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Bloc G - Infection > May8 M1-Endovascular infection > Flashcards

May8 M1-Endovascular infection Flashcards

1
Q

3 types of endovascular infections

A
  • direct infection of blood and its components (blood cells, RBCs, WBCs)
  • infection of endovascular device (prosthetic heart valve, PPM, ICD, CVL, LVAD, etc.)
  • direct infection of vasculature and structures
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2
Q

acute vs subacute infective endocarditis (IE)

A
  • acute: abrupt toxic course lasting days to weeks

- subacute: indolent protracted (prolonged) course, systemic symptoms, many weeks

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3
Q

characteristic of metal or foreign or plastic objects related to infections

A
  • get biofilm formed on them

- CoNS** very common biofilm forming group of organisms

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4
Q

In IE, what can get infected

A
  • native valve
  • prosthetic valve
  • endovascular device utilization (IV access, CVAD much more than peripheral IV, implanted devices, surgical material)
  • IVDU (IV drug user)
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5
Q

steps for the formation of a nonbacterial thrombotic endocarditis (first step of IE pathogenesis)

A
  • trauma or debris hits tissue (valve for ex) and cell surface markers are exposed
  • platelets and fibrin deposit on valve
  • get NBTE (initial structure)
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6
Q

how does a NBTE get infected

A
  • transient bacteremia occurs often because our flora (colonizers) express virulence factors and can enter blood
  • when body can’t clear it, may go and adhere to the NBTE (initial non sterile vegetation)
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7
Q

what happens when bacteria adhere to NBTE

A
  • microscopic vegetation
  • then macroscopic vegetation
  • mature vegetation
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8
Q

(imp?) most common sites of IE

A 
#1 mitral valve
#2 aortic valve
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9
Q

virulence factors bacteria use to reach NBTE

A
  • dextran (strep spp: S. mutans of caries, S viridans) for adherence to platelet-fibrin matrix
  • fibronectin (Staph aureus) to bind normal endothelium and make it apoptose
  • bacteria-platelet aggregates using surface Rs and surface Ags (staph spp and strep spp) to use platelets as camouflage (but platelet not infected)
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10
Q

what do prophylactic Abx do in IE (note: given rarely nowadays)

A

prevent IE by

  • reducing expression of adhesion virulent factors
  • direct cell killing
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11
Q

3 categories of native valve infections

A
  • community acquired
  • nosocomial
  • IVDU
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12
Q

(imp?) most common pathogen in native valve IE no matter the category (comm, hosp or IVDU) and special note about comm acquired

A
  • staph aureus (aggressive infections)

* comm acquired = staph aureus AND strep viridans

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13
Q

3 categories of prosthetic valve IE

A
  • early post surgical (<2mo)
  • intermediate post surgical (2-12 mo)
  • late post-surgical (>12 mo)
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14
Q

(imp?) most common pathogen in prosthetic valve early post surgical IE

A

CoNS like staph epi (indolent infection)

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15
Q

(imp?) most common pathogen in prosthetic valve intermediate post surgical IE

A

CoNS like staph epi (indolent infection)

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16
Q

(EXAM) most common pathogen in prosthetic valve in late post surgical IE

A 
#1 staph aureus/strep viridans (so back like native valve comm acquired IE)
#2 CoNS (coag negative staph)
17
Q

4 typical symptoms of IE (non-specific but a 5th symptom will help)

A
  • fever
  • chills
  • weakness
  • dyspnea
18
Q

(imp?) important physical exam sign that can be very indicative of IE even though it is uncommon

A

CHANGED murmur or NEW murmur on auscultation

19
Q

other physical exam signs of IE

A
  • skin manifestations (Janeway, Osler, etc.)
  • clubbing
  • splenomegaly
  • septic complications
  • etc
20
Q

(imp?) main diagnostic test of IE

A

blood cultures (2 cultures)

21
Q

(important) two types of echocardiograms (US) to know about for IE investigation AND WHAT DO YOU LOOK FOR

A
  • transthoracic echo (TTE) = over chest
  • transesophageal echo (TEE) = more invasive but more sensitive. TEE immediately if prosthetic valve
  • looking for vegetations moving with flow and valves*
22
Q

TTE and TEE in IE are better to investigate what part of the heart

A

right heart

23
Q

T-F: you can rule out IE with a negative TTE or TEE

A

False. can’t rule out endocarditis with negative US

24
Q

major criteria for IE dx (each point is a criteria)

A
  • positive blood culture for 2 sets with atypical org, many sets with many org or 1 set with coxiella
  • positive echo or new/changed murmur
25
Q

minor criteria for IE dx

A
  • predisposing heart condition or IVDU
  • fever over 38
  • vascular phenomenon (like petechiae and Janeway lesions on physical)
  • immunologic phenomenon (like Osler nodes and Roth spots)
  • microbiological evidence that is not major
26
Q

diagnosis of definite IE definition

A
  • pathologic def: culture or histo or vegetation embolized or intracardiac abscess show microorg
  • clinical def: 2 major criteria OR 1 major+3 minor OR 5 minor.
27
Q

diagnosis of possible IE definition

A

1 major+1 minor criteria OR 3 minor

28
Q

heart pathology in IE

A
  • valve vegetations and destruction
  • heart tissue infection
  • rupture of chordae tendineae, intraventricular septum, papillary muscle
29
Q

extra cardiac pathology in IE

A
  • embolic phenomenon to kidneys, spleen, coronaries, brain give Abx to reduce this risk
  • immune phenomenon (immune complex deposition)
30
Q

kidney pathology in IE

A
  • abnormal architecture
  • abscess
  • infarction
  • GN
31
Q

vascular pathology in IE

A

if strep viridans infection (comm acquired native valve IE or late post surgical prosthetic valve IE), mycotic aneurysm (not fungal)

32
Q

brain pathology in IE

A
  • cerebral emboli
  • ischemic and eventually hemorrhagic stroke
  • brain abscess
  • edema
  • meningitis
33
Q

Ostringe (or Osler) triad for meningitis in IE

A

Strep pneumo infection, bacteremia and meningitis (+ IE obviously)

34
Q

spleen patho in IE

A
  • splenomegaly
  • infarction
  • abscess
  • rupture
35
Q

lung patho in IE

A
  • septic emboli with infarction
  • acute pneumonia
  • pleural effusion
  • empyema
36
Q

skin patho in IE

A
  • petechiae
  • Osler nodes (IMMUNE mediated). immune complex deposition in blood vessels
  • Janeway lesions (VASCULAR event): SEPTIC emboli
37
Q

eye patho in IE

A
  • conjunctival petechiae (under eyelid)
  • conjunctival hemorrhage
  • flare hemorrhage (in white of the eye)
  • roth spots on retina = lymphocytes infiltration

Bloc G - Infection (39 decks)

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