Infective Endocarditis

Question 1

Etiology of IE:
What main pathogens can cause infective endocarditis?

Answer 1

Staphylococcus aureus
Viridans streptococci
Staphylococcus epidermidis
Enterococci (especially enterococcus faecalis)
Streptococcus gallolyticus
Gram negative HACEK group
Fungal endocarditis (candida, asperigillus, fumigatus)
Coxiella burnetii bartonella species

Question 2

What bacterium are apart of the HACEK group?

Answer 2

Haemophilus species, Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae

Question 3

What’re some characteristics of staphylococcus aureus in IE?

Answer 3

• Most common cause of acute IE, including those who inject drugs
• Usually fatal within 6 weeks if left untreated

-Typically affects healthy valves

Question 4

What’re some characteristics of Viridans streptococci in IE?

Answer 4

Most common cause of subacute IE, especially in pre damaged native valves

Common cause of IE following dental procedures, respiratory tract incision and biopsy

Question 5

Characteristics of staphylococcus epidermidis in IE?

Answer 5

Bacteremia from infected peripheral venous catheters

Most common cause of subacute IE in patients with prosthetic heart valves, pacemakers and ICD

Question 6

Characteristics of enterococci in IE?

Answer 6

Multiple drug resistance
Common cause of IE following nosocomial UTI’s (required within health care facilities)
Occurs following gastrointestinal or genitourinary procedures

Question 7

Characteristics of streptococcus gallolyticus (SGG) in IE?

Answer 7

Associated with colorectal cancer
If Sgg is detected, colonoscopy is indicated

Question 8

Characteristics of gram negative HACEK group in IE?

Answer 8

In patients with poor dental hygiene and/or periodontal infection

Question 9

Characteristics of Fungal endocarditis in IE?

Answer 9

Immunosupressed patients
People who inject drugs
Patients with long term indwelling IV catheters

Question 10

Characteristics of coxiella burnetii bartonella species in IE?

Answer 10

Gram negative pathogens responsible for culture negative endocarditis

Question 11

What’re some clinical features associated with IE?

Answer 11

Fever, chills, tachycardia, general malaise and weakness, Dyspnea

Question 12

What’re some cardiac manifestations with infective endocarditis?

Answer 12

Development of new heart murmur or change in preexisting murmur.
•Tricuspid valve regurgitation
^- holosystolic murmur that is loudest at the left sternal border

Question 13

Any extra cardiac manifestations of IE?

Remember (R SOR)

Answer 13

Petechiae, especially splinter hemorrhages (underneath fingernails)
Jane way lesions
• Small, nontender, erythematous macules on palms and soles
• Osler nodes: painful nodules on pads of the fingers and toes
• Roth spots: round retinal hemorrhages

Question 14

What is the pneumonic “FROM JANE” stand for?

Answer 14

Fever, Roth spots, Osler nodules, Murmur, Janeway lesions, Anemia, Nail bed hemorrhage, and Emboli

Question 15

Diagnostic tests to perform with suspected IE?

Answer 15

Lab studies, blood cultures, TTE, EKG, CXR, colonoscopy

Question 16

Differential diagnoses of IE?

Answer 16

Rare, noninfective form of endocarditis due to sterile platelet thrombus formation
Libman-Sacks endocarditis (type of endocarditis with those who have lupus or antiphospholipid syndrome)

Question 17

Treatment of native valve endocarditis

Answer 17

Vancomycin PLUS a beta-lactam

Question 18

Treatment of prosthetic valve endocarditis

Answer 18

ADD gentamicin PLUS rifampin to vancomycin PLUS a beta-lactam (if less than one year after placement)

Question 19

Valve type || Clinical Presentation || common
regimen
Treatment of :
Native || Acute and Subacute IE

Answer 19

Native valve | Acute bacterial endocarditis (days) || vancomycin (15mg/kg IV q12) and cefepime (1-2 g IV q 8-12)

Subacute bacterial endocarditis (weeks) || vancomycin (15mg/kg IV q 12) plus ampicillin-sulbactam (3g IV q 6)