Infective endocarditis is an infection of the inner lining of the heart chambers and heart valves. It has varying presentations from subacute to acute. Diagnosis involves blood cultures, echocardiography, and clinical criteria. Common causes are bacteria like streptococci and staphylococci. Complications include heart failure, embolic events, and kidney or brain infections. Treatment involves prolonged antibiotics and sometimes surgery.
The document provides information on sepsis definitions, pathophysiology, and assessment tools. It discusses:
1) The 1992 and 2001 consensus definitions of sepsis, severe sepsis, and septic shock based on SIRS criteria and organ dysfunction.
2) The key pathophysiological processes in sepsis including dysregulated inflammation, coagulation, fibrinolysis and endothelial dysfunction which can lead to organ failure.
3) Limitations of the SIRS criteria and introduction of newer assessment tools like qSOFA and SOFA score which include clinical variables and lab markers to better predict patient outcomes.
The document provides guidelines for the management of infective endocarditis from the European Society of Cardiology. It discusses definitions of infective endocarditis, recommendations for antibiotic prophylaxis, the role of echocardiography in diagnosis, etiologic agents, predictors of poor outcome, surgical indications, and treatment of various microorganisms including streptococci, staphylococci, enterococci, and culture-negative cases. It also addresses management considerations for infective endocarditis in specific patient populations such as those with prosthetic valves, congenital heart disease, or pregnancy.
This document discusses infective endocarditis (IE), a serious infection of the heart valves or inner lining of the heart. It provides details on the epidemiology, symptoms, physical exam findings, causative organisms, risk factors, diagnostic criteria (Modified Duke Criteria), investigations including echocardiography and blood cultures, and treatment approach for IE. Staphylococcus aureus is a leading cause worldwide and viridans group streptococci are common causes after dental procedures. Diagnosis relies on modified Duke criteria incorporating positive blood cultures, echocardiogram findings, and clinical features.
Infective endocarditis is an infection of the heart valves or endocardium. It is caused by bacteria or fungi entering the bloodstream and colonizing the endocardial surface. Common causes are streptococci, staphylococci, and enterococci. It has an indolent subacute course or acute fulminant course. Diagnosis is based on modified Duke's criteria using positive blood cultures, echocardiogram findings, and clinical features. Treatment involves long-term antibiotic therapy guided by microbiology results with surgery for complications or antibiotic treatment failure. Prevention focuses on antibiotic prophylaxis for high-risk patients before certain medical procedures.
This document provides an overview of infective endocarditis, including:
- It defines infective endocarditis and discusses its history and evolution.
- It covers the epidemiology, classification, predisposing factors, pathogenesis, signs/symptoms, diagnosis, treatment, complications, and prognosis of infective endocarditis.
- It provides details on the various types of infective endocarditis including native valve, prosthetic valve, intravenous drug abuse, nosocomial, and pacemaker infective endocarditis.
Infective endocarditis is an infection of the heart valves. It can affect native or prosthetic valves. Common causes are streptococci and staphylococci bacteria. Diagnosis involves blood cultures, echocardiogram, and application of the Duke criteria. Treatment involves intravenous antibiotics for 2-6 weeks along with surgery if needed for complications. Prognosis depends on the causative organism and underlying heart condition.
Ch. 24 Infections of Central Nervous Systemkevperrino
The document discusses infections of the central nervous system. It provides an overview of the anatomy of the CNS and explains that infections can be caused by bacteria, viruses, fungi, parasites or prions. Common pathogens that cause meningitis, encephalitis and other CNS infections are described. Specific sections cover bacterial meningitis, viral meningitis, tetanus caused by Clostridium tetani, and treatments for various CNS infections.
The document provides information on sepsis definitions, pathophysiology, and assessment tools. It discusses:
1) The 1992 and 2001 consensus definitions of sepsis, severe sepsis, and septic shock based on SIRS criteria and organ dysfunction.
