Infective endocarditis Flashcards
What is meant by bacteraemia (used to be septicaemia)?
Viable bacteria in the bloodstream
What should be done before blood cultures are taken?
The skin should be sterilised
How long can some blood cultures take to give a positive result?
Up to 2 days
When should broad spectrum antibiotics be started on a patient with suspected bacteraemia?
After blood cultures are taken but before a result
What are some bacteria that can cause bacterial meningitis?
Streptococcus pneumoniae
Neisseria meningitidis
Haemophilus influenzae
Streptococcus agalactiae
Listeria monocytogenes
What is the main bacteria that causes otitis media?
Streptococcus pneumoniae
What are some bacteria that can cause eye infections?
Staphylococcus aureus
Neisseria gonorrhoaea
Chlamydia trachomatis
What are some bacteria that can cause sinusitis?
Streptococcus pneumoniae
Haemophilus influenzae
What are some bacteria that can cause upper respiratory tract infections?
Streptococcus pyogenes
Haemophilus influenzae
What are some bacteria that can cause community acquired pneumonia?
Streptococcus pneumoniae
Haemophilus influenzae
Staphylococcus aureus
What are some bacteria that can cause atypical pneumonia?
Mycoplasma pneumoniae
Chlamydia pneumoniae
Legionella pneumophila
Which bacteria can cause tuberculosis?
Mycobacterium tuberculosis
What are some bacteria that can cause skin infection?
Staphylococcus aureus
Streptococcus pyogenes
Pseudomonas aeruginosa
What are some bacteria that can cause sexually transmitted diseases?
Chlamydia trachomatis
Neisseria gonnorhoaea
Treponema pallidum
Ureaplasma urealyticum
Haemophilus ducreyi
What are some bacteria that can cause urinary tract infections?
Escherichia coli
Enterobacteriaceae sp
Staphylococcus saprophyticus
Pseudomonas aeruginosa
What bacteria is the most common cause of gastritis?
Helicobacter pylori
What are some bacteria that can cause food poisoning?
Campylobacter jejuni
Salmonella sp
Shigella sp
Clostridium sp
Staphylococcus aureus
Escherichia coli
How many blood samples should be taken in suspected endocarditis?
At least 3 samples, as the more samples taken, the higher the detection sensitivity
How can implantable devices lead to endocarditis?
Implantable devices can carry a biofilm on their surface which can infect leads and then the heart
How long after removal of an infected ICED should blood tests be taken?
48 - 72 hours
What are some pre-disposing factors for infective endocarditis?
Heart valve abnormality
Prosthetic heart valves
People who inject drugs
Intravascular lines
What are some forms of heart valve abnormality that can predispose to infective endocarditis?
Calcification
Congenital
Rheumatic fever
What are the 4 most common bacteria in infective endocarditis?
Staphylococcus aureus
Viridans group Streptococci
Enterococcus sp
Staphylococcus epidermidis
What are some examples of bacteria that can cause infective endocarditis, but won’t grow on agar?
Bartonella
Coxiella burnetti (Q-fever)
Chlamydia
Legionella
Mycoplasm
Brucella
What is required for testing if a bacteria won’t grow on agar?
Serology testing
What are the HACEK bacteria that grow very slow on agar?
H - Haemophilus sp
A - Aggregatibacter sp
C - Cardiobacterium sp
E - Eikenella sp
K - Kingella sp
What are the major conditions in the duke criteria for infective endocarditis?
2 separate positive blood cultures with microorganisms typical for infective endocarditis:
- Strep viridian’s groups
- Strep gallolyticus
- HACEK groups
- Staph aureus
- Community acquired enterococci
Echocardiographical evidence of endocardial involvement:
- Vegetation
- Abscess
- Valvular lesions
- New murmur
What are the tests performed in blood culturing?
Gram staining
Microscopy
Coagulase testing
MALDI-TOF
What is shown on blood agar in a culture of staphylococcus aureus?
A gold aura
What is the main acute presentation of infective endocarditis?
Overwhelming sepsis and cardiac failure
What are some sub-acute presentations of infective carditis?
Slow onset
Fever
Malaise
Weight loss
Tiredness
Breathlessness
New or changing heart murmur
Finger clubbing
Splinter haemorrhage
Splenomegaly
Roth spots, Janeway lesions and Osler nodes
Microscopic haematuria
What is meant by a Roths spots?
White, central retinal haemorrhages
What is meant by Janeway lesions?
Painless, flat red/blue spots on the palms and soles
What is meant by Osler nodes
Painful, pea sized lesions on the fingers and toes
How are people likely to contract infective endocarditis with Streptococcus viridans?
It is most commonly found in the mouth and so it can move into the blood stream via broken tissue in the gums, or in IV drug user as they can lick the needle
What are some common skin infections that can contaminate the blood during surgery?
Staphylococcus aureus
Staphylococcus epidermidis
Corynebacterium sp
Propionibacterium acnes
In the Dukes criteria, what does the mnemonic BE TIMER stand for?
Blood cultures positive
Echocardiogram
Temperature
Immunological (Osler’s nodes, Roth spots)
Microbiological evidence
Emboli
Risk factors (Heart condition or IV drug use)
What is the main first site of infection in IV drug users?
Right sided endocarditis
What is the treatment option for Coxiella burnetti?
Doxycycline and hydroxychloroquine for 18 months
What is the main treatment option for Streptococcus viridans group endocarditis?
Amoxicillin and gentamicin IV
What is the main treatment option for prosthetic valve endocarditis?
Vancomycin and gentamicin IV
Then oral rifampicin after 3-5 days
What is the main treatment option for endocarditis in IV drug users?
Flucloxicillin IV
What is the main treatment option for staphylococcus aureus endocarditis?
Flucloxicillin IV
What is the main treatment option for enterococcus sp endocarditis?
Vancomycin and gentamicin IV
What is the main treatment option for staphylococcus epidermidis endocarditis?
Vancomycin and gentamicin IV and oral rifampicin
How long are most anti-biotic courses for infective endocarditis?
4-6 weeks
What are the main symptoms of myocarditis?
Fever
Chest pain
Shortness of breath
Palpitations
What are some clinical signs of myocarditis?
Arrhythmia
Cardiac failure
