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Microbiology > Infective endocarditis > Flashcards

Infective endocarditis Flashcards

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1
Q

Define infective endocarditis

A

An infection of the innermost layer of the heart, usually the valves

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2
Q

How many of the Dukes criteria are required for a diagnosis of infective endocarditis?

A 
2 major criteria
OR
1 major and 3 minor criteria
OR 
5 minor criteria
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3
Q

What are the 3 major criteria?

A
  • Persistent bacteraemia (>2 +ve blood cultures)
  • Vegetations/new regurge seen on echo
  • +ve serology for bartonella, coxiella or brucella
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4
Q

What are the 6 minor criteria?

A
  • Predisposing risk factors eg murmur, IVDU
  • Fever >38C or high CRP
  • Evidence of immune complex formation: splinter haemorrhages, haematuria
  • Vascular phenomena: major arterial emboli - stroke, PE
  • Positive echo findings but not meeting major criteria
  • Positive blood culture that does not meet major criteria
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5
Q

How does infective endocarditis often present (in a non-acute presentation)?

A 
Symptoms v non-specific: -
Fever (usually PUO)
Anorexia
Weight loss
Malaise
Fatigue
Rigors
Night sweats
Weakness
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6
Q

What are 3 acute symptoms of infective endocarditis?

A

SOB
Chest tightness
Embolic complications

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7
Q

List 8 important factors to look for in PMH/SHx of a pt with suspected infective endocarditis

A 
Recent dental work
Rheumatic fever
Congenital heart disease
Valve replacement
Long term lines
Previous bacteraemias (S. aureus, enterococcus)
GI/bowel issues
IVDU
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8
Q

What might be heard on auscultation of a pt with infective endocarditis?

A

New and changing heart murmurs

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9
Q

List 7 subacute signs that may be detected on examination of a pt with infective endocarditis

A 
Clubbing
Splinter haemorrhages
Osler's nodes
Janeway lesions
Roth spots (retinal hemorrhages with pale centers)
Splenomegaly
Haematuria
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10
Q

A mnemonic for the main signs and symptoms of infective endocarditis is FROM JANE, what does this stand for?

A 
Fever
Roth's spots
Osler's nodes
Murmur
Janeway lesions
Anemia
Nail hemorrhage
Emboli
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11
Q

Which investigations are appropriate when diagnosing infective endocarditis?

A 
Urinalysis
FBC (↓Hb)
U&E
CRP (to monitor therapy)
ESR
3x blood cultures w/o Abx
Serology (if cultures -ve)
CXR
Echo
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12
Q

Which pathogen is likely to be responsible for subacute bacterial endocarditis (SBE)?

A

Low virulence strep (often Strep viridians)

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13
Q

How does subacute bacterial endocarditis compare to more acute forms of infective endocarditis?

A

Mild-moderate illness progressing over weeks-months

↓propensity to haematogenously seed extracardiac sites

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14
Q

Describe the onset of acute bacterial endocarditis

A

Fulminant disease emerges in days - weeks

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15
Q

Which pathogen is most likely to be responsible for acute bacterial endocarditis?

A

Staph. aureus (frequently “metastatic” infection from elsewhere in body.

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16
Q

Which type of staph is most likely to be responsible for prosthetic valve endocarditis?

A

Coagulase negative staphylococci

17
Q

What is the most common cause of -ve cultures in infective endocarditis?

A

Cultures taken after antibiotic therapy started

18
Q

Other than strep and staph, which other pathogens can cause infective endocarditis?

A
  • Aspergillus
  • Brucella
  • Coxiella
  • Chlamydia
  • Mycoplasma
  • The HACEK of fastidious gram -ves (Haemophilus parainfluenzae, Aggregatibacter/Actinobacillus, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae)
19
Q

What is the empirical treatment for acute infective endocarditis of a native valve?

A

Flucloxacillin

20
Q

What is the empirical treatment for indolent infective endocarditis of a native valve?

A

Penicillin AND gentamicin

21
Q

What is the empirical treatment for infective endocarditis of a prosthetic valve?

A

Vancomycin AND gentamicin

22
Q

What is the treatment for confirmed Strep viridans endocarditis?

A

Benzylpenicillin AND gentamicin

23
Q

What is the treatment for confirmed MSSA endocarditis?

A

Flucloxacillin for 4 weeks

24
Q

What is the treatment for confirmed MRSA endocarditis?

A

Vancomycin AND Gentamicin/Rifampicin/Rucidin

25
Q

What is the treatment for confirmed enterococcal endocarditis?

A

Ampicillin AND gentamicin

26
Q

Which valves are most commonly involved in infective endocarditis?

A

Aortic and mitral

27
Q

Which valve is affected in 50% of IVDUs aged 20-24?

A

Tricuspid

28
Q

What comorbidity makes an IVDU more susceptible to infective endocarditis?

A

HIV +ve

29
Q

Which organism most commonly causes infective endocarditis in IVDUs?

A

S. aureus/polymicrobial

30
Q

List 7 indications for surgical intervention in infective endocarditis

A 
>1 serious systemic embolus / high risk
Uncontrolled infection
Significant valve dysfunction
Lack of response to antibiotics
Local supurative complication eg perivalvular abscess
Congestive heart failure
Prosthetic valve endocarditis

Microbiology (27 decks)

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