2) The key pathophysiological processes in sepsis including dysregulated inflammation, coagulation, fibrinolysis and endothelial dysfunction which can lead to organ failure.
3) Limitations of the SIRS criteria and introduction of newer assessment tools like qSOFA and SOFA score which include clinical variables and lab markers to better predict patient outcomes.
The document provides guidelines for the management of infective endocarditis from the European Society of Cardiology. It discusses definitions of infective endocarditis, recommendations for antibiotic prophylaxis, the role of echocardiography in diagnosis, etiologic agents, predictors of poor outcome, surgical indications, and treatment of various microorganisms including streptococci, staphylococci, enterococci, and culture-negative cases. It also addresses management considerations for infective endocarditis in specific patient populations such as those with prosthetic valves, congenital heart disease, or pregnancy.
This document discusses infective endocarditis (IE), a serious infection of the heart valves or inner lining of the heart. It provides details on the epidemiology, symptoms, physical exam findings, causative organisms, risk factors, diagnostic criteria (Modified Duke Criteria), investigations including echocardiography and blood cultures, and treatment approach for IE. Staphylococcus aureus is a leading cause worldwide and viridans group streptococci are common causes after dental procedures. Diagnosis relies on modified Duke criteria incorporating positive blood cultures, echocardiogram findings, and clinical features.
Infective endocarditis is an infection of the heart valves or endocardium. It is caused by bacteria or fungi entering the bloodstream and colonizing the endocardial surface. Common causes are streptococci, staphylococci, and enterococci. It has an indolent subacute course or acute fulminant course. Diagnosis is based on modified Duke's criteria using positive blood cultures, echocardiogram findings, and clinical features. Treatment involves long-term antibiotic therapy guided by microbiology results with surgery for complications or antibiotic treatment failure. Prevention focuses on antibiotic prophylaxis for high-risk patients before certain medical procedures.
This document provides an overview of infective endocarditis, including:
- It defines infective endocarditis and discusses its history and evolution.
- It covers the epidemiology, classification, predisposing factors, pathogenesis, signs/symptoms, diagnosis, treatment, complications, and prognosis of infective endocarditis.
- It provides details on the various types of infective endocarditis including native valve, prosthetic valve, intravenous drug abuse, nosocomial, and pacemaker infective endocarditis.
Infective endocarditis is an infection of the heart valves. It can affect native or prosthetic valves. Common causes are streptococci and staphylococci bacteria. Diagnosis involves blood cultures, echocardiogram, and application of the Duke criteria. Treatment involves intravenous antibiotics for 2-6 weeks along with surgery if needed for complications. Prognosis depends on the causative organism and underlying heart condition.
Ch. 24 Infections of Central Nervous Systemkevperrino
The document discusses infections of the central nervous system. It provides an overview of the anatomy of the CNS and explains that infections can be caused by bacteria, viruses, fungi, parasites or prions. Common pathogens that cause meningitis, encephalitis and other CNS infections are described. Specific sections cover bacterial meningitis, viral meningitis, tetanus caused by Clostridium tetani, and treatments for various CNS infections.
Infective endocarditis remains a serious disease with high mortality and morbidity. While improvements have been made in diagnostics, antibiotics, and surgery, the incidence has remained unchanged over the past 20 years. Native valve infective endocarditis is now often caused by degenerative valve disease, congenital heart disease, or intravenous drug use rather than rheumatic heart disease. Prosthetic valve endocarditis has early and late onset forms and is commonly caused by Staphylococcus aureus and coagulase-negative staphylococci. New diagnostic criteria have been proposed along with treatments such as antibiotics and cardiac surgery. Vaccines and new antibiotics may help with prevention and treatment in the future.
This document discusses different types of ectopic beats, which are heartbeats originating from locations other than the sinoatrial node. It describes supraventricular ectopics including atrial ectopics, their causes and characteristics on electrocardiogram. Ventricular ectopics are also discussed, outlining their causes, appearance on ECG including secondary T wave changes, and potential treatments. The document provides an overview of ectopic beats and how they present differently depending on their origin location in the heart.
