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Infective Endocarditis

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Infective Endocarditis

Uploaded by

avanthikathara1442002
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as KEY, PDF, TXT or read online on Scribd
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INFECTIVE

ENDOCARDITIS
Chapter 128
Manickam, Srithick Vallesh
MD, 3-C
4
OBJECTIVES CLINICAL
MANIFESTATIONS

1 OVERVIEW &
APPROACH TO
EPIDEMIOLOGY 5
THE PATIENT

2 ETIOLOGIC FACTORS
6 TREATMENT

3 PATHOGENESIS
7 PREVENTION
& PROGNOSIS
OVERVIEW & EPIDEMIOLOGY
Infective endocarditis (IE) is an infection of the heart valves or
endocardium, typically characterized by the formation of
vegetations (masses of platelets, fibrin, and microorganisms) on
the heart valves. It can lead to significant morbidity and mortality
if not promptly treated.

Incidence: Approximately 3-10 cases per 100,000 person-years in


developed countries.
Prevalence: Variable; typically assessed through hospital data
and regional studies. The incidence is higher in certain
populations, such as those with prosthetic valves or intravenous
drug users.
ETIOLOGIC FACTORS
Microbial Causes:
Staphylococci: Staphylococcus aureus is a major pathogen, especially in acute
cases and among intravenous drug users.
Streptococci: Viridans group streptococci commonly cause subacute
endocarditis, often related to preexisting heart disease.
Enterococci: Associated with genitourinary infections or procedures.
HACEK Organisms: Gram-negative bacteria (Haemophilus species,
Actinobacillus, Cardiobacterium, Eikenella, Kingella) are less common but
significant.
Fungi: Rare, seen in immunocompromised individuals or with prolonged antibiotic
use.
Risk Factors:
Preexisting Heart Conditions: Including rheumatic heart disease, congenital
heart defects, and prosthetic valves.
Intravenous Drug Use: Major risk factor for right-sided endocarditis.
Healthcare Exposure: Use of intravascular devices, recent surgeries, or
procedures.
Other Conditions: Diabetes, malignancy, chronic renal failure.
PATHOGENESIS
Infection Initiation: Often begins with bacteremia or
fungemia. Pathogens adhere to and colonize damaged or
abnormal heart valves, forming vegetations

Vegetation Formation: The infection leads to the


formation of vegetations composed of microorganisms,
platelets, and fibrin on the heart valves.

Valve Damage: The vegetations can cause valve


destruction, leading to valve incompetence or obstruction.
Embolic events can also occur, leading to systemic
infections or infarcts in distant organs.
CLINICAL MANIFESTATIONS
Acute Endocarditis: Rapid onset with severe symptoms such
as fever, chills, and malaise. Can include systemic symptoms
like septicemia, heart failure, and embolic phenomena.
Subacute Endocarditis: More gradual onset with symptoms
that may include low-grade fever, night sweats, fatigue, and
weight loss. Often associated with underlying heart disease.
Chronic Endocarditis: Insidious onset with symptoms that may
include vague constitutional symptoms. Often seen in individuals
with preexisting heart conditions..
APPROACH TO THE PATIENT
History and Physical Examination: Focus on risk factors,
symptom onset, and signs of systemic infection.
Diagnostic Tests:
Blood Cultures: Essential for identifying the causative
organism.
Echocardiography: To visualize vegetations and assess
valve damage. Both transthoracic and transesophageal
echocardiography may be used.
Other Tests: May include serologies, imaging studies (e.g.,
chest X-ray, CT scan), and possibly PET scans for persistent
or unusual cases.
TREATMENT
Antibiotic Therapy: Tailored to the identified organism; typically
requires prolonged courses (4-6 weeks) of intravenous antibiotics.
For Staphylococcus aureus: Often treated with beta-lactam
agents like nafcillin or methicillin, or vancomycin if resistant.
For Streptococci: Penicillin or a combination of penicillin and
gentamicin.
For Enterococci: Often treated with ampicillin and
gentamicin.
Surgical Intervention: May be required for severe valve damage,
persistent infection despite appropriate therapy, or complications
such as abscesses.
PREVENTION & PROGNOSIS
Prevention:
Prophylactic Antibiotics: Recommended for high-risk patients
undergoing certain dental or surgical procedures.
Good Hygiene Practices: For those at risk of endocarditis, such as
individuals with prosthetic valves or congenital heart defects.
Prognosis:
Early Diagnosis and Treatment: Significantly improves prognosis.
Complications: Can include heart failure, embolic events, and
persistent infection.
Overall Outcome: Varies based on the causative organism, the
presence of underlying heart disease, and the timeliness of treatment.
Generally, the prognosis is better with prompt and appropriate
treatment, but it remains a serious condition with potential for
significant morbidity and mortality.
THANK
YOU!!

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