Infective Endocarditis Flashcards
(35 cards)
What layer of heart is affected in endocarditis?
Endocardium
What is the prevalence of infective carditis?
3-10/100,000
What is the ratio of male to female?
2;1
What are the signs of infective endocarditis?
- Splinter Haemorrhages
- Vasculitic rash
- Roth spots
- Oslers Nodes
- Janeway lesions
- Nephritis
What is the pattern of vasculitic rash?
- Diffuse
- Non-Blanching
- Petechial
- Purpuric
What are roth spots?
-Retinal haemorrhages
-White/pale centre
=Coagulated fibrosis
What are oslers nodes?
-Deep, red spots
-Painful
-raised
-Finger pulps
(palm/soles)
What are Janeway lesions?
- Flat, macular
- Echymotic (escape of blood into the tissues from ruptured blood vessels)
- Palms/soles
- Nontender
- Pathognomic (dead giveaway)
Where may the signs be absent?
- elderly
- After antibiotic treatment
- Immunocompromised
- IE Involving less virulent/atypical organism
What are the investigations for IE?
- Markers of infection/inflammation
- -FBC
- -CRP
- -ESR
- U+E`s
- Nephritis
- infection
- sepsis
What will be seen on an ECG?
-Conduction Delay
What will be seen on CXR?
- Heart failure
- Pulmonary abscesses
What will be seen on an echocardiogram?
-Transthoracic
then Trans oesophageal
What are the causes of IE with -ve blood cultures?
- Prior antibiotics reaction
- fastidious organisms
- Intracelluar bacteria
What 3 bacteria cause 85% of all IE?
- Streptococci
- Enterococci
- Staphylococcus
Name the different strep infections?
-Oral (viridans) streptococci
-S.Milleri S.anginosus grp
Group D streptococci
Streptococcus bovis/equinus
What are the different types of enterococci?
E.Fecalis
E.Faecium
E.durans
What are the different types of Staphylcoccus?
S.Aureus
(health care associated)
-Coagulase negative staph (CNS) S.epidermidis
What are the two reasons why blood cultures would be negative?
- Prior antibiotic treatment
- fastidious organisms
- Intracelluar bacteria
Name the fastidious organisms that can cause IE?
- Nutritionally variant streptococci
- Fastidious Gram -VE bacilli _HACEK grp (feckin loads)
- Brucella
- Fungi
Name the intracelluar bacteria that can cause -ve blood cultures?
(5% of all IE)
- Coxiella burnetii
- Bartonella
- Chlamydia
What is the Major criteria using the modified Duke Criteria?
- Identify organism
- Providing evidence of infection anywhere in the heart
What is the minor criteria using the modified duke criteria?
-Focus on the endocarditis complex of clinical findings
What is the modified Duke criteria for blood cultures positive for IE?
- Typical organisms consistent with IE from 2 seperate blood cultures
- Organisms consistent with IE from persistently positive blood cultures
- Single +ve blood culture for coxiella burnetti
