Infective Endocarditis Flashcards
What are some areas of the heart be affected by infective endocarditis besides the valves?
- Aorta
- Aneurysms
- Prothetic Devices
- Blood Vessels
Essentially anywhere in your heart that there’s foreign object or preexisting damage
Differentiate between Acute and Subacute Infective Endocarditis.
Acute:
• RAPIDLY developing fever, Arthralgias, Pleuritic pain
• Previously NORMAL heart valve infected
• HIGHLY virulent organisms (Staph. aureus)
• LOTS of NECROSIS and DESTRUCTION
Subacute: • Gradual low-grad fever • Previously DEFORMED heart valves • LESS virulent organisms (Strep. viridans) • less necrosis and destruction
Both include symptoms of night sweats, weight loss, anorexia, fatigue
What are the gram staining characteristics of the bugs that cause infective endocarditis?
ALL infectious bacteria except HACEK organisms are gram +
List the bacteria that are responsible for infective endocarditis from most to least common.
- Staphylococcus Aureus (31%)
- Steptococcus Viridans (17%)
- Enterococcus (11%)
- Coagulase neg. staph (e.g. Staph. Epidermidis) (11%)
- HACEK (2%)
- Fungi (2%)
- Culture Negative Endocarditis
What organisms are responsible for gram - infective endocarditis?
• Culture Negative?
Gram - :
• HACEK - these are all COMMENSALS in the ORAL CAVITY
Culture Negative:
• Bartonella (cat scratch fever) or Coxiella (Q fever)
What are the 3 most common organisms to cause Infective endocarditis in IV drug users?
- Staph. aureus (probably just from skin)
- Pseudomonas (carried by NEEDLE)
- Candida
What is the most common bacteria to cause Infective Endocarditis on a prosthetic valve?
• What about colon cancer?
Staph. epideridis - good at creating biofilms
Colon Cancer: Streptococcus gallolyticus (aka S. bovis)
What happens when bulky Friable lessions fall off the tricuspid or mitral valve in Infective Endocarditis?
- Abscesses in Myocardium
* Emboli can cause Septic Infarcts, Septic Joints, etc.
What are 4 major risk factors for Infective Endocarditis?
*others?
- IV Drug Use - staph. aureus
- Male Sex
- Over 60
- Poor Dentition - viridans most often
- Structural Heart Disease
- Valvular Heart Disease
- Congenital Heart Disease
- Prosthetic Heart Valve
- History of IE - had it once it will likely happen again
- Presence of IV device (Central Line)
- Chronic Hemodialysis
- HIV
What are the MOST common signs of Infective endocarditis?
• Less common but HIGHLY tested?
MOST COMMON:
• Cardiac Murmur
• Splenomegaly
• Petechiae (extremities, Palate, or CONJUNCTIVA)
• Splinter Hemorrhages - non-blanching and red/brown in the nail bed
LESS COMMON:
• Janeway Lesions
• Osler nodes
• Roth spots
What are…
• Janeway Lesion
• Osler nodes
• Roth Spots
Janeway Lesions:
• NON-tender, erythematous, Macules on the Palms and Soles
Osler nodes:
• Purple-White TENDER subcutaneous violaceous nodules mostly on the pads or fingers and toes
Roth Spots:
• Exudative, edematous Hemorrhagic Lessions on the retina with PALE centers
Between Janeway Lesions, Osler nodes, and Roth spots, which is most associated with ACUTE infective endocarditis?
• which are immune mediated? how?
Janeway Lesions - non-tender, erythmatous Macules on hands and soles
• caused by neutrophil infiltrate of minor abscesses
Immune Mediated = vascular occlusion by microthrombi leading to localized immune mediated vasculitis:
• Osler Nodes
• Roth Spots
Who should you expect Infective Endocarditis in?
• what should you do before giving antibiotics to these people?
- Patients with FEVER (WITH or WITHOUT bacteremia) and CARDIAC risk factors like IV Drug use or Recent Dental Procedure
- OBTAIN 3 POSITIVE CULTURES BEFORE giving ABX.
T or F: ALL of the following may clue you into the fact that a patient has infective endocarditis?
- Elevated Inflammatory Markers
- Anemia
- Positive Rheumatoid Factor
- Hematuria
- Proteinuria, Pyuria
What immune phenomena are seen in Infective Endocarditis?
- GLOMERULONEPHRITIS
- Osler Nodes
- Roth Spots
