Infective Endo Flashcards
How common is IE?
Rare
2-6/100 000
M same as F
What it infective endocarditis?
This is a bacterial or fungal infection of the heart valves or endocardium
What is the mortality rate if IE?
20%
What are the four types of IE?
Native valve
Prosthetic Valve
IVDU IE
Nosocomial IE
Which diseases and problems are associated with native valve IE?
Congenital heart diseases
Rheumatic Herat disease
Mitral valve prolapse
Degenerative lesions
Which organisms are assorted with native valve IE?
Strep viridans
What are the two types of prosthetic heart valve IE?
Early and late
Early within 2 months of surgery
Which organisms predominate in prosthetic heart valve?
Staphylococci
Which side of the heart is re commonly affected in IVDU and which organisms associated with this type of IE?
Right sided Staph aureus (sometimes fungi)
What predisposes to nosocomial IE?
IV lines and invasive procedures
More common in those older than 60
Which side of the heart is affected in nosocomial IE?
Right sided dud to CVP lines and pulmonary artery Catherters
What is the pathogenesis to IE?
Heart defect which creates pressure gradient across valve
Then you get and fibrin platelet clot
If you then get a bacteraemia the bacteria colonise the clot causing further fibrin deposition leading to a vegetation
What is the key problem with IE with regards to the located of the organisms?
Once they are located inside the endocardium immune cells cannot reach them
What host factors are associated with an increased risk of IE?
Rheumatic fever Invasive procedure Congenital abnormalities causing turbulent blood flow Cardiac conditions : Acquired valvular disease with stenosis and regurgitation Valve replacement Structural Congenital heart disease Hyoertrophic cardiomyopathy
What are the common organisms involved in IE?
Staph aureus
HACEK group
Culture negative group eg chlamydiaye
What things can cause a transient bacteriaemia?
Tooth brushing
Dental procedures
Medial and surgical procedure
What are the symptoms of IE?
Oilers nodes Jane way lesions Roth spots splinter heamorrage Pyrexia Haematuria Splenomegaly
What are oslers nodes?
Lesions on hand and fingers PAINFUL
What are janeways lesions?
Painless spots on foot
What are Roth spots?
Flame shaped retinal haemorrhage
Diagnosis of IE is made based on what?
Major and minor criteria
What major criteria exist for diagnosis of IE?
Positive blood culture and evidence of endocardium involvement
What ,minor criteria exist?
Fever
Predisposition
Echocardiogram positive
Which tests would you consider in IE?
FBC
Echocardiogram
Urine
ESR raised
What would the FBC show?
Normocytic normochro mic anaemia
What are the complication from IE?
Cardiac failure
Death
Emboli (pulmonary or cerebral)
Renal failure
Which heart defects are NOT associated with an increased risk if IE?
Isolated atrial septal defects
Repaired ventricular septal defects
Repaired patent ductus arteriosis
Closure devices that have been endothelialised
How can we prevent IE?
Inform patients re Tattoos Body piercing Improve access to oral care Prompt treatment for episodes of infection Educate on symptoms
