Infective Endocarditis

Question 1

for definitive diagnosis ?

Answer 1

we need from duke criteria
2 major criteria
or
1 major criteria +3 minor criteria
or
5 minor criteria

Question 2

duke major criterias

Answer 2

1) positive blood culture :
(s.aureus,s.viridans,s,gallolycticus , enterococci , HACEK)
- at least 2 positive blood cultures > 12 hours apart
or
-all 3 or majority of > 4 separate blood cultures (1st and last > 1 hr apart)
or
-coxiella burnetii titer of anti phase 1 IgG > 1;800

2)characteristic echocardiographic findings

Question 3

Duke minor criteria

Answer 3

1) predisposing conditions -IV drug user ,underlying cardiac abnormality
2) fever > 38 c
3)vascular phenomenon -arterial emboli,septic infarctions,intracranial/conjunctival hemorrhage,janeway lesions ,mycotic aneurism
4) immunological phenomenon - osler nodes ,glomerulonephritis,roth spots,positive rheumatoid factor
5) positive blood culture -that do not fulfill the major criteria

Question 4

common symptoms

Answer 4

fever , night sweat , back pain

Question 5

prophylactic antibiotics indications

Answer 5

• prosthetic heart valve
  *history of previous endocarditis
  *unrepaired congenital cyanotic heart disease ,including palliative shunts
  *within 6 months after repair of congenital heart defects
  *incompletely repaired congenital heart defect ,leading to residual defects near the prosthetic material
  *post-cardiac transplantation valvopathy

Question 6

prophylactic antibiotics

Answer 6

*penicillin / amoxicillin
if allergy : clindamycin/azithromycin

Question 7

infective endocarditis tx in case of streptococci

Answer 7

penicillin G /ceftriaxone

Question 8

infective endocarditis tx in case of enterococci

Answer 8

ampicillin (+- gentamicin)

Question 9

infective endocarditis tx in case of staphylococci (MSSA)

Answer 9

*MSSA on native valve: cefazolin /oxacillin
*MSSA on prosthetic valve:oxacillin+gentamicin +rifampin

Question 10

infective endocarditis tx in case of staphylococci (MRSA)

Answer 10

*MRS on native valve: vancomycin +gentamicin
*MRSA on prosthetic valve :vancomycin+gentamicin +rifampin

Question 11

infective endocarditis tx in case of coxiella burnetii

Answer 11

doxycycline +hydroxychloroquine

Question 12

infective endocarditis in case of < 1 year of prosthetic valve (biological/mechanical)

Answer 12

staph aureus + cons

Question 13

infective endocarditis in case of > 1 year of prosthetic valve (biological/mechanical)

Answer 13

streptococcus

Question 14

infective endocarditis in case of < 1 year of native valve

Answer 14

staph

Question 15

infective endocarditis in case of > 1 year of native valve

Answer 15

strep.

Question 16

Indication for early
surgery

Answer 16

*symptomatic heart failure and
valvular dysfunction
* left-sided infective
endocarditis caused by
fungal infections or
highly-resistant
organisms;
*associated complications, such
as annular or aortic abscess,
destructive penetrating
lesions. or heart block
* Early surgery is reasonable in
patients with recurrent emboli
and persistent valve vegetations
and may be considered in the
presence of a large (>10-mm), left
sided vegetation
* persistent bacteremia or
fevers lasting more than 5 to 7
days despite appropriate
antimicrobial therapy
* When infective endocarditis is
associated with a pacemaker or
defibrillator. the entire system
(generator and leads) must be
removed.

Question 17

paravalvular abscess

Answer 17

*associated with aortic valve endocarditis
*can caus conduction abnormality like AV block
* life threatening require urgent surgery