Infective Endocarditis Flashcards Preview

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Flashcards in Infective Endocarditis Deck (24):
1

What do oral strep use to adhere to NBTE?
What is NBTE?
What are most oral strep?

Dextran
Nonbacterial thrombotic endocarditis
Viridans strep

2

Complications of IE

Heart murmur, CHF, emobli --> strokes / infarcts, fistula b/w heart chambers, pericarditis, bacteremia, immune complexes. abscesses, vertebral osteomyelitis

3

Complications of bacteremia

Sepsis, mycotic aneurysm (due to destruction of tunica media), meningitis, abscess, osteomyelitis, septic arthritis

4

Which valve is highest risk for embolization?

Mitral

5

Cardiac risk factors

Rheumatic heart disease, congenital heart / valve disease, degenerative valve disease (age), prosthetic valve

6

Complications of immune-overactivity

Hypergammaglobulinemia, splenomegaly, immune complexes (glomerulunephritis, Osler's nodes, vasculitis, arthralgia / myalgia)

7

Osler's nodes

Painful, red, raised lesions on hands / feet

8

Clinical signs

Murmur
Splinter hemorrhage - infarct in finger nail
Janeway's Lesion - painless, flat infarcts on palms / soles
Roth's spots - retinal hemorrhage
Conjunctival hemorrhage
Osler's Nodes
Petechial rash - most common skin finding
Splenomegaly

9

Labs

3 sets of blood cultures from 2 diff parts of body
ESR - measure of inflammation
Immunologic tests may show positive ANA, rheumatoid factor, or low complement

10

Common portals of infection and organisms

•Oral source: Recent dental procedures or poor dentition. Portal for viridans strep
•GI tract: Bleeding, pain, diarrhea, change in bowel habits. Often involves Enterococci or Streptococci.
•GU tract: UTI symptoms, bleeding, procedures. Often involves Enterococci or Gram-negative anaerobes.
•Skin and soft tissue: Cuts, boils, infections. Portal for Staph aureus and Staph epidermidis.
•IV catheters: portal for Staph and Candida

11

ABE vs SBE
Which has prior valve disease more often?
Which has murmur more often?
Which has splenomegaly more often?
Which has larger vegetations?
Which needs surgery more often?
Which has emboli more often?
Which has immunologic complications more often?

Prior valve disease: subacute
Murmur: subacute
Splenomegaly: subacute
Vegetaions: acute
Surgery: acute
Emboli: acute
Immunologic complications: subacute

12

Which valve most often affected from IV drug use?

Tricuspid

13

What 2 organisms cause 80% of IE?

Strep and Staph

14

Causes of SBE

Viridans strep (most common)
Enterococci
Staph aureus

15

Causes of ABE

Staph aureus
GAS
GBS
Pneumococcus
Gram neg bacilli

16

What is most common cause of IE?

Staph aureus

17

What is most common cause of SBE?

Viridans strep

18

Treatment for Strep

IV penicillin or IV ceftriaxone. Add gentamicin if MIC is high.

19

What types of IE involve gram-neg bacilli?
Specific organisms

PVE and drug use
Pseudomonas aeruginosa, Klebsiella, Salmonella

20

HACEK
General description
Specific types

Fastidious Gram-negative organisms
•Haemophilus spp
•Actinobacillus
•Cardiobacterium
•Eikenella
•Kingella spp

21

What types of IE involve Candidia?

Catheter IV, drug IV, PVE

22

Indications for surgery

CHF, uncontrolled infection, multiple emboli, AB resistance

23

Indications for AB prophylaxis

Dental work, prosthetic heart valve, prior endocarditis, CHD, post-cardiac transplant

24

What is #1 risk for endocarditis?

having had it in the past