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Microbiology 2 > M27 Infective Endocarditis > Flashcards

M27 Infective Endocarditis Flashcards

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1
Q

what is IE caused by

A

micro organisms settling on heart valves (bac/fungi)

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2
Q

is IE fatal

A

yes without treatment

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3
Q

how does IE come about

A 
predisposing lesion on valve 
attracts layer of platelets/fibrin 
sticky surface
bac attch 
VEGETATION 
infection develops
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4
Q

how do pathogens causing IE get into the bloodstream

A

diff routes
injury
oral cav
catheter

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5
Q

how to pathogens rapidly adhere

A

platelet fibrin deposition

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6
Q

what do some sp do

A

obtain intracellular access

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7
Q

what does embolisation or heamatogenous spread lead to

A

range of complications

  • stroke
  • meningeal infections
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8
Q

what are some clinical effects of IE

A

bacteraemia
damage to valve form vegetative growth
emboli
immune complex effects

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9
Q

what is bacteraemia diagnosis linked to

A

positive blood culture

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10
Q

how can a valve be damaged by vegetative growth

A

valve rupture

mitral/atrial

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11
Q

how do emboli effect the body

A

bits flake off and lodge into small vessels

stroke etc

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12
Q

where ca remote embolic effects be seen

A

often found on extremities or mucous mems

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13
Q

what is palatal petechiae assc with

A

IE
Leukemia
STD
Viral infection - infectious mononucleosis

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14
Q

what are th two sources of bacteriamia

A

spontaneous and induced

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15
Q

what is the spontaneous source of bacteriaemai

A

oral flora

gut flora

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16
Q

what is induced cause of bacterimia

A

gum margin manipulation - extraction

IVDU

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17
Q

what are the types of organisms assc with IE

A 
staphylococci -25%
streptococci - 50-70%
enterococci - 10%
Candida 
culture negative
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18
Q

what are the specifics of the staphylococci involved in IE

A

coagulase - ve - epidermis

causing rapid valave degeneration

19
Q

does candida and colifrms usually seen to cause IE

A

uncommon

20
Q

what are the assc culture negative bacteria in iE

A

HACEK
haemophilia
aggregatibacter
eikenella

21
Q

what si he percentage of IE cases oral origin

A

20%

22
Q

what are some key concepts when thinking of virulence in IE

A 
entry/circ blood
adherence - platelet/fibrin
biofilm form
host cell invasion
aggressive damage
sec toxins
intracellular persistence
23
Q

what re some surface adhesins assc with streptococcus gordonii

A

PadA
Hsa

fro platelet adhesion and aggregation

24
Q

what are pt most at risk of IE

A 
individuals with damage heart valves 
history
IVDU 
prothetic valves 
cardiac surgery
25
Q

what are some symptoms of subacute

A 
malaise 
headache
night sweats
rigors
heart murmur 
embolic manifestations
immune complex disease
26
Q

what are some symptoms of a high index of suspicion

A 
fever and unknown cause
murmur
heart lesion
bacteriamia 
malaise
positive blood culture
27
Q

what are some other ways of identifying IE

A

echocardiography
C relative protein (marker of inflam)
serology

28
Q

what is the principle of treatment

A

empiric therapy

  • tidal
  • large dose
  • long time
29
Q

when is Ab started for IE

A

after blood cultures

for acute infection s aureus targeted

30
Q

what bac is targeted particularly with beta lactam

A

gm +ve cocci

31
Q

what are the Ab used in therapy

A

beta lactase
gentamicin
vancomycin
rifampicin

32
Q

what are some beta lactams

A

amoxicillin
benzyl penicillin
flucloaxacillin

33
Q

what does gentamicin do

A

coliforms and synergy with beta lactamsfor strept

34
Q

what does vancomycin do

A

ag MRSA/ s epidermidis

less active used with something

35
Q

what does rifampicin do

A

penetrates well and synergy with vancomycin not alone or get resist

36
Q

what is used for native valve acute/sever

A

flucloxacillin

37
Q

what is used for native valve subacute

A

amoxicillin and gentamicin

38
Q

what is used for prosthetic valve

A

vancomycin
gentamicin
rifampicin

39
Q

what is sued for MRSA

A

vancomycin
gentamicin
rifmpiicin

40
Q

is suspected s aureus causing what is sued

A

high dose flucloxacillin

41
Q

is suspected enterococci is the cause use

A

high does amoxicillin and gentamicin

42
Q

is suspected Viridans Group Streptococci

A

high dos penicillin

4 weeks

43
Q

when is prophylactic prescribing considered

A

medical status
immunological status
preceding infection at site
invasiveness of procedure

Microbiology 2 (23 decks)

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