Infectious Disease Flashcards
What is endocarditis?
an inflammation of the endocardium; infection of the heart valves by various organisms characterized by valvular vegetations and fibrin deposits
What are some common signs and sxs of IE?
Fever, chills, weakness, night sweats, weight loss
heart murmur, splenomegaly, skin manifestations (Osler’s nodes & Janeway’s lesions)
Difference between Janeway lesion
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
What 3 groups of organisms cause a majority of infective endocarditis?
Staphylococci
Streptococci
Enterococci
Describe the treatment approach to IE?
- 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)
Why has Staphylococcal endocarditis become more prevalent?
Mainly bc of increased IVDA
Also, more frequent peripheral/central catheters and valve replacment surgeries
Which organism is the most common organism causing IE among those w/ IVDA and persons w/ venous catheters?
Staph aureus
What is the tx for a pt w/a native valve?
Nafcillin OR Oxacillin PLUS an aminoglycoside
What is a common cause of Prosthetic valve endocardits?
Staphylococcus epidermidis
What is a common cause of Native valve endocarditis?
Streptococci viridans (common inhabitant of the oral cavity
Enterococci are normal inhabitants of…
human GI tract and sometimes anterior urethra
What is the most common clinical isolate of the enterococci associated w/ endocarditis?
E. faecalis
Name the gram-negative bacteria of the HACEK group
Haemophilus parainfluenzae Haemophilus aphrophilus Actinobacillus actinomycetemcomitans Cardiobacterium hominis Eikenella corrodens Kingella kingae
The HACEK group is a common cause of…
5-10% of native valves
Community-acquired IE
subacute illness w/large vegetations and emboli
How would you treat against an IE caused by an organism belonging to the HACEK group?
High-dose Ampicillin WITH Gentamicin for 4 weeks
What are the beta-lactam abx drugs of choice for strep, staph, and enterococci?
strep –> Penicillin G (or ceftriaxone)
staph –> Nafcillin
entero –> Ampicillin
Who should you recommend IE abx prophylaxis to for dental procedures? and when?
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
Who is IE abx prophylaxis not recommended for?
increased lifetime risk of IE genitourinary or GI tract procedures common valve problems bicuspid aorta, mitral valve, aquired aortic valve prolapse/regurg hypertrophic cardiomyp
Who is IE abx prophylaxis not recommended for?
increased lifetime risk of IE genitourinary or GI tract procedures common valve problems bicuspid aorta, mitral valve, acquired aortic valve prolapse/regurg hypertrophic cardiomyopathy
List examples of high risk patients needing prophylaxis for dental procedures
- 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
which dental procedures do not require prophylaxis in high risk patients?
routine anesthetic injections in noninfected tissue, xrays, prosthodontic appliances, bleeding from trauma to the mouth
