Infective Endocarditis Flashcards
What layer of heart is affected in endocarditis?
Endocardium
What is the prevalence of infective carditis?
3-10/100,000
What is the ratio of male to female?
2;1
What are the signs of infective endocarditis?
- Splinter Haemorrhages
- Vasculitic rash
- Roth spots
- Oslers Nodes
- Janeway lesions
- Nephritis
What is the pattern of vasculitic rash?
- Diffuse
- Non-Blanching
- Petechial
- Purpuric
What are roth spots?
-Retinal haemorrhages
-White/pale centre
=Coagulated fibrosis
What are oslers nodes?
-Deep, red spots
-Painful
-raised
-Finger pulps
(palm/soles)
What are Janeway lesions?
- Flat, macular
- Echymotic (escape of blood into the tissues from ruptured blood vessels)
- Palms/soles
- Nontender
- Pathognomic (dead giveaway)
Where may the signs be absent?
- elderly
- After antibiotic treatment
- Immunocompromised
- IE Involving less virulent/atypical organism
What are the investigations for IE?
- Markers of infection/inflammation
- -FBC
- -CRP
- -ESR
- U+E`s
- Nephritis
- infection
- sepsis
What will be seen on an ECG?
-Conduction Delay
What will be seen on CXR?
- Heart failure
- Pulmonary abscesses
What will be seen on an echocardiogram?
-Transthoracic
then Trans oesophageal
What are the causes of IE with -ve blood cultures?
- Prior antibiotics reaction
- fastidious organisms
- Intracelluar bacteria
What 3 bacteria cause 85% of all IE?
- Streptococci
- Enterococci
- Staphylococcus
Name the different strep infections?
-Oral (viridans) streptococci
-S.Milleri S.anginosus grp
Group D streptococci
Streptococcus bovis/equinus
What are the different types of enterococci?
E.Fecalis
E.Faecium
E.durans
What are the different types of Staphylcoccus?
S.Aureus
(health care associated)
-Coagulase negative staph (CNS) S.epidermidis
What are the two reasons why blood cultures would be negative?
- Prior antibiotic treatment
- fastidious organisms
- Intracelluar bacteria
Name the fastidious organisms that can cause IE?
- Nutritionally variant streptococci
- Fastidious Gram -VE bacilli _HACEK grp (feckin loads)
- Brucella
- Fungi
Name the intracelluar bacteria that can cause -ve blood cultures?
(5% of all IE)
- Coxiella burnetii
- Bartonella
- Chlamydia
What is the Major criteria using the modified Duke Criteria?
- Identify organism
- Providing evidence of infection anywhere in the heart
What is the minor criteria using the modified duke criteria?
-Focus on the endocarditis complex of clinical findings
What is the modified Duke criteria for blood cultures positive for IE?
- Typical organisms consistent with IE from 2 seperate blood cultures
- Organisms consistent with IE from persistently positive blood cultures
- Single +ve blood culture for coxiella burnetti
What is the evidence of endocardial involvement using the modified Duke Criteria?
- Positive echocardiogram
- New valvular regurgitation/murmur
What is the minor criteria for the modified duke scale for IE?
- Predisposition
- Fever
- vascular phenomena
- Immulnologic phenomena
- Microbiological evidence
What is the main antibiotic group to choose when treating IE?
-Aminoglycosides synergies with cell wall inhibitor (beta lactams, glycopeptides)
What do you treat native valves infected with?
IV Gentamycin
IV amoxycilllin
Potentially Vancomycin
How do you treat native valves when sepsis also happens?
- Gentamicin
- IV vancomycin
How do you treat IE in prosthetic valves?
- Gentamicin
- Vancomycin
- Rifampicin
what are the side effects of gentamicin?
- nephrotoxic
- Ototoxic
When can Fungi cause IE?
-PVE
_Intra venous drug abuser
-Immunocompromised
What are the two likely causes of fungal IE?
- Candida
- Aspergillus
What can be the complications of IE surgery?
- heart failure
- Fistula formation
- Leaflet perforation
- Uncontrolled infection
- Abcess formation
- atrioventricular heart block
- Embolism
- Prosthetic valve dysfunction
What are the cardiac conditions that are at the highest risk of IE?
- Acquired valvular heart disease
- valve replacement
- Structural congenital heart disease
- Hypertrophic cardiomyopathy
- Previous IE
