Infective Endocarditis Quiz
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Questions and Answers

Which microorganism is the most common cause of subacute infective endocarditis following dental procedures?

  • Staphylococcus aureus
  • Staphylococcus epidermidis
  • Streptococcus viridans (correct)
  • Enterococcus faecalis

Which of the following is NOT a recognized risk factor for developing infective endocarditis?

  • Hypertension (correct)
  • Congenital heart disease
  • Rheumatic heart disease
  • IV drug use

What primarily causes bacteremia leading to infective endocarditis?

  • Airborne infections
  • Foodborne illnesses
  • Non-sterile injections (correct)
  • Zoonotic diseases

Staphylococcus aureus is primarily associated with which type of infective endocarditis?

<p>Acute endocarditis (B)</p> Signup and view all the answers

Which factor is associated with a more severe course of infective endocarditis when untreated?

<p>Staphylococcus aureus (D)</p> Signup and view all the answers

What are the major criteria for rheumatic fever?

<p>Carditis (B)</p> Signup and view all the answers

Which of the following is a symptom associated with Sydenham's chorea?

<p>Irregular, purposeless movements (D)</p> Signup and view all the answers

What is the most serious effect of rheumatic fever on the heart?

<p>Rheumatic myocarditis (C)</p> Signup and view all the answers

Which of the following is NOT a minor criterion for diagnosing rheumatic fever?

<p>Carditis (A)</p> Signup and view all the answers

What is a common cause of fibrinous (serofibrinous) pericarditis?

<p>Rheumatic fever (D)</p> Signup and view all the answers

Which of the following complications can arise from repeated attacks of rheumatic fever?

<p>Heart failure (D)</p> Signup and view all the answers

What is a potential cause of death related to rheumatic fever?

<p>Pneumonia (C)</p> Signup and view all the answers

Which type of pericarditis is often associated with bacterial infections?

<p>Suppurative pericarditis (B)</p> Signup and view all the answers

What is a common characteristic of Enterococcus faecalis in relation to infective endocarditis?

<p>It is part of the normal flora of the human colon. (A)</p> Signup and view all the answers

Which pathogen is most closely associated with colorectal cancer in elderly patients?

<p>Streptococcus gallolyticus (B)</p> Signup and view all the answers

What initiates the pathological process leading to the formation of vegetations in infective endocarditis?

<p>Valvular endothelial damage. (D)</p> Signup and view all the answers

Which method is considered the standard test for diagnosing infective endocarditis?

<p>Blood cultures (D)</p> Signup and view all the answers

In what specific circumstance are antibiotics administered as prophylaxis for infective endocarditis?

<p>Patients with preexisting heart conditions during dental procedures. (A)</p> Signup and view all the answers

What clinical feature is NOT typically associated with infective endocarditis?

<p>Hypertension (C)</p> Signup and view all the answers

What can happen if infective endocarditis is left untreated?

<p>It can be fatal within a few weeks. (A)</p> Signup and view all the answers

Which of the following is considered less common as a pathogen in subacute infective endocarditis but may relate to poor dental hygiene?

<p>HACEK organisms (A)</p> Signup and view all the answers

What is the primary causative organism of the disease described?

<p>Viridans group of α-hemolytic streptococci (D)</p> Signup and view all the answers

What potential complications can arise from vegetations fragmenting?

<p>Coronary artery embolism (D)</p> Signup and view all the answers

Which of the following is NOT a characteristic of vegetations observed in the disease?

<p>Translucent and smooth (B)</p> Signup and view all the answers

What is the termination condition typically associated with the disease?

<p>Congestive heart failure (C)</p> Signup and view all the answers

From which locations can organisms that cause the disease enter the bloodstream?

<p>Dental sepsis and throat infections (C)</p> Signup and view all the answers

What type of degeneration is observed in the myocardium due to toxaemia?

<p>Cloudy swelling and fatty degeneration (C)</p> Signup and view all the answers

Which of the following systemic symptoms may occur due to toxic lesions?

<p>Clubbing of the fingers (A)</p> Signup and view all the answers

What can result from the organization of vegetations when treated with antibiotics?

<p>Fibrosis and calcification (B)</p> Signup and view all the answers

What is the correct sequence of blood flow through the heart chambers?

<p>Right atrium → Right ventricle → Pulmonary arteries → Lungs → Pulmonary veins → Left atrium → Left ventricle → Aorta (B)</p> Signup and view all the answers

Which age group is most commonly affected by rheumatic fever (RF)?

