Oxacillin PLUS an aminoglycoside

Question 9

What is a common cause of Prosthetic valve endocardits?

Answer 9

Staphylococcus epidermidis

Question 10

What is a common cause of Native valve endocarditis?

Answer 10

Streptococci viridans (common inhabitant of the oral cavity

Question 11

Enterococci are normal inhabitants of…

Answer 11

human GI tract and sometimes anterior urethra

Question 12

What is the most common clinical isolate of the enterococci associated w/ endocarditis?

Answer 12

E. faecalis

Question 13

Name the gram-negative bacteria of the HACEK group

Answer 13

Haemophilus parainfluenzae
Haemophilus aphrophilus
Actinobacillus actinomycetemcomitans
Cardiobacterium hominis
Eikenella corrodens
Kingella kingae

Question 14

The HACEK group is a common cause of…

Answer 14

5-10% of native valves
Community-acquired IE
subacute illness w/large vegetations and emboli

Question 15

How would you treat against an IE caused by an organism belonging to the HACEK group?

Answer 15

High-dose Ampicillin WITH Gentamicin for 4 weeks

Question 16

What are the beta-lactam abx drugs of choice for strep, staph, and enterococci?

Answer 16

strep –> Penicillin G (or ceftriaxone)
staph –> Nafcillin
entero –> Ampicillin

Question 17

Who should you recommend IE abx prophylaxis to for dental procedures? and when?

Answer 17

only for pt’s w/ underlying cardiac conditions associated w/the highest risk

all dental procedures involving manipulation of gingival tissue or the periapical region of teeth or perforation of the oral mucosa

Question 18

Who is IE abx prophylaxis not recommended for?

Answer 18

increased lifetime risk of IE
genitourinary or GI tract procedures
common valve problems
bicuspid aorta, mitral valve, aquired aortic valve prolapse/regurg
hypertrophic cardiomyp

Question 19

Who is IE abx prophylaxis not recommended for?

Answer 19

increased lifetime risk of IE
genitourinary or GI tract procedures
common valve problems
bicuspid aorta, mitral valve, acquired aortic valve prolapse/regurg
hypertrophic cardiomyopathy

Question 20

List examples of high risk patients needing prophylaxis for dental procedures

Answer 20

• prosthetic heart valves
• prior hx of IE
• un-repaired cyanotic congenital heart dz
• completely repaired congenital heart dz w/prosthetic materials placed w/in 6 mo’s after procedure
• transplanted heart w/valve regurg
• repaired congenital defects w/residual defects at site near patch or prosthetic device

Question 21

which dental procedures do not require prophylaxis in high risk patients?

Answer 21

routine anesthetic injections in noninfected tissue, xrays, prosthodontic appliances, bleeding from trauma to the mouth