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Infectious Disease > Infectious Endocarditis > Flashcards

Infectious Endocarditis Flashcards

1
Q

Definition

A

infection of the heart valves by various microorganisms

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2
Q

Acute bacterial endocarditis

A

High fevers
Systemic toxicity
Leukocytosis
Death possible within days if left untreated

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3
Q

Subacute bacterial endocarditis

A

Slow, indolent course associated with low-grade fevers
Night sweats
Weight loss
Vague systemic complaints
Usually in setting of previous valvular damage

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4
Q

Risk factors for Endocarditis

A 
Presence of prosthetic valve
Previous endocarditis
DM
Health-care related exposure
Congenital heart disease with cyanosis
Acquired valvular dysfunction
Hypertrophic cardiomyopathy
Mitral valve prolapse with regurgitation
Chronic IV access
IV drug abuse
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5
Q

Common organisms in endocarditis

A

Staphylococcus
Streptococcus
Enterococci

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6
Q

HACEK organisms

A 
slow growing, fastidious G- bacilli
Haemophilus parainfluenzae/aphrophilus
Actinobacillus actubinycetemcomitans
Cardiobacterium hominis 
Eikenella coroodens
Kingella kingae
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7
Q

Pathogenesis for endocarditis

A

Hematogenous spread via:
Endothelial surface damaged
Sterile platelet-fibrin thrombi form on surface
Bactermia gives organisms access to and results in colonization of the endocardial surface
After colonization of endothelial surface, a “vegetation” of fibrin, platelets, and bacteria forms

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8
Q

Complications secondary to vegetation formation

A

HF
Septic emboli
Antibody complexes can form and deposit in organs

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9
Q

Endocarditis sx

A 
Fever
Schills, night sweats
Weight loss
Weakness
Malaise
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10
Q

Endocarditis signs

A

Fever
Heart murmur
Embolic phenomenon
Skin manifestations: osler nodes, splinter hemorrhages, Janeway lesions

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11
Q

Endocarditis lab findings

A

Positive blood cultures

Nonspecific: anemia, normal/slightly elevated WBC with a mild left shift, elevated ESR or CRP

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12
Q

Diagnostic tests for endocarditis

A 
Transesophageal echocardiogram (TEE) is preferred
Transthoracic echocardiogram (TTE) may also be performed
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13
Q

Osler’s nodes

A

Purplish or erythematous subcutaneous papules or nodules on the pads of the fingers and toesl These lesions are 2-15 mm in size and are painful and tender. These nodes are not specific for infective endocarditis.

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14
Q

Janeway’s lesions

A

Hemorrhagic, painless plaques on the palms of the hands or soles of the feet. Likely embolic in origin.

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15
Q

Splinter hemorrhages

A

Thin, linear hemorrhages found under the nail beds of the fingers or toes; not specific for infective endocarditis

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16
Q

Petechiae

A

Small, erythrematous, painless, hemorrhagic lesions

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17
Q

Clubbing of the fingers

A

Proliferative changes in the soft tissues about the terminal phalanges observed in long-standing endocarditis

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18
Q

Roth’s spots

A

Retinal infarct with central pallor and surrounding hemorrhage

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19
Q

Peripheral manifestations of endocarditis

A 
Osler's nodes
Janeway's lesions
Splinter hemorrhages
Petechiae
Clubbing of the fingers
Roth's spots
20
Q

Major Duke criteria

A

Positive blood culture (at least 2 separate)

Evidence of endocardial involvement (via diagnostic test)

21
Q

Minor Duke Criteria

A 
Predisposition, predisposing heart condition or IVDU
Fever (>100.4)
Vascular phenomena
Immunologic phenomena
Microbiologic evidence
22
Q

Vascular phenomena

A

Major arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, Janeway’s lesions

23
Q

Immunologic phenomena

A

Glomerulonephritis
Osler’s nodes
Roth’s spots
Rheumatic factor

24
Q

Microbiologic evidence

A

Positive blood culture or serologic evidence of active infection with organism consitent with IE

25
Q

Definitive IE

A 
2 major criteria 
OR 
1 major criteria + 3 minor criteria
OR
5 minor criteria
26
Q