2015 ESC Guidelines on Infective Endocarditis ppt. by Dr Abhishek Rathore MDdrabhishekbabbu
The document summarizes guidelines for the management of infective endocarditis (IE). It recommends an endocarditis team approach in a reference center for complicated IE cases. It emphasizes the importance of early diagnosis, antibiotic therapy, and consideration of early surgery. It also discusses new recommendations for specific IE situations, antibiotic prophylaxis, surgical management, and the roles of imaging and multidisciplinary care in IE management.
Sepsis and septic shock result from a dysregulated host response to infection that leads to organ dysfunction. Management involves immediate resuscitation within 1 hour with IV fluids, antibiotics, and vasopressors if needed. Ongoing care includes source control, frequent reassessment of volume status, and supportive care such as mechanical ventilation and nutrition. The goals are to treat the underlying infection while supporting failing organs until the host response normalizes. Sepsis affects millions worldwide and requires swift treatment to prevent progression to septic shock and death.
1) Infective endocarditis is an infection of the heart valves or endocardial surface. It can be caused by various organisms and has multiple risk factors.
2) It presents with non-specific symptoms like fever and heart murmur, and can lead to complications affecting the heart, brain, spleen and other organs. Investigations include blood cultures, echocardiography and modified Duke's criteria.
3) Management involves long-term intravenous antibiotics based on culture results, treating complications, and possibly surgery to repair or replace infected valves. Patients are monitored in the hospital for resolution of symptoms and complications of infective endocarditis.
Infective endocarditis is an infection of the inner lining of the heart chambers and heart valves. It has an incidence of about 1 in 1,000 hospital admissions and risks include structural heart disease, immunosuppression, pacemakers, prolonged cardiac surgery, intravenous drug use, and nosocomial infections. Clinical presentations can be acute with toxicity and metastatic infection developing over days to weeks, or subacute progressing over weeks to months with less toxicity. Complications include heart failure, abscesses, and embolism, with an overall mortality rate of 10-20%. Treatment involves antibiotics tailored to the infecting organism and surgery may be required in some cases.
A powerpoint presentation about infective Endocarditis, with the most recent updates from the most reliable sources. I highlighted an introduction, pathology, approach to disease & different management plans in this presentation. 2018. Please don't forget to give me credit to my work.
Infective endocarditis is a microbial infection of the heart valves or endocardium. It typically involves the valves and can be caused by many pathogens. The most common causes are streptococci, staphylococci, and enterococci. Untreated infective endocarditis has a high fatality rate. The pathogenesis involves endothelial damage, platelet-fibrin deposition forming nonbacterial thrombotic endocarditis (NBTE), and microbial colonization of the NBTE resulting in bacterial vegetations. Local effects include valvular damage, abscesses, fistulae, and conduction abnormalities. Distant effects occur via septic emboli that can lodge in organs like the brain, lungs,
Infective Endocarditis and It's Surgical ManagementAlireza Kashani
This document defines and describes infective endocarditis. Key points include:
- Infective endocarditis involves infection of the heart valves or structures, most commonly the valves. This can lead to valvular dysfunction, sepsis, or embolism.
- The infection involves bacterial, viral, or fungal invasion of the endocardium and formation of vegetations on the valves or endocardium.
- Risk factors include underlying heart conditions, IV drug use, dental procedures, and indwelling catheters. The aortic and mitral valves are most commonly involved.
- Symptoms may include fever, heart murmur, embolic phenomena, and heart failure. Diagnosis
This ppt of endocarditis consists of definition, classification, etiology, clinical presentation, risk factors, diagnosis, pathophysiology, pharmacotherapy, management of endocarditis
A 75-year-old diabetic male presented with chest pain and other symptoms of acute coronary syndrome. The most probable diagnosis is myocardial infarction. Relevant investigations include ECG, biochemical markers like CK-MB and troponin, and echocardiogram. Management involves medical therapy in emergency, possible fibrinolysis or PCI, and long term preventative treatment. Complications can include heart failure, cardiogenic shock, arrhythmias if not properly managed.
