M27 Infective Endocarditis

Question 1

what is IE caused by

Answer 1

micro organisms settling on heart valves (bac/fungi)

Question 2

is IE fatal

Answer 2

yes without treatment

Question 3

how does IE come about

Answer 3

predisposing lesion on valve 
attracts layer of platelets/fibrin 
sticky surface
bac attch 
VEGETATION 
infection develops

Question 4

how do pathogens causing IE get into the bloodstream

Answer 4

diff routes
injury
oral cav
catheter

Question 5

how to pathogens rapidly adhere

Answer 5

platelet fibrin deposition

Question 6

what do some sp do

Answer 6

obtain intracellular access

Question 7

what does embolisation or heamatogenous spread lead to

Answer 7

range of complications

• stroke
• meningeal infections

Question 8

what are some clinical effects of IE

Answer 8

bacteraemia
damage to valve form vegetative growth
emboli
immune complex effects

Question 9

what is bacteraemia diagnosis linked to

Answer 9

positive blood culture

Question 10

how can a valve be damaged by vegetative growth

Answer 10

valve rupture

mitral/atrial

Question 11

how do emboli effect the body

Answer 11

bits flake off and lodge into small vessels

stroke etc

Question 12

where ca remote embolic effects be seen

Answer 12

often found on extremities or mucous mems

Question 13

what is palatal petechiae assc with

Answer 13

IE
Leukemia
STD
Viral infection - infectious mononucleosis

Question 14

what are th two sources of bacteriamia

Answer 14

spontaneous and induced

Question 15

what is the spontaneous source of bacteriaemai

Answer 15

oral flora

gut flora

Question 16

what is induced cause of bacterimia

Answer 16

gum margin manipulation - extraction

IVDU

Question 17

what are the types of organisms assc with IE

Answer 17

staphylococci -25%
streptococci - 50-70%
enterococci - 10%
Candida 
culture negative

Question 18

what are the specifics of the staphylococci involved in IE

Answer 18

coagulase - ve - epidermis

causing rapid valave degeneration

Question 19

does candida and colifrms usually seen to cause IE

Answer 19

uncommon

Question 20

what are the assc culture negative bacteria in iE

Answer 20

HACEK
haemophilia
aggregatibacter
eikenella

Question 21

what si he percentage of IE cases oral origin

Answer 21

20%

Question 22

what are some key concepts when thinking of virulence in IE

Answer 22

entry/circ blood
adherence - platelet/fibrin
biofilm form
host cell invasion
aggressive damage
sec toxins
intracellular persistence

Question 23

what re some surface adhesins assc with streptococcus gordonii

Answer 23

PadA
Hsa

fro platelet adhesion and aggregation

Question 24

what are pt most at risk of IE

Answer 24

individuals with damage heart valves 
history
IVDU 
prothetic valves 
cardiac surgery

Question 25

what are some symptoms of subacute

Answer 25

``` malaise headache night sweats rigors heart murmur embolic manifestations immune complex disease ```

Question 26

what are some symptoms of a high index of suspicion

Answer 26

``` fever and unknown cause murmur heart lesion bacteriamia malaise positive blood culture ```

Question 27

what are some other ways of identifying IE

Answer 27

echocardiography C relative protein (marker of inflam) serology

Question 28

what is the principle of treatment

Answer 28

empiric therapy - tidal - large dose - long time

Question 29

when is Ab started for IE

Answer 29

after blood cultures | for acute infection s aureus targeted

Question 30

what bac is targeted particularly with beta lactam

Answer 30

gm +ve cocci

Question 31

what are the Ab used in therapy

Answer 31

beta lactase gentamicin vancomycin rifampicin

Question 32

what are some beta lactams

Answer 32

amoxicillin benzyl penicillin flucloaxacillin

Question 33

what does gentamicin do

Answer 33

coliforms and synergy with beta lactamsfor strept

Question 34

what does vancomycin do

Answer 34

ag MRSA/ s epidermidis | less active used with something

Question 35

what does rifampicin do

Answer 35

penetrates well and synergy with vancomycin not alone or get resist

Question 36

what is used for native valve acute/sever

Answer 36

flucloxacillin

Question 37

what is used for native valve subacute

Answer 37

amoxicillin and gentamicin

Question 38

what is used for prosthetic valve

Answer 38

vancomycin gentamicin rifampicin

Question 39

what is sued for MRSA

Answer 39

vancomycin gentamicin rifmpiicin

Question 40

is suspected s aureus causing what is sued

Answer 40

high dose flucloxacillin

Question 41

is suspected enterococci is the cause use

Answer 41

high does amoxicillin and gentamicin

Question 42

is suspected Viridans Group Streptococci

Answer 42

high dos penicillin | 4 weeks

Question 43

when is prophylactic prescribing considered

Answer 43

medical status immunological status preceding infection at site invasiveness of procedure