Infective endocarditis Flashcards
Definition
Infection of the innermost layer of heart, usually the valves
History of IE
Fever - often PUO
Non-specific symptoms - anorexia, weight-loss, malaise, fatigue, rigors and night sweats, weakness
Acute symptoms - SOB, chest tightness, embolic complications
Dental History - important infection route
PMH - RhF, congenital heart disease, cardiac Sx, valve replacement, long term lines, bacteraemias (S aureus, enterococcus), GI?Bowel issues
IVDU Hx - important route - often right sided
Examination findings
Heart murmurs that often change
Subacute - Clubbing, splinter haemorrhages, Osler’s nodes, Janeway lesions, Roth spots, Splenomegaly, Haematuria
Investigations
Urinalysis FBC - lowered Hb U&E CRP - monitor therapy ESR 3x blood cultures w/o Abx Serology (if culture -ve) CXR Echo
Classification criteria for IE
Dukes Criteria
Diagnosis - 2 major or 1 major 3 minor or 5 minor
Major criteria for IE
Persistent Bacteraemia >2 +ve blood cultures
Echo findings - vegetations
+ve serology for bartonella, coxiella, brucella
Minor criteria for IE
Predisposing RF - murmur, IVDU etc
Fever >38C or high CRP
Evidence of immune-complex formation: splinter haemorrhages, haematuria
Vascular phenomena - major arterial emboli - stroke, PE
+ve echo that is not major
+ve blood culture that is not major
Low virulence
Mild-moderate illness progressing over weeks-months
Lowered propensity haematogenously to seed cardiac sites
Subacute bacterial endocarditis
Often S viridans
Fulminant illness days-weeks
Frequently metastatic infection
Acute bacterial endocarditis
S aureus
Coag -ve most common cause of prosthetic valve disease
Culture -ve due to being taken post Abx
ASpergillus Brucella Coxiella Chalmydia Mycoplasma HACEK: - Haemophilus parainfluenzae - Aggregatibacter/Actinobacillus - Cardiobacterium hominis, - Eikenella corrodens - Kingella kingae
Empirical Treatment
Empirical: Prosthetic valve - Vanc + Gent + Rifampicin
Native Valve - Acute - flucloxacillin
Indolent - Penicillin + Gentamicin
Treatment for Strep viridans
Benzylpenicillin + Gentamicin
Treatment for MSSA endocarditis
Flucloxacillin for 4 weeks
Treatment for MRSA endocarditis
Vancomycin + Gentamicin/RIfampicin/Fucidin
Treatment for enterococcal endocarditis
Ampicillin + Gentamicin
