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Infective Endocarditis Final

Infective endocarditis is a microbial infection of the heart valves or endocardium. It is characterized by the formation of cardiac vegetations, embolic manifestations, and immune complex formation. Major risk factors include previous history of IE, cardiac diseases, prosthetic valves, IV drug use, and immunosuppression. Common causative organisms are streptococci and staphylococci. Diagnosis involves blood cultures, echocardiography, and applying the Duke criteria. Treatment involves long-term intravenous antibiotics and may require cardiac surgery for uncontrolled infection or heart valve damage.

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14 views

Infective Endocarditis Final

Infective endocarditis is a microbial infection of the heart valves or endocardium. It is characterized by the formation of cardiac vegetations, embolic manifestations, and immune complex formation. Major risk factors include previous history of IE, cardiac diseases, prosthetic valves, IV drug use, and immunosuppression. Common causative organisms are streptococci and staphylococci. Diagnosis involves blood cultures, echocardiography, and applying the Duke criteria. Treatment involves long-term intravenous antibiotics and may require cardiac surgery for uncontrolled infection or heart valve damage.

Uploaded by

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

Endocarditis

ABDALLAH ELSHAL MD
Definition

Is a microbial infection of the endocardial surface of the heart


particularly the heart valves, but may occur at septal defect, on
chordae tendinae or in the mural endocardium

Characterized by formation of cardiac vegetation, embolic


manifestation and immune complex manifestation
Pre-existing risk factors
• Previous history of IE.

• Pre-existing cardiac disease.

• Presence of prosthetic valves.

• Presence of intracardiac devices.

• History of IVDU.

• Presence of chronic intravenous access (e.g. hemodialysis catheters, chemo ports and central venous catheters).

• Presence of CHD.

• Co-existing conditions such as diabetes, human immunodeficiency virus (HIV) or immunocompromised patients.

• infection and malignancy.


Etiology

Source of Causative Cardiac


infection organism lesion
Dental Infected
procedures vascular cath

Source of
infection
GIT &
Infected skin
Genitourinary
lesion
surgery
Causative organisms
Strep. Viridians (the commonest )
Enterococcus faecalis
Staph. aureus ( most virulent form )
Fungal infection ( in I.V drug addicts)
Gm -ve organisms ( after urinary procedures )
Rheumatic heart disease

MVP e’ MR

Prosthetic valves & intra cardiac sutures

Cardiac lesions
Congenital heart diseases

• .Bicuspid AV
• .PDA
• .VSD
• .Tetralogy of fallot
• .Coarctation of aorta
Pathogenesis
1-Endothelial damage by strong jets of blood

2-Adhesion of platelets & fibrin on the


damaged endocardium

3-Formation of non bacterial thrombotic


endocarditis

4-Infection by circulating organism

5-Formation of vegetation which is formed on


atrial surface of atrioventricular valves &
ventricular surface of semilunar valves
Classification
Clinical manifestations
The effect of endocarditis are produced by

1. continuous release of organisms and their toxins

2. separation of infected parts from the vegetation causing septic emboli

3. antigen-antibody reaction and formation of immune complexes

4. further destruction of the already damaged valves


Clinical manifestations
Persistent Fever is the most common symptoms

Anorexia, weight-loss, malaise, night sweats

Heart :

New murmur formation due to destruction of valves

Symptoms of heart failure in advanced cases due to toxic myocarditis or valves destruction
Septic pulmonary
Lung:
embolism

Clinical Spleen:
Splenomegaly, Splenic
artery
manifestations embolism{infarction}

Immune complex
Kidney: glomerulonephritis,
hematuria, renal failure
Neurological:

Septic cerebral embolism leading to septic infarction and brain abscess

Cerebral hemorrhage resulting from rupture mycotic aneurysm

Clinical Meningitis and encephalitis


manifestations
Eye:

Retinal emboli or immune complex causing areas of hemorrhage with


pale center (Roth spots)

Sub Conjunctival hemorrhage


Mycotic
aneurysm
Roth spot and Sub Conjunctival hemorrhage
Skin lesions:

Petechial hemorrhage

Splinter hemorrhage
Clinical
manifestations Osler nodules

Janeway lesions

Pale clubbing
Splinter
hemorrhage
Streaks of hemorrhage under the nail
Osler nodules
Painful and erythematous nodules

Located on pulp of fingers and toes


Janeway lesions
Erythematous macules, Nonpainful

Located on palms and soles


Pale clubbing
Investigation
Blood culture:
--- -

Isolation of microorganism from culture is important for


diagnosis and for treatment.
At least 3 sets of samples should be taken from different
venipuncture sites one hour apart from each other
-CBC/ESR/CRP
-Kidney function test:
Elevated creatinine, Urine analysis: proteinuria & hematuria
- ECG
-Chest x-ray:
CHF , pleural effusion, pulmonary embolism
Investigations

Transthoracic echo for detection of


vegetation and valve lesions
TEE which is more sensitive
Diagnosis by Duke Criteria
Major Criteria
 Positive blood culture
 Typical organism from at least two separate cultures
 Evidence of endocardial involvement by echo
 Positive echocardiographic findings of vegetations
Prevention and
prophylaxis of
IE
High risk patients:

Patients with previous IE

Patients with prosthetic valves

Patients with transcatheter implanted


valves

Patients with cyanotic CHD

Patients with ventricular assist


devices
Situations and procedures at risk:

Dental extractions, oral surgery procedures, and


Prevention and procedures requiring manipulation of the gingival
prophylaxis of
IE Invasive diagnostic or therapeutic procedure of the
respiratory, gastrointestinal, genitourinary tract, skin,
or musculoskeletal systems

In all patients undergoing implantation of a


prosthetic valve, any type of prosthetic device or
CIED
Amoxicillin or ampicillin 2gm oral or IV single dose
30-60 min before procedure
Prophylactic If penicillin allergy:
antibiotic Azithromycin 500 mg oral or ceftriaxone 1gm single
regime dose 30-60 min before procedure
Treatment
Principles of medical treatment

Use of bactericidal intravenous antibiotic


with very big doses and for long duration
4weeks to 6 weeks

Start empiric therapy until the causative


organism is identified by blood culture
Antibiotic regimens for
initial empirical treatment
In patients with NVE or late PVE (≥12
months post-surgery), ampicillin in
combination with ceftriaxone and
gentamicin

In patients with early PVE (<12 months


post-surgery), vancomycin combined with
gentamicin and rifampin
Heart failure due to severe valve damage

Uncontrolled infection despite antibiotic


therapy
Indication for Local complication as abscesses or fistula
surgery Large vegetation and recurrent systemic emboli

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