2. occurs when microorganisms (bacteria or fungi)
colonize the endocardial surface of the heart
Classified into four groups:
1. Native Valve IE
2. Prosthetic Valve IE
3. Intravenous drug abuse (IVDA) IE
4. Nosocomial IE
3. Epidemiology
The valves involved in IE:
1. Mitral 28-45%
2. Aortic 5-36%
3. Both 0-35%
4. Tricuspid 0-6%
5. Pulmonary <1%
4. Males > females
May occur at any age and increasingly common in
elderly
Mortality 20-30%
5. Predisposing Factors
IV drug use
Central line Prosthetic valve
Previous IE
Dental procedure
Rheumatic heart disease
6. High Risk
1. Prosthetic cardiac valve
2. Prior episodes of endocarditis
3. Complex congenital cardiac defect
4. Surgical systemic-pulmonary shunts
5. Intravenous drug abuse
6. Intravascular catheters
8. Low Risk
1. Isolated secundum atrial septal defect
2. ASD, VSD, or PDA > 6 months past repair
3. “Innocent” heart murmur by auscultation in the
pediatric population
9. Pathophysiology
a. Turbulent blood flow disrupts the endocardium
making it “sticky”
b. microorganisms infect the endocardial surface of
the heart.
c. Adherence of the organisms to the endocardial
surface
d. Eventual invasion of the valvular leaflets
10. Etiology
Common bacteria in children
Strep. viridans–50%
Staph aureus–40%
Strep fecalis, Grp D Streptococcus(Enterococci)
11. Clinical Presentations
High grade fever w/ chills
SOB
Arthralgias/myalgias
Abdominal pain
Pleuritic chestpain
Backpain
Anorexia
Weight loss
Fatigue
13. Osler’s Nodes Janeway Lesions
Painful Erythematous
Erythematousnodules Blanchingmacules
Located on pulp of fingers and Nonpainful
toes
Located in the palms and soles
15. CBC Immunologic tests:
ESR Increase in
CRP gammaglobulins
Urinalysis Presence of cryoglobulin
Low Complement
levels(C3,C4)
RF-positive
16. Imaging
CXR: multiple focal infiltrates and calcification of
heart valves
ECG: Look for evidence of ischemia, conduction delay
and arrhythmias
Echocardiography: diagnostic tool for culture
negative cases
17. Duke Criteria
Clinical criteria for infective endocarditis requires:
Two major criteria, or
One major and three minor criteria, or
Five minor criteria
18.
19. Management
Give for 2 – 6 weeks
1.Penicillin - susceptible strep on native cardiac valves: 4
weeks Pen G or Ceftriaxone + Gentamicin for 2wks
2.Penicillin - resistant strep on native cardiac valves:
Penicillin, ampicillin, or ceftriaxone for 4weeks +
gentamicin for the first 2 weeks
20. 5. Enterococcal infection on native valves - penicillin or
ampicillin + gentamicin for 4-6 weeks
6. (MSSA) on native valves : Nafcillin or oxacillin for at least 6
weeks + gentamicin for 3-5 days is optional
7. (MRSA) on native valves: Vancomycin for at least 6 weeks
with or without 3-5 days of gentamicin
21. 8. MSSA infection on prosthetic valve : Nafcillin or Oxacillin +
Rifampin for at least 6 weeks, in combination with Gentamicin
for 2 weeks.
9. MRSA infection on prosthetic valve: Vancomycin + Rifampin
for at least 6 weeks, in combination with Gentamicin for 2
weeks
10. Gram Negative endocarditis due to HACEK: Ceftriaxone or
Ampicillin plus Gentamicin for 4 weeks