Flashcards in Infective Endocarditis Deck (24):
What do oral strep use to adhere to NBTE?
What is NBTE?
What are most oral strep?
Nonbacterial thrombotic endocarditis
Complications of IE
Heart murmur, CHF, emobli --> strokes / infarcts, fistula b/w heart chambers, pericarditis, bacteremia, immune complexes. abscesses, vertebral osteomyelitis
Complications of bacteremia
Sepsis, mycotic aneurysm (due to destruction of tunica media), meningitis, abscess, osteomyelitis, septic arthritis
Which valve is highest risk for embolization?
Cardiac risk factors
Rheumatic heart disease, congenital heart / valve disease, degenerative valve disease (age), prosthetic valve
Complications of immune-overactivity
Hypergammaglobulinemia, splenomegaly, immune complexes (glomerulunephritis, Osler's nodes, vasculitis, arthralgia / myalgia)
Painful, red, raised lesions on hands / feet
Splinter hemorrhage - infarct in finger nail
Janeway's Lesion - painless, flat infarcts on palms / soles
Roth's spots - retinal hemorrhage
Petechial rash - most common skin finding
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
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
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
Immunologic complications: subacute
Which valve most often affected from IV drug use?
What 2 organisms cause 80% of IE?
Strep and Staph
Causes of SBE
Viridans strep (most common)
Causes of ABE
Gram neg bacilli
What is most common cause of IE?
What is most common cause of SBE?
Treatment for Strep
IV penicillin or IV ceftriaxone. Add gentamicin if MIC is high.
What types of IE involve gram-neg bacilli?
PVE and drug use
Pseudomonas aeruginosa, Klebsiella, Salmonella
Fastidious Gram-negative organisms
What types of IE involve Candidia?
Catheter IV, drug IV, PVE
Indications for surgery
CHF, uncontrolled infection, multiple emboli, AB resistance
Indications for AB prophylaxis
Dental work, prosthetic heart valve, prior endocarditis, CHD, post-cardiac transplant