INFECTIVE ENDOCARDITIS | from PART 1 (AB) Flashcards
What is infective endocarditis (IE) often a complication of?
Congenital or acquired heart diseases
In the absence of congenital heart disease (CHD)
what is a common risk factor for IE?
What percentage of pediatric IE cases occur without structural heart disease?
8% to 10%
What factors are commonly associated with IE in adults and adolescents?
IV drug use and degenerative heart disease
What are common etiologic agents for native valve endocarditis after dental procedures?
Viridans group Streptococci
Which pathogen can be diagnostic of IE if found in even one culture?
Coxiella burnetii
Which bacteria are associated with prosthetic valve endocarditis?
Staphylococcus epidermidis
What initial process usually triggers infective endocarditis?
Turbulent blood flow
What cardiac conditions can lead to endothelial trauma predisposing to IE?
PDA
What forms on damaged endothelium that serves as a nidus for bacterial growth?
Non-bacterial thrombotic endocarditis (NBTE) and biofilm
Why is good oral hygiene important for cardiac patients?
Reduces risk of transient bacteremia
At what age should oral hygiene begin?
6 months
What is the minimum recommended toothbrushing frequency for adults?
Twice a day
What cardiac history is relevant in a patient with suspected IE?
CHD
What are common preceding procedures linked to IE?
Dental
What are the classic constitutional symptoms of IE?
Fever
What are some embolic phenomena seen in IE?
Roth spots
Where are Osler nodes located?
Palmar or plantar aspects of extremities
How do Janeway lesions present?
Erythematous papular rash
What new physical exam finding may suggest IE?
New or changing heart murmur
What is a common sign of IE affecting the spleen?
Splenomegaly
What types of metastatic infections may complicate IE?
Meningitis
What are common laboratory findings in IE?
Positive blood cultures
What are classic immune-related lab findings in IE?
Rheumatoid factor
What are classic findings on echocardiogram in IE?
Vegetations
What are the major Duke criteria for diagnosing IE?
Positive blood cultures and evidence of endocardial involvement
How many major and minor criteria are needed for a definitive IE diagnosis?
2 major OR 1 major + 3 minor OR 5 minor
What findings are required for a pathologic diagnosis of IE?
Microorganisms in vegetation
How is “possible” infective endocarditis defined?
1 major + 1 minor OR 3 minor criteria
What are reasons to reject an IE diagnosis?
Alternative diagnosis
What bacteria must be found in 2 separate cultures to meet a major Duke criterion?
Viridans streptococci
What is the minimum time interval for blood cultures in persistent bacteremia for IE?
≥12 hours apart OR ≥1 hour apart for 3 out of 4 cultures
What echocardiographic findings meet major Duke criteria?
Oscillating mass
What minor Duke criteria relate to the patient’s background?
Predisposing heart condition or IV drug use
What minor Duke criteria relate to clinical findings?
Fever >38°C
What lab finding meets a minor Duke criterion?
Positive blood culture not meeting major criteria
What is the mortality rate for infective endocarditis?
20% to 25%
What are common complications of IE?
Heart failure
What is the first-line antibiotic treatment for native valve endocarditis?
Penicillin G Sodium or Ceftriaxone PLUS Gentamicin
What antibiotic can be used if Pen G or Ceftriaxone is not tolerated in native valve endocarditis?
Vancomycin
What is the first-line treatment for staphylococcal IE without prosthetic valve?
Nafcillin or Oxacillin PLUS Gentamicin
What if the patient is allergic to penicillin for staphylococcal IE?
Vancomycin
What echocardiographic findings in IE require surgery?
Persistent vegetation
What valvular dysfunction requires surgery in IE?
Acute aortic or mitral insufficiency with heart failure
What perivalvular complications indicate need for surgery in IE?
Abscess
Which cardiac conditions have highest risk for adverse IE outcomes?
Prosthetic valves
In what situation is dental prophylaxis for IE no longer needed after 6 months?
Completely repaired CHD with no residual defect