Acute infections of the nervous system like bacterial meningitis can be life-threatening if not recognized and treated early. The document discusses various acute infections including bacterial meningitis, viral meningitis, encephalitis, and fungal infections. It provides details on the clinical presentation, diagnosis, and management of bacterial meningitis, which is often characterized by the classic triad of fever, headache, and neck stiffness, and requires prompt lumbar puncture and antibiotic treatment to identify the pathogen and prevent complications.
This document discusses the evaluation of syncope in adults. Syncope is defined as a brief, self-limited loss of consciousness due to decreased blood flow to the brain. The causes of syncope can be categorized as neurally-mediated, orthostatic, cardiac, or structural/cardiopulmonary. A thorough history, physical exam, and diagnostic testing are needed to determine the underlying cause and guide treatment. The history provides clues to distinguish syncope from other conditions and identify risk factors, while the physical exam focuses on vital signs and signs of end-organ damage or dysfunction.
Acute rheumatic fever is a multisystem disease caused by an autoimmune reaction to a Group A streptococcal infection. It commonly affects children between 5-14 years old in developing countries. Symptoms include migratory polyarthritis, carditis, chorea, and skin manifestations. Diagnosis is based on clinical features and evidence of a preceding streptococcal infection. Treatment involves antibiotics to prevent recurrence and symptom relief. Ongoing antibiotic prophylaxis is also needed long-term to prevent recurrence, especially in those who develop cardiac involvement.
The document discusses infective endocarditis, including:
1. Vegetations form on heart valves from bacterial deposition, usually due to a susceptible cardiovascular substrate and source of bacteremia. Common causes are streptococcus, staphylococcus, and enterococcus.
2. Predisposing factors include age, pre-existing heart conditions, dental procedures, injection drug use, and medical implants.
3. Treatment involves antibiotics to eradicate the infection and sometimes surgery for complications. Outcomes depend on the causative organism and severity of cardiac involvement.
The document discusses shock and sepsis. It defines shock as a clinical condition characterized by a fast pulse rate and low blood pressure. The main types of shock discussed are hypovolemic, cardiogenic, septic, anaphylactic, and neurogenic. Sepsis is defined as a life-threatening organ dysfunction caused by the body's response to an infection. As sepsis progresses it can lead to septic shock, which is associated with high mortality. The stages of shock and signs and symptoms of early and late sepsis are also summarized.
LECTURE ON ATRIAL FIBRILLATION TO 9TH TERM MEDICAL STUDENTS REFERENCES: DAVIDSON(2018) HARRISON 20TH ED OF MEDICINE AND 2020 EUROPEAN HEART GUIDELINES ON AF
This document provides an overview of endocarditis. It defines endocarditis as a microbial infection of the endocardial surface of the heart, most commonly affecting heart valves. A characteristic pathological lesion is a vegetation composed of platelets, fibrin, microorganisms, and inflammatory cells. The document discusses the pathogenesis, epidemiology, clinical presentations, diagnosis, complications including septic thrombophlebitis and mycotic aneurysms, treatment with antibiotics and surgery, and mortality rates associated with different causative organisms.
This document discusses infective endocarditis, which is a microbial infection of the heart valves or inner lining of the heart. It forms vegetations composed of thrombotic debris and organisms that can damage the heart valves. It is usually caused by bacteria entering the bloodstream, with common culprits being streptococci and staphylococci. Risk factors include pre-existing heart valve problems, intravenous drug use, and dental procedures. It can range from acute to subacute and cause complications like heart failure, neurological problems, and kidney damage if not properly treated with antibiotics and possibly surgery to repair or replace damaged valves. Nursing care focuses on monitoring for worsening symptoms and preventing further infection.