<p>Children and young adults aged 5-15 years (C)</p> Signup and view all the answers

What factors increase the likelihood of developing rheumatic fever in developing countries?

<p>Damp weather and low socioeconomic conditions (A)</p> Signup and view all the answers

What is the main cause of rheumatic fever following infection?

<p>Group A beta-hemolytic streptococci (B)</p> Signup and view all the answers

What is a consequence of the autoantibodies produced in rheumatic fever?

<p>Damage to human tissues due to cross-reactivity (A)</p> Signup and view all the answers

How long is the latent period after streptococcal infection before rheumatic fever can develop?

<p>2-4 weeks (B)</p> Signup and view all the answers

What is the impact of long-term penicillin administration regarding rheumatic fever?

<p>It prevents further attacks of streptococcal pharyngitis and RF (C)</p> Signup and view all the answers

Which of the following is NOT a characteristic of rheumatic fever?

<p>It is primarily caused by viral infection (D)</p> Signup and view all the answers

What is a common pathological feature of acute infective endocarditis?

<p>Suppurative inflammation with ulceration (C)</p> Signup and view all the answers

Which organs or structures can be involved with adherent mediastino-pericarditis?

<p>Parietal pericardium and adjacent mediastinal structures (C)</p> Signup and view all the answers

Which of the following organisms is a common causative agent of acute infective endocarditis?

<p>Streptococcus haemolyticus (A)</p> Signup and view all the answers

What complication may result from the organization of a pericardial lesion?

<p>Constrictive pericarditis (D)</p> Signup and view all the answers

Which of the following best describes the vegetations associated with acute infective endocarditis?

<p>Friable and yellow in color (D)</p> Signup and view all the answers

What is one of the types of non-infective endocarditis?

<p>Non-infective thrombotic endocarditis (B)</p> Signup and view all the answers

Which structure can be constricted due to complications from pericardial lesions?

<p>Orifice of the venae cava (D)</p> Signup and view all the answers

What causes the bacteria to reach the heart in cases of acute infective endocarditis?

<p>Septic focus in the body (C)</p> Signup and view all the answers

Flashcards

Infective Endocarditis (IE)

Infectious inflammation of the heart valves, a result of bacteremia.

Causative Microorganisms (IE)

Bacteria like Streptococcus viridans, Staphylococcus aureus, and Staphylococcus epidermidis can cause IE.

Streptococcus viridans

Common bacteria in the mouth & throat. Often linked with subacute IE, especially after dental procedures.

Staphylococcus aureus

Often linked with acute IE primarily in compromised or unhealthy heart valves.

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Risk Factors (IE)

Factors like rheumatic heart disease, IV drug use, prosthetic heart valves, and congenital heart disease increase the likelihood of IE.

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Subacute Infective Endocarditis

A less severe form of infective endocarditis, often caused by Streptococcus viridans or similar bacteria, typically developing gradually and impacting patients with pre-existing heart valve damage or undergoing dental work.

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Acute Infective Endocarditis

A more rapid and severe form of IE, often caused by Staphylococcus aureus, impacting individuals with already compromised or unhealthy heart valves.

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Bacteremia

The presence of bacteria in the bloodstream.

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Vegetations

Fibrin and platelet deposits on heart valves, caused by bacteria and further worsening of the inflammatory process.

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Blood Cultures

The primary diagnostic test for IE, involves culturing blood samples to identify the infecting bacteria.

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HACEK bacteria

A group of fastidious gram-negative bacteria commonly associated with infective endocarditis, particularly in IV drug users or those with poor dental hygiene.

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Prosthetic Valve IE

Infective endocarditis affecting prosthetic artificial heart valves, often caused by Staphylococcus epidermidis.

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Infective Endocarditis (IE) clinical features

Constitutional symptoms such as fatigue, fever or chills, malaise, signs of pathological cardiac changes such as new or changed heart murmur or heart failure and possible manifestations of subsequent damage to other organs as in the case of glomerulonephritis, septic, embolic stroke.

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Heart Chambers

The heart is divided into four chambers: two atria (top) and two ventricles (bottom).

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Blood Flow Pathway

Blood travels through the heart in a specific route: systemic veins to the right, through the lungs, and then to the left side for systemic circulation.

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Rheumatic Fever

Autoimmune disease affecting connective tissue following strep throat.

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Rheumatic Fever Cause

Group A Streptococcus bacteria trigger an autoimmune response in a susceptible host.

