Infective Endocarditis

Question 1

Prototypic lesions

Answer 1

Vegetation’s [ mass of platelets, fibrin, microcolonies of microorganisms, scant inflammatory cells)

Question 2

Location

Answer 2

Heart vlves, either naive or prosthetics

Olther: low pressure side of ventricular septum at site of defect, mural endocardium damage aberrant jets of blood, or foreign bodies, intracranial devices

Question 3

Analogous process involving AV shunts, atrioarterial shunts (PDA]
Coarctation of the aorta

Answer 3

Infective endarteriris

Question 4

Hectic febrile illness, rapid damage to cardiac structures, hematogenous seeding of extracardiac sites, progress to death within weeks if untreated)

Answer 4

Acute endocarditis

Question 5

Indolent course, slow structural cardiac damage only if any, rarely causes metastatic infection, gradually progressive unless complicated by major emboli event

Answer 5

Subacute endocarditis

Question 6

Predisposition

Answer 6

RHD, developing countries, CHD, illicit drug use, degenerative valve disease, intracardiac devices

Question 7

Community acquired native valve endocarditis (NVE) portal of entry

Answer 7

Oral cavity: viridans streptococci
Skin:staphylococci
Upper respiratory tract: HAcEK (haemophilia, actinobacillus, cardiobacterium, eikenella, kingella)

GIT: streptococcus gallolyticus (s. Bovis) associated with polyps and colonic Tumors)

Question 8

Health care associated NVE

Answer 8

Common: staphylococcus aureus CoNS (coagulase negative staphylococcus l enterococci
NosocomiaL: 55%
Community onset: 45% past 90 days

Question 9

Prosthetic valves endocarditis [PVE)

Answer 9

If within 2 months: intraoperative contamination of prosthesis or Bacteremia postoperative complications

Organisms: s. Aureus, facultative gram neg, diptheriods, fungi

If more than 2months- 12 months: cons
If more than 12months: Like community acquired NVE

Question 10

68-85% of ConS strains in PVE are methecillin resistant regardless of time onset after surgery

Answer 10

Methecillin resistant

Question 11

CIED: cardiovascular implantable electronic devices-associated endocarditis

Answer 11

Associated with aortic or mitral valve infection
Rule of 3rds
1/3 with in 3 months
1/3 at 4-12 months
1/3 beyond 1 year
Most commonly MRSA cons

Question 12

Endocarditis among injection drug users

Answer 12

Right sided: usual S. aureus (many are MRSA) especially tricuspid valve

Left sided; pseudomonas, Candida species, sporadic cases ( bacillus, lactobacillus, corynaebacterium

Polymicrobial endocarditis: common among injection myocarditis

Question 13

Causes indolent culture negative afebrile form of endocarditis

Answer 13

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