Basic description of Infective Endocarditis from a Clinical and Microbiological point of view with description on Pathogenesis, Clinical Manifestations, Clinical and Laboratory diagnosis.
Infective endocarditis remains a serious disease with high mortality and morbidity. While improvements have been made in diagnostics, antibiotics, and surgery, the incidence has remained unchanged over the past 20 years. Native valve infective endocarditis is now often caused by degenerative valve disease, congenital heart disease, or intravenous drug use rather than rheumatic heart disease. Prosthetic valve endocarditis has early and late onset forms and is commonly caused by Staphylococcus aureus and coagulase-negative staphylococci. New diagnostic criteria have been proposed along with treatments such as antibiotics and cardiac surgery. Vaccines and new antibiotics may help with prevention and treatment in the future.
This document discusses different types of ectopic beats, which are heartbeats originating from locations other than the sinoatrial node. It describes supraventricular ectopics including atrial ectopics, their causes and characteristics on electrocardiogram. Ventricular ectopics are also discussed, outlining their causes, appearance on ECG including secondary T wave changes, and potential treatments. The document provides an overview of ectopic beats and how they present differently depending on their origin location in the heart.
2015 ESC Guidelines on Infective Endocarditis ppt. by Dr Abhishek Rathore MDdrabhishekbabbu
The document summarizes guidelines for the management of infective endocarditis (IE). It recommends an endocarditis team approach in a reference center for complicated IE cases. It emphasizes the importance of early diagnosis, antibiotic therapy, and consideration of early surgery. It also discusses new recommendations for specific IE situations, antibiotic prophylaxis, surgical management, and the roles of imaging and multidisciplinary care in IE management.
Sepsis and septic shock result from a dysregulated host response to infection that leads to organ dysfunction. Management involves immediate resuscitation within 1 hour with IV fluids, antibiotics, and vasopressors if needed. Ongoing care includes source control, frequent reassessment of volume status, and supportive care such as mechanical ventilation and nutrition. The goals are to treat the underlying infection while supporting failing organs until the host response normalizes. Sepsis affects millions worldwide and requires swift treatment to prevent progression to septic shock and death.
1) Infective endocarditis is an infection of the heart valves or endocardial surface. It can be caused by various organisms and has multiple risk factors.
2) It presents with non-specific symptoms like fever and heart murmur, and can lead to complications affecting the heart, brain, spleen and other organs. Investigations include blood cultures, echocardiography and modified Duke's criteria.
3) Management involves long-term intravenous antibiotics based on culture results, treating complications, and possibly surgery to repair or replace infected valves. Patients are monitored in the hospital for resolution of symptoms and complications of infective endocarditis.
Infective endocarditis is an infection of the inner lining of the heart chambers and heart valves. It has an incidence of about 1 in 1,000 hospital admissions and risks include structural heart disease, immunosuppression, pacemakers, prolonged cardiac surgery, intravenous drug use, and nosocomial infections. Clinical presentations can be acute with toxicity and metastatic infection developing over days to weeks, or subacute progressing over weeks to months with less toxicity. Complications include heart failure, abscesses, and embolism, with an overall mortality rate of 10-20%. Treatment involves antibiotics tailored to the infecting organism and surgery may be required in some cases.
A powerpoint presentation about infective Endocarditis, with the most recent updates from the most reliable sources. I highlighted an introduction, pathology, approach to disease & different management plans in this presentation. 2018. Please don't forget to give me credit to my work.
Infective endocarditis is a microbial infection of the heart valves or endocardium. It typically involves the valves and can be caused by many pathogens. The most common causes are streptococci, staphylococci, and enterococci. Untreated infective endocarditis has a high fatality rate. The pathogenesis involves endothelial damage, platelet-fibrin deposition forming nonbacterial thrombotic endocarditis (NBTE), and microbial colonization of the NBTE resulting in bacterial vegetations. Local effects include valvular damage, abscesses, fistulae, and conduction abnormalities. Distant effects occur via septic emboli that can lodge in organs like the brain, lungs,
Infective Endocarditis and It's Surgical ManagementAlireza Kashani
This document defines and describes infective endocarditis. Key points include:
- Infective endocarditis involves infection of the heart valves or structures, most commonly the valves. This can lead to valvular dysfunction, sepsis, or embolism.
- The infection involves bacterial, viral, or fungal invasion of the endocardium and formation of vegetations on the valves or endocardium.
- Risk factors include underlying heart conditions, IV drug use, dental procedures, and indwelling catheters. The aortic and mitral valves are most commonly involved.
- Symptoms may include fever, heart murmur, embolic phenomena, and heart failure. Diagnosis
This ppt of endocarditis consists of definition, classification, etiology, clinical presentation, risk factors, diagnosis, pathophysiology, pharmacotherapy, management of endocarditis
A 75-year-old diabetic male presented with chest pain and other symptoms of acute coronary syndrome. The most probable diagnosis is myocardial infarction. Relevant investigations include ECG, biochemical markers like CK-MB and troponin, and echocardiogram. Management involves medical therapy in emergency, possible fibrinolysis or PCI, and long term preventative treatment. Complications can include heart failure, cardiogenic shock, arrhythmias if not properly managed.
Acute infections of the nervous system like bacterial meningitis can be life-threatening if not recognized and treated early. The document discusses various acute infections including bacterial meningitis, viral meningitis, encephalitis, and fungal infections. It provides details on the clinical presentation, diagnosis, and management of bacterial meningitis, which is often characterized by the classic triad of fever, headache, and neck stiffness, and requires prompt lumbar puncture and antibiotic treatment to identify the pathogen and prevent complications.
This document discusses the evaluation of syncope in adults. Syncope is defined as a brief, self-limited loss of consciousness due to decreased blood flow to the brain. The causes of syncope can be categorized as neurally-mediated, orthostatic, cardiac, or structural/cardiopulmonary. A thorough history, physical exam, and diagnostic testing are needed to determine the underlying cause and guide treatment. The history provides clues to distinguish syncope from other conditions and identify risk factors, while the physical exam focuses on vital signs and signs of end-organ damage or dysfunction.
Acute rheumatic fever is a multisystem disease caused by an autoimmune reaction to a Group A streptococcal infection. It commonly affects children between 5-14 years old in developing countries. Symptoms include migratory polyarthritis, carditis, chorea, and skin manifestations. Diagnosis is based on clinical features and evidence of a preceding streptococcal infection. Treatment involves antibiotics to prevent recurrence and symptom relief. Ongoing antibiotic prophylaxis is also needed long-term to prevent recurrence, especially in those who develop cardiac involvement.
The document discusses infective endocarditis, including:
1. Vegetations form on heart valves from bacterial deposition, usually due to a susceptible cardiovascular substrate and source of bacteremia. Common causes are streptococcus, staphylococcus, and enterococcus.
2. Predisposing factors include age, pre-existing heart conditions, dental procedures, injection drug use, and medical implants.
3. Treatment involves antibiotics to eradicate the infection and sometimes surgery for complications. Outcomes depend on the causative organism and severity of cardiac involvement.
The document discusses shock and sepsis. It defines shock as a clinical condition characterized by a fast pulse rate and low blood pressure. The main types of shock discussed are hypovolemic, cardiogenic, septic, anaphylactic, and neurogenic. Sepsis is defined as a life-threatening organ dysfunction caused by the body's response to an infection. As sepsis progresses it can lead to septic shock, which is associated with high mortality. The stages of shock and signs and symptoms of early and late sepsis are also summarized.