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Rheumatic Fever Incidence

Common in children and young adults, often following strep throat.

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Rheumatic Fever Predisposing Factors

Overcrowding, damp conditions, and socioeconomic factors increase the risk.

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Autoimmune Response

The immune system mistakenly attacks healthy body tissues.

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Latent Period (RF)

The time between strep infection and the development of rheumatic fever (2-4 weeks).

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Rheumatic Fever

An inflammatory disease that can damage the heart valves after a streptococcal infection (strep throat).

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Sydenham's Chorea

Sudden, involuntary, irregular, and purposeless movements, especially of the extremities, caused by rheumatic fever.

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Rheumatic Myocarditis

Inflammation of the heart muscle, a serious complication of rheumatic fever.

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Fibrinous Pericarditis

Inflammation of the pericardium (outer layer of the heart) with fibrin deposits.

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Suppurative Pericarditis

Infected (pus-filled) inflammation of the pericardium, often due to bacterial infections.

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Heart Failure (complicating RF)

A condition arising from rheumatic fever-related damage to heart valves or muscles.

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Erythema Marginatum

A characteristic, reddish rash with a clear center, a sign of rheumatic fever.

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Major Criteria (RF)

The significant and defining features for diagnosing rheumatic fever.

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Pericardial Adhesions

Fibrous tissues connecting the pericardial layers and surrounding structures after pericarditis, limiting heart expansion.

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Constrictive Pericarditis

Severe pericardial scarring, completely or partially restricting heart filling and compromising venous return.

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Infective Endocarditis

Bacterial infection of heart valves, potentially leading to vegetations and sepsis.

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Vegetations

Blood clots, bacteria and inflammatory cells on heart valves in endocarditis, potentially causing emboli.

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Septic Emboli

Fragments of vegetations that break off and travel through the bloodstream, lodging in other organs and causing abscesses.

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Acute Infective Endocarditis

Rapid, severe bacterial infection of heart valves, often caused by virulent bacteria.

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Subacute Infective Endocarditis

Slower, less severe endocarditis often caused by specific species of bacteria, usually affecting damaged valves.

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Causative Organism (IE)

Specific bacteria like streptococcus, staphylococcus, and pneumococci can cause IE.

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Subacute Bacterial Endocarditis

A less severe form of bacterial infection of heart valves, often caused by Streptococcus viridans, developing gradually.

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Valve Incompetence

Inability of the heart valve to close properly, resulting in blood leakage.

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Bacterial Infection (Heart)

An infection of heart valves, primarily from bacteria entering the bloodstream.

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Streptococcus viridans

Common bacteria in the mouth & throat, a major cause of subacute bacterial endocarditis.

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Vegetations (Endocarditis)

Clusters of bacteria, fibrin, and platelets that form on heart valves during endocarditis, potentially harming the heart .

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Emboli

Fragments that detach from vegetations and travel to other parts of the body, causing blockages.

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Aetiology of Infective Endocarditis

The cause of infective endocarditis (infection of the heart valves) which can be different bacteria types, mainly Streptococci and low virulent bacteria.

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Bacteremia

Bacteria in the bloodstream.

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Study Notes

Infective Endocarditis (IE)

  • IE is an infectious inflammation of the endocardium affecting heart valves.
  • Etiology: Bacteremia, often caused by dental procedures, surgery, distant primary infections, and non-sterile injections.
  • Risk Factors:
    • Rheumatic heart disease
    • Intravenous (IV) drug use
    • Immunosuppression
    • Prosthetic heart valve
    • Congenital heart disease

Main Causative Pathogens

  • Streptococcus viridans:
    • Normal flora of oral cavity and upper respiratory tract.
    • Common cause of IE, especially in previously damaged heart valves, can be subacute.
  • Staphylococcus aureus:
    • Affects healthy valves
    • Usually fatal if left untreated, can cause acute IE
  • Staphylococcus epidermidis:
    • Causes IE in patients with peripheral venous catheters, prosthetic heart valves, etc.
  • Enterococcus faecalis:
    • Normal flora of human colon, urethra, and female genital tract
    • Causes IE in patients with preexisting heart valve damage, is usually subacute.