Possible IE

A

1 major criteria + 1 minor criteria
OR
3 minor criteria

27
Q

Veridans Group Streptococci, Native valve, IE therapy: PCN susceptible

A 
Aqueous crystalline PCN G (12-18 mU/d) or ceftriaxone - 4 weeks
OR
same + gentamicin - 2 weeks
OR
Vancomycin - 4 weeks
28
Q

Veridans Group Streptococci, Native valve, IE therapy: relative resistance to PCN

A

Aqueous crystalline PCN (24 mU/d) or ceftriaxone - 4 weeks + Gentamicin - 2 weeks
OR
Vancomycin - 4 weeks

29
Q

Veridans Group Streptococci, Native valve, IE therapy: PCN resistant

A

Vancomycin + gentamicin - 6 weeks

30
Q

Veridans Group Streptococci, Prosthetic valve, IE therapy: PCN-susceptible

A

Aqueous crystalline PCN (24 mU/d) or ceftriaxone - 6 weeks +/- gentamicin - 2 weeks
OR
Vancomycin - 6 weeks

31
Q

Veridans Group Streptococci, Prosthetic valve, IE therapy: PCN relatively or fully resistant

A

Aqueous crystalline PCN G (24 mU/d) or ceftriaxone + gentamicin - 6 weeks
OR
Vancomycin - 6 weeks

32
Q

Staphylococci Endocarditis, Native valve, IE therapy: MSSA

A

6 weeks
Nafcillin/oxacillin
OR
If PCN allergic: cefazolin

33
Q

Staphylococci Endocarditis, Native valve, IE therapy: MRSA

A

6 weeks

Vancomycin/Daptomycin

34
Q

Staphylococci Endocarditis, Prosthetic valve, IE therapy: MRSA

A

Vaconmycin > 6 weeks
Rifampin > 6 weeks
Gentamicin - 2 weeks

35
Q

Staphylococci Endocarditis, Prosthetic valve, IE therapy: MSSA

A

Nafcillin/oxacillin > 6 weeks
Rifampin > 6 weeks
Gentamicin - 2 weeks

36
Q

Enterococcal endocarditis, strains susceptible to PCN, gentamicin, and vancomycin

A

Ampicillin or aqueous crystalline PCN G + Gentamicin (4-6 weeks)
If CrCl < 50: ampicillin + ceftriaxone - 6 weeks
Vancomycin + gentamicin - 6 weeks

37
Q

Enterococcal endocarditis strains susceptible to PCN, but resistant to aminoglycosides

A

Ampicillin + ceftriaxone - 6 weeks

38
Q

Enterococcal endocarditis, strains susceptible to vancomycin and aminoglycosides, but resistant to PCN

A

Vancomycin + gentamicin - 6 weeks

39
Q

Enterococcal endocarditis, strains resistant to PCN, vancomycin and aminoglycosides

A

Linezolid or daptomycin > 6 weeks

40
Q

Therapy for HACEK endocarditis

A 
Native valves - 4 weeks
Prosthetic valves - 6 weeks
Ceftriaxone
Ampicillin/sulbactam
If pt unable to tolerate a beta-lactam: Cipro
41
Q

Surgery and endocarditis

A
  • Important adjunt to antibiotic management in certain patients
  • Valve removed and replaced: removes infected tissue and restores hemodynamic function
  • Indications: HF, persistent fever, recurrent embolic events, prosthetic valves, abscesses, ineffective abx therapy, fungal IE
42
Q

Procedures and prophylaxis recommendations

A

Dental - all procedures invlolving manipulation of gingival tissue or priapical region of teeth or perforation of the oral mucosa
Respiratory tract - no prophylaxis
GI or GU tract - no prophylaxis
Take 30-60 minutes before procedure

43
Q

Prophylactic regimens: oral

A

Amoxicillin 2g

44
Q

Prophylactic regimens: unable to take oral

A

Ampicillin 2g IM/IV
Cefazolin 1g IM/IV
Ceftriaxone 1g IM/IV

45
Q

Prophylactic regimens: allergy to PCN - oral

A

Keflex 2g
Clinda 600mg
Azithromycin/Clarithromycin 500mg

46
Q

Prophylactic regimens: allergy to PCN - unable to take oral

A

Cefazolin 1g IM/IV
Ceftriaxone 1g IM/IV
Clindamycin 600mg IM/IV

Infectious Disease (19 decks)

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