infectious endocarditis Flashcards
what is it?
infection of the endothelium of the heart valves (left side)
predisposing features?
- heart valve abnormality
- prosthetic heart valves
- IV drug user
- IV line
- dental treatment
- previous rheumatic fever
- recent surgery
causes of infectious endocarditis?
Bacteria (most common)
- strep viridans
- staph aureus
- enterococcus
- staphylococcus epidermis
Atypical organisms:
- HACEK (gram neg orgnaisms)
- coxiella burnetti
- chlamydia
- legionella
- mycoplasma
Fungi
-candida aspergillus
causes of non infectious endocarditis?
- rheumatic fever
- SLE
- non bacterial thrombotic endocarditis
- carcinoid heart disease
symptoms of infectious endocarditis?
- fever
- malaise
- weight loss
- breathlessness
- tiredness
signs of infectious endocarditis?
- fever
- new/changing heart murmur
- finger clubbing
- splinter haemorrhages
- roth spots
- janeway lesions
- Osler nodes
- septic emboli
what investigations will take place for infective endocarditis?
- blood cultures
- antibiotic serology (for atypical organisms)
- echocardiogram (to show vegetation)
- CT (to look for emboli)
what is used for diagnosing infectious endocarditis?
Duke criteria (2 major or 1 major and 3 monor or 5 minor)
how must the blood cultures be taken?
3 sets (2 bottles each) taken with >6 hours between them, prior to antibiotics
treatment for staphylococcus aureus (MSSA)
Flucloaxicillin IV
treatment for viridians streptococci?
Benzylpenicillin IV and gentamycin IV for 4 weeks
treatment for enterococcus sp?
amoxicillin/vancomycin and gentamycin IV
treatment for staphylococcus epidermis?
vancomycin and gentamycin IV and rifampicin treat for 6 weeks
treatment for fungi?
surgery
