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Infective Endocarditis
Zoltán Pozsonyi, MD3rd Dep. of Internal Medicine
Semmelweis UniveryityBudapest, Hungary
Definition
• Microbal infection of the endothelial surface of the heart
• Mainly valves• Mainly valves– but ASD, VSD
Incidence
• About 4-6/100000 in a year
• The age of the patients is increasing
• Valvularheartdiseas: predisposingfactor• Valvularheartdiseas: predisposingfactor
• Risk is higher in males
• >45 y
Prosthetic valve endocarditis
• 10-30 % of all cases
• Early: in one year following the operation– Staphylococcus– Staphylococcus
• Periannular complictions are common– leak, regurgitation, abscess, fistula
Microorganisms
• Viridans streptococci– in the oropharinx, susceptible to penicillin
• Streptococcus bovis• Streptococcus bovis– in the GI tract, susceptible to penicillin
• Enterococci– part of the GI flora– resistant to cephalosporin, oxacillin,
aminoglicoside
Microorganisms
• Staphylococci– S. aureus, S. epidermidis
– implanted devices, nosocomial settings– implanted devices, nosocomial settings
– resistant penicillin, ampicillin
– susceptible to oxacillin, first gen. cephalosporins
– but: MRSA
– toxic febrile illness, complications (S. aureus)
HACEK
• Gram gen bacteria– Haemophilus
– Actinobacillus– Actinobacillus
– Cardiobacterium
– Eikenella
– Kingella
• large vegetations, emboli
Other organisms• Corynebacterium• Lysteria monocytogenes• Tropheryma whippeli• rickettsia Coxiela burnetti (Q fever)• Bartonella quintana and henselae
• Funghi ( Candida, Histoplasma, Aspergillus)– rare
Pathogenesis
• Bacteremia endocarditis
• factors:– endocardial injury– endocardial injury
– high velocity jet
– devices
Pathophysiology
• Clinical manifestations:– local destructive effects
– embolization resulting in infarction– embolization resulting in infarction
– haematogenous seeding of remote sites during continous bacteraemia
– antibody response• subsequent tissue injury; IC; antigenes deposits in
tissues
Diagnosis
• Echocardiography– TTE, TEE, depends on the risk
• Blood cultures• Blood cultures
– Laboratory tests• CRP, Sedimentation rate
• IC, RF
• Urinanalysis
TTE
TEE
Complications
• Heart failure
• Uncontrolled infection– Persisting infection
– Local propagation (fistula, abscess)
• Systemic embolism– Stroke (ishemic)
– Infectious (mycotic) embolism
– Spleen
• Arrhythmia
• Renal failure
Stroke
Treatment- antimicrobal therapy
• should erdicate the microba
• should be not toxic
• Native valve therapy=prosthetic valve • Native valve therapy=prosthetic valve therapy – Exept Staphylococcus