Less Common Pathogens (Subacute IE)

  • Streptococcus gallolyticus:
    • Normal flora of colon.
    • Associated with colorectal cancer in the elderly and immunocompromised.
  • HACEK group (G-ve bacilli):
    • Haemophilus
    • Aggregatibacter
    • Cardiobacterium
    • Eikenella
    • Kingella
    • Associated with IV drug users who contaminate needles with saliva
    • Poor dental hygiene and/or periodontal infections
  • Candida species:
    • Normal flora of mucous membranes
    • Causes IE in immunosuppressed patients.
    • Associated with vascular catheters

Pathogenesis

  • Valvular Endothelial Damage: Damage from rheumatic fever, prosthetic valves, etc, creates turbulent blood flow.
    • This leads to fibrin-platelet aggregates on the valve.
  • Bacteremia: Bacterial colonization of damaged valves.
    • Further fibrin and platelet deposition leads to formations called vegetations.
    • Eventually, valve destruction occurs with loss of function

Clinical Features

  • Constitutional symptoms: fatigue, fever/chills, and malaise
  • Signs of pathological cardiac changes: new or changed heart murmurs, heart failure signs
  • Possible manifestations of subsequent damage to other organs, such as glomerulonephritis, or septic embolic stroke

Lab Diagnosis (Before Antimicrobial Therapy)

  • Blood cultures: The standard test to determine the microbiologic cause of the disease.
    • 5-day standard blood cultures allow for the recovery of most cultivable microorganisms, including Candida and fastidious HACEK organisms.
    • Subculturing on solid media isolates the causative organism for further identification (morphology, biochemical reactions), and antibiotic susceptibility testing.
  • Serology
  • PCR

Prophylaxis

  • Antibiotics are typically administered only in specific situations like those with preexisting heart conditions undergoing dental or surgical procedures.

Prognosis

  • Untreated IE can be fatal within a few weeks.

Rheumatic Fever

  • Definition: Delayed complication of streptococcal pharyngitis/tonsillitis, usually occurring 2-4 weeks after the initial infection.

  • Etiology: Molecular mimicry—Antibodies formed against streptococcal M protein may cross-react with heart tissue, triggering inflammation.

  • Epidemiology: Peak incidence amongst 5-15 year olds. More common in developing countries.

  • Pathophysiology: Type II hypersensitivity reaction—Antibodies damage heart tissues.

  • Clinical Features (JONES criteria):

    • Migratory polyarthritis
    • Pancarditis (endocarditis, myocarditis, pericarditis)
    • Subcutaneous nodules
    • Erythema marginatum
    • Sydenham chorea

  • Diagnosis: Jones criteria plus evidence of preceding streptococcal infection (GAS).

    • Confirming GAS infection: elevated Antistreptolysin O (ASO) titers, positive rapid antigen test from throat swab.

  • Treatment: Bed rest is important, antibiotics to eradicate GAS, and symptomatic treatment for fever, arthritis, or cardiac issues.

  • Complications: Chronic rheumatic heart disease, and potentially death due to myocarditis or congestive heart failure.

  • Prevention:

    • Early treatment of streptococcal pharyngitis (within 10 days of onset).
    • Prolonged prophylactic antibiotic therapy (at least 5 years) after an episode.

Pericarditis

  • Definition: Inflammation of the pericardium, the sac surrounding the heart.
  • Types:
    • Fibrinous (serofibrinous) pericarditis
    • Suppurative pericarditis
  • Causes (Fibrinous Type): Rheumatic fever, lobar pneumonia, bronchopneumonia, tuberculous pericarditis, post-myocardial infarction, uraemia, diabetes mellitus.
  • Causes (Suppurative Type): Streptococcus, staphylococcus, meningococcus septicaemia, blood/lymphatic spread from pneumococcal lung infection, direct spread from empyema, osteomyelitis, subphrenic/liver abscess, penetrating chest wounds.
  • Pathological features (Suppurative): Suppurative inflammation with pus accumulation in the pericardial sac.
  • Complications (Suppurative): If survivors, heals by organization causing pericardial adhesions; leading to constrictive pericarditis or adherent mediastino-pericarditis.

Myocarditis

  • Definition: Inflammation of the myocardium (heart muscle).
  • Causes: Direct involvement by causal agents, toxin-mediated injury, local hypersensitivity reaction.
  • Types:
    • Viral interstitial myocarditis
    • Suppurative myocarditis
    • Toxic myocarditis
    • Hypersensitivity reactions
    • Granulomatous myocarditis

Cardiomyopathy

  • Definition: Heterogeneous group of disorders marked by chronic myocardial dysfunction (uncertain cause).
  • Types: Classified into hypertrophic, dilated, and restrictive cardiomyopathy.
  • Further divide into primary (unknown etiology) and secondary (related to systemic disorders).

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