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Cardiovascular system > Infective endocarditis > Flashcards

Infective endocarditis Flashcards

1
Q

What is meant by bacteraemia (used to be septicaemia)?

A

Viable bacteria in the bloodstream

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2
Q

What should be done before blood cultures are taken?

A

The skin should be sterilised

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3
Q

How long can some blood cultures take to give a positive result?

A

Up to 2 days

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4
Q

When should broad spectrum antibiotics be started on a patient with suspected bacteraemia?

A

After blood cultures are taken but before a result

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5
Q

What are some bacteria that can cause bacterial meningitis?

A

Streptococcus pneumoniae
Neisseria meningitidis
Haemophilus influenzae
Streptococcus agalactiae
Listeria monocytogenes

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6
Q

What is the main bacteria that causes otitis media?

A

Streptococcus pneumoniae

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7
Q

What are some bacteria that can cause eye infections?

A

Staphylococcus aureus
Neisseria gonorrhoaea
Chlamydia trachomatis

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8
Q

What are some bacteria that can cause sinusitis?

A

Streptococcus pneumoniae
Haemophilus influenzae

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9
Q

What are some bacteria that can cause upper respiratory tract infections?

A

Streptococcus pyogenes
Haemophilus influenzae

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10
Q

What are some bacteria that can cause community acquired pneumonia?

A

Streptococcus pneumoniae
Haemophilus influenzae
Staphylococcus aureus

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11
Q

What are some bacteria that can cause atypical pneumonia?

A

Mycoplasma pneumoniae
Chlamydia pneumoniae
Legionella pneumophila

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12
Q

Which bacteria can cause tuberculosis?

A

Mycobacterium tuberculosis

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13
Q

What are some bacteria that can cause skin infection?

A

Staphylococcus aureus
Streptococcus pyogenes
Pseudomonas aeruginosa

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14
Q

What are some bacteria that can cause sexually transmitted diseases?

A

Chlamydia trachomatis
Neisseria gonnorhoaea
Treponema pallidum
Ureaplasma urealyticum
Haemophilus ducreyi

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15
Q

What are some bacteria that can cause urinary tract infections?

A

Escherichia coli
Enterobacteriaceae sp
Staphylococcus saprophyticus
Pseudomonas aeruginosa

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16
Q

What bacteria is the most common cause of gastritis?

A

Helicobacter pylori

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17
Q

What are some bacteria that can cause food poisoning?

A

Campylobacter jejuni
Salmonella sp
Shigella sp
Clostridium sp
Staphylococcus aureus
Escherichia coli

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18
Q

How many blood samples should be taken in suspected endocarditis?

A

At least 3 samples, as the more samples taken, the higher the detection sensitivity

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19
Q

How can implantable devices lead to endocarditis?

A

Implantable devices can carry a biofilm on their surface which can infect leads and then the heart

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20
Q

How long after removal of an infected ICED should blood tests be taken?

A

48 - 72 hours

21
Q

What are some pre-disposing factors for infective endocarditis?

A

Heart valve abnormality
Prosthetic heart valves
People who inject drugs
Intravascular lines

22
Q

What are some forms of heart valve abnormality that can predispose to infective endocarditis?

A

Calcification
Congenital
Rheumatic fever

23
Q

What are the 4 most common bacteria in infective endocarditis?

A

Staphylococcus aureus
Viridans group Streptococci
Enterococcus sp
Staphylococcus epidermidis

24
Q

What are some examples of bacteria that can cause infective endocarditis, but won’t grow on agar?

A

Bartonella
Coxiella burnetti (Q-fever)
Chlamydia
Legionella
Mycoplasm
Brucella

25
Q

What is required for testing if a bacteria won’t grow on agar?

A

Serology testing

26
Q

What are the HACEK bacteria that grow very slow on agar?

A

H - Haemophilus sp
A - Aggregatibacter sp
C - Cardiobacterium sp
E - Eikenella sp
K - Kingella sp

27
Q

What are the major conditions in the duke criteria for infective endocarditis?

A

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

28
Q

What are the tests performed in blood culturing?

A

Gram staining
Microscopy
Coagulase testing
MALDI-TOF

29
Q

What is shown on blood agar in a culture of staphylococcus aureus?

A

A gold aura

30
Q

What is the main acute presentation of infective endocarditis?

A

Overwhelming sepsis and cardiac failure

31
Q

What are some sub-acute presentations of infective carditis?

A

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

32
Q

What is meant by a Roths spots?

A

White, central retinal haemorrhages

33
Q

What is meant by Janeway lesions?

A

Painless, flat red/blue spots on the palms and soles

34
Q

What is meant by Osler nodes

A

Painful, pea sized lesions on the fingers and toes

35
Q

How are people likely to contract infective endocarditis with Streptococcus viridans?

A

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

36
Q

What are some common skin infections that can contaminate the blood during surgery?

A

Staphylococcus aureus
Staphylococcus epidermidis
Corynebacterium sp
Propionibacterium acnes

37
Q

In the Dukes criteria, what does the mnemonic BE TIMER stand for?

A

Blood cultures positive
Echocardiogram
Temperature
Immunological (Osler’s nodes, Roth spots)
Microbiological evidence
Emboli
Risk factors (Heart condition or IV drug use)

38
Q

What is the main first site of infection in IV drug users?

A

Right sided endocarditis

39
Q

What is the treatment option for Coxiella burnetti?

A

Doxycycline and hydroxychloroquine for 18 months

40
Q

What is the main treatment option for Streptococcus viridans group endocarditis?

A

Amoxicillin and gentamicin IV

41
Q

What is the main treatment option for prosthetic valve endocarditis?

A

Vancomycin and gentamicin IV
Then oral rifampicin after 3-5 days

42
Q

What is the main treatment option for endocarditis in IV drug users?

A

Flucloxicillin IV

43
Q

What is the main treatment option for staphylococcus aureus endocarditis?

A

Flucloxicillin IV

44
Q

What is the main treatment option for enterococcus sp endocarditis?

A

Vancomycin and gentamicin IV

45
Q

What is the main treatment option for staphylococcus epidermidis endocarditis?

A

Vancomycin and gentamicin IV and oral rifampicin

46
Q

How long are most anti-biotic courses for infective endocarditis?

A

4-6 weeks

47
Q

What are the main symptoms of myocarditis?

A

Fever
Chest pain
Shortness of breath
Palpitations

48
Q

What are some clinical signs of myocarditis?

A

Arrhythmia
Cardiac failure

Cardiovascular system (45 decks)

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