Infectious endocarditits Flashcards
Why do patients have splenomegaly?
Answer will be in class
What is the most common organism that causes infectious endocarditis? What type of IE does it cause?
Staphylococcus aureus
- causes Acute Infectious endocarditis
The uncommon clinical manifestations of IE?
- Janeway lesions - nontender erythematous macules on the palms and soles (microabscesses) (more common in acute IE)
- Osler nodes - tender subcutaneous purple nodules mostly on the pads of the fingers and toes (Immune-mediated)
- Roth Spots - exudative, edematous hemorrhagic lesions of the retina with pale centers (immune-mediated)
Neurologic complications of IE?
- Embolic stroke
- Intracerebral hemorrhage
- Brain abscesses
Characteristics of the vegetations found in infectious endocarditis?
Friable, bulky lesions containing fibrin, inflammatory cells, bacteria, and other organisms
- single or multiple
- can erode into myocardium, developing abscesses
- prone to embolization
- abscesses frequently develop where they lodge, leading to septic infarcts
Clinical presentation of Acute endocarditis?
Acute/ rapid onset of:
- Fever!
- Cardiac murmers
- Splenomegaly
- Petchiae
- Splinter hemorrhages
- chills, weakness, malaise, anorexia, weight loss
- headaches, myalgias, arthralgias, night sweats, dyspnea, cough, pleuritic pain
When should IE be suspected?
In patients with:
- Fever and relevant cardiac risk factors or noncardiac risk factors (IVDU or recent dental procedure)
Acute vs. subacute Infectious endocarditis
Acute: infection of a previously NORMAL heart valve by a HIGHLY virulent organism
- produces necrotizing and destructive lesions
Subacute: insidious infection of DEFORMED valves by organism with LESS virulence
- less destruction
Pathological criteria used for definite endocarditis according to the Modified Duke Criteria?
- Path Lesion: Vegitation or intracardiac abscess demonstrating active endocarditis on histology
- Microorganisms: demonstrated by culture or histology of a vegatation or intracardiac abscess
What is infectious endocarditis?
A microbial infection of the heart valves or mural endocardium
- leads to vegitations composed of thrombotic debris and organism
- associated with destruction of underlying cardiac tissue
Diagnosis of IE is based on?
- Clinical manifestations
- Blood cultures
- Echocardiography
- other hints: Elevated ESR, CRP, anemia, positive rheumatoid factor, UA with hematuria, proteinuria or pyuria
Special population etiology:
Organisms that cause IE in those with colon cancer?
Streptococcus gallolyticus (formerly S. bovis)
Tx of IE?
Emperically tx with Vancomycin (assuming gram-positive)
- in rare case that it is a gram-negative organism, we can adjust tx
Etiology:
Organisms that cause IE?
- Staph. Aureus
- Streptococcus Viridans
- Enterococcus species
- Staph epidermidis
- HACEK organisms (Gram-Neg!)
- Fungi
- Bartonella or Coxiella (culture-neg)
Clinical presentation of subacute endocarditis?
Gradual onset of:
- low-grade fever
- Cardiac murmers
- Splenomegaly
- Petchiae
- Splinter hemorrhages
night sweats, weight loss, anorexia and fatigue
Prognosis for IE?
Not good
~25% die in hospital
Unique features of HACEK organisms?
- Gram-negative
- more difficult to culture
Clinical Criteria used for definite endocarditis according to the Modified Duke Criteria?
- Two major clinical criteria = Dx
- One major and 3 minor = Dx
- Five minor = Dx
Special population etiology:
Organisms that cause IE in IV drug users?
- S. Aureus!
- Pseudomonas
- Candida species
-in that order
Risk factors for IE?
- IV drug use
- Males
- Age > 60
- Poor dentition
- Preexisting heart disease
- prosthetic heart disease
- hx of IE
- other foreign devices
- chronic hemodialysis
- HIV
Special population etiology:
Organisms that cause IE in PTs w/ prosthetic valve?
S. epidermidis
- Able to form a biofilm on the prosthesis
Why is streptoccocus gallolyticus associated with colon cancer?
Answer will be in class
What needs to be obtained before tx of IE with antibiotics?
At least 3 sets of blood cultures from separate sites
other non-specific complications of IE?
- Septic emboli (infarcts of kidneys, spleen, etc)
- pumlonary emboli w/ right-sided IE from IVDU - Metastatic infection (vertebral osteomyelitis, septic arthritis, psoas abscess
- Systemic immune reaction
