L 91 Endocarditis Flashcards
What are some common risk factors for IE?
Over 60 Male IV drugs Poor dentition or dental infection
What are the stages of infective endocarditis?
1) Nonbacterial thrombotic vegetation: this is any defect of the heart the creates an opportunity for thrombotic events or bacteria to create an infection, creates a fibrin-platelet deposition 2) Bacteremia: need an organism capable of adhering to damaged area and replicating and growing the size of the vegetation until it eventually breaks off
Virulence factors allowing for adhesion of bacteria to vegetations in the heart
Extracellular polysaccharides–Dextran: viridans streptococci Lipoteichoic acid: g(+) bacteria FimA: fibrin binding protein of strep Fibronectin binding protein: E. faecalis, S. mutans, S sanguis, S, aureus Recognizing fibronectin: protein present on injured endocardium Clumping factor: S. aureus
Findings of IE that are specific and nonspecific
Nonspecific: petechiae, subungual hemorrhages Specific: osler nodes, janeway lesions, roth spots, glomerulonephritis
What are the lesions pictured and what do they indicate?
These are macular, painless, red lesions on the palms and the soles. Called Janeway lesions. Sign of protracted bacteremia.
Describe manifestations of acute endocarditis
Acute onset
Fever always present
Complications appear within 1 week: dyspnea, fatigue, CNS SX
Cause: possibly S. aureus
Describe subacute endocarditis
Fever possible, but low grade
Subtle and non-specific Sx: anorexia and weight loss, flu-like, abd distress
6 weeks for diagnosis
Causes: viridan, HACEK, oral flora, S. sanguis
What are the most common isolates for bacteremia?
Staph and g(-) bacilli
What is SIRS?
Systemic Inflammatory Response Syndrome
Comes from a dyregulated inflammatory response leading to increased temperature, increased heart ratem increased resp rate, increase WBC (some can be too low as well)
Define sepsis
SIRS + documented infection
Severe sepsis includes organ dysfunction
Septic shock includes hypotension despite resuscitation
