Infective Endocarditis Flashcards
Infective Endocarditis- Epidemiology Predisposing
Rheumatic Fever Calcific aortic stenosis Cogenital Heart Disease Prosthetic Valves Residual damage from previous IE Mitral valve prolaspse
Acute Native Valve Endocarditis
Abrupt Onset
Fever always
Complications one 1 wekk
S. aureus maybe
Subacute Native Valve Endocarditis
Fever subtl and nonspecific symptoms flu like/ anorexia onset to dx 6 wks Etiology: HACEK or viridans
Site of infection and etiology S. aureus viridans stept enterococci s epidermidis s gallolyticus other strept Non HACEK FUNGI HACEK
ACUTE
Subacute
Major PVE
H A C E K
Haemophilus aphrophilus actinobacillus actinomycetes Cardiobacterium hominis Eikenella corrodens Kingella kingae
HACEK
most common sub acute gram neg
Non bacterial thrombotic Vegetation
Aggregation of platelets and fibrin
- trauma
- defective Valves
- Changes endocardium
Stage 2 Bacteremia
organism adheres seeds begins to replicate aggregation of fibrin & platelets infections avascular Surface-- Active internal Depp-- inactive/stationary
Formation of Vegetations
pressure gradient fibrin platelet colonized fibrin platelet further deposits of thrombus Vegetations increase in size and break away
MSCRAMMS Virulence Factors
MSC- extracellular polysaccharide, lipteichoic acid, FimA
Recognize:Platelet Fibrin aggregates
Adherence: Fibronectin adhesion, clumping factor
Clinical Syndrome
Symptoms of left side heart disease signs of pulmonary= right side Fever Petechiae subungual hemorrhages Specific= Osler, janeway, roth, glomerularnephritis
Janeway Lesion
On palm and soles
macular painless
Vascular Phenomena
Immunologic Phenomena
Glomerulonephritis, flea bitten kidneys
Osley Nodes- painful, tips of hands, more subacute
Roth Spots- exudative lesions of retina
Subconjuctival petechiae-
Vascular Phenomena
NOT DUKE CRITERIA
Subungual hemorrhages
IE Diagnosis
Certainty only: micro or hist o view
Duke criteria: clin laboratory and Echo
IE Therapy and prophylaxis
no spontaneous cure
Parental Antibiotics
Bactericidal
Monitor treatment
If no response to Abx treatment
surgical removement of vegetation
Bacteremia
NOT DISEASE STATES
Transient- Not clinical (like brushing teeth)
Intermittant
Continuous
Transient
Swiftly cleared brush teeth normal childbirth endoscopy Defecation
Transient Etiology
Viridans streptococci
Virulence determines ability to colonize
Intermittant
Repeated blood cultures, monitor treatment
abscess, UTI infection
Continuous
IV catheter surgery, underline disease leak in gi or endocarditis ( bovis or galoliticus)
Common isolates
most frequent staphylococci
Gram negative
Unusual Pathogens
Bacteroides, below diaphragm
Diagnosis bacteremia
blood is sterile,differentiation
Treatment
What abx is working in the area good point of reference
Systemic Inflammatory Response Syndrome
2 or more • fever •Heart Rate •Breathing Rate •WBC
SEPSIS
Clinical Syndrome
Presence of infection & systemic manifestation
Sever Sepsis
Tissue hypoperfusion Organ dysfunction hypotension elev lactate oliguria hypotension
Septic Shock
Reduced resistance
increase in cardiac output
Multiple Organ Dysfunction
progressive organ dysfunction
acutely ill patient
Intervention required to maintain homeostasis
3 steps to tx of septic shock
- Resusitate
- Identify
- maintain organ function