LECTURE ON ATRIAL FIBRILLATION TO 9TH TERM MEDICAL STUDENTS REFERENCES: DAVIDSON(2018) HARRISON 20TH ED OF MEDICINE AND 2020 EUROPEAN HEART GUIDELINES ON AF
This document provides an overview of endocarditis. It defines endocarditis as a microbial infection of the endocardial surface of the heart, most commonly affecting heart valves. A characteristic pathological lesion is a vegetation composed of platelets, fibrin, microorganisms, and inflammatory cells. The document discusses the pathogenesis, epidemiology, clinical presentations, diagnosis, complications including septic thrombophlebitis and mycotic aneurysms, treatment with antibiotics and surgery, and mortality rates associated with different causative organisms.
This document discusses infective endocarditis, which is a microbial infection of the heart valves or inner lining of the heart. It forms vegetations composed of thrombotic debris and organisms that can damage the heart valves. It is usually caused by bacteria entering the bloodstream, with common culprits being streptococci and staphylococci. Risk factors include pre-existing heart valve problems, intravenous drug use, and dental procedures. It can range from acute to subacute and cause complications like heart failure, neurological problems, and kidney damage if not properly treated with antibiotics and possibly surgery to repair or replace damaged valves. Nursing care focuses on monitoring for worsening symptoms and preventing further infection.
Basic description of Infective Endocarditis from a Clinical and Microbiological point of view with description on Pathogenesis, Clinical Manifestations, Clinical and Laboratory diagnosis.
Infective endocarditis is an infection of the heart valves or inner lining of the heart that is usually caused by bacteria entering the bloodstream. It can cause inflammation of the heart valves and formation of vegetations, which can lead to heart failure, embolic episodes, or death if not treated properly with antibiotics and sometimes surgery. The document discusses the definition, causes, clinical presentation, diagnosis, and treatment of infective endocarditis.
This document provides an overview of infective endocarditis, including its definition, epidemiology, anatomy, pathogenesis, classification, etiology, risk factors, clinical manifestations, diagnosis, management, and complications. Infective endocarditis is a bacterial or fungal infection of the heart valves or endocardium. It most commonly affects the mitral valve and is usually caused by streptococci, staphylococci, or enterococci. It can be acute or subacute and is diagnosed using the modified Duke criteria.
Blood stream infections- clinical microbiologySijo A
Blood stream infections (BSI) refers to the presence of organisms in blood which are threat to every organ in the body.
It causes shock, multiple organ failure and DIC (Disseminated Intravascular Coagulation).
The presence of bacteria in blood is called Bacteremia.
The bacteria circulate and actively multiply in the blood stream is called Septicemia.
The presence of virus in blood is called Viremia.
The presence of parasite in blood is called Parasitemia.
The presence of fungi in blood is called Fungemia.
Infective endocarditis is an infection of the inner lining of the heart (endocardium) that involves the heart valves and adjacent structures. It is caused by bacteria or fungi entering the bloodstream and can lead to heart valve damage or death. Common symptoms include fever, fatigue, heart murmur. Diagnosis involves blood cultures, echocardiogram, and the modified Duke criteria. Treatment involves antibiotic therapy, which depends on the identified organism. Prevention focuses on proper dental hygiene and antibiotic prophylaxis for certain at-risk patients before invasive procedures.
This document discusses infective endocarditis, including trends, classifications, microbiology, pathogenesis, clinical manifestations, diagnosis and treatment. Some key points:
- IE is an infection of the heart valves or endocardium that is usually caused by bacteria. Common predisposing factors include rheumatic heart disease and intravenous drug use.
- It is classified based on several factors such as the site of infection, causative organism, and underlying risk factors. Acute IE has a rapid course while subacute IE progresses more slowly.
- Common symptoms include heart murmurs, heart failure, embolic phenomena affecting organs like the brain, lungs and kidneys. Specific findings include petechiae, splinter
This document provides an overview of infective endocarditis, including its definition, pathogenesis, epidemiology, clinical presentation, diagnosis, and treatment. It defines infective endocarditis as a microbial infection of the heart valves or endocardium. It discusses the typical pathogens involved and describes the formation of vegetations on heart valves. It also outlines the diagnostic criteria, including blood cultures and echocardiography. Treatment involves prolonged antibiotic therapy tailored to the causