Infective Endocarditis PDF

Infective Endocarditis ‫مي‬#‫د علي يحيى الس‬  Definition Infection of the endocardial surface of heart characterized by - Colonization or invasion of the heart valves (native or prosthetic) or the mural endocardium by a microbe, - leading to formation of bulky, friab...

Infective Endocarditis ‫مي‬#‫د علي يحيى الس‬  Definition Infection of the endocardial surface of heart characterized by - Colonization or invasion of the heart valves (native or prosthetic) or the mural endocardium by a microbe, - leading to formation of bulky, friable vegetation composed of thrombotic debris and organisms - often associated with destruction of underlying cardiac tissue. Sites involved Heart valves Ventricular septum defects Mural endocardium Intracardiac devices Predisposing factors HOST FACTORS CARDIAC AND VASCULAR ABNORMALITIES Neutropenia RHD Immunodeficiency Myxomatous mitral valve Malignancy Degenerative calcific valvular Therapeutic stenosis immunosuppression Bicuspid aortic valves Diabetes mellitus Prosthetic valves Alcohol IV drug abuse Microbiology Staphylococcus aureus (35%) : Either healthy or deformed valves, IV drug abusers (polymicrobial), devices Streptococcus viridans (32%) : Native but previously damaged/ abnormal valves Enterococci (8 %) S. epidermidis (4%): Prosthetic valve endocarditis, devices G –ve bacilli of HACEK group (4%) Yeast and Fungi(1%) Culture negative endocarditis (5 %) Portal of entry: ◦ Dental / Surgical Procedures ◦ Contamination by IV drug use ◦Obvious infections (Skin) ◦ Occult source from gut, oral cavity ◦ Intravascular catheter infection ◦ Chronic invasive procedures Symptom ; Persistent fever Constitutional symptoms New signs of valve dysfunction Heart failure Embolic Stroke Peripheral arterial embolism Other features Modified Dukes Criteria for diagnosis of Infective Endocarditis Definitive Endocarditis if, - Two major or, - One major and three minor or, - five minor Possible Endocarditis if, - One major and one minor or, - Three minor Major Criteria Positive blood culture Minor criteria ◦Typical organism from two cultures Predisposing valvular or cardiac abnormality Intravenous drug misuse ◦Persistent positive blood cultures taken > 12 hours apart Pyrexia ≥38°C (≥100.4°F) ◦Three or more positive cultures taken over more than 1 Embolic phenomenon hour. Vasculitic/ immunologic phenomenon Endocardial involvement Blood cultures suggestive: -organism grown but not achieving ◦Positive echocardiographic findings of vegetations major criteria ◦New valvular regurgitation Suggestive echocardiographic findings  Investigation ; Echocardiograph y ECG CXR BLOOD TEST  TREATMENT Antimicrobial Therapy Therapy requires identification of specific pathogen and its susceptibility to antimicrobials. Empirical therapy should be started as soon as possible targeting most likely pathogens. Bactericidal drugs should be used. Resolution of fever occurs in 5 to 7 days.if fever persists patient should be evaluated for complications like paravalvular abscess and extracardiac abscess. Serologic abnormalities resolve slowly and do not reflect response to treatment. Surgery Indications 4.Badly damaged 1.patients with valves. direct extension of 5.IE caused by fungi infection to or gram-ve or myocardial resistant organisms. structuires. 6.Large vegetations 2.Prosthetic valve on dysfunction. echocardiography 3.Congestive heart 7.Recurrent embolic failure. attacks. THANK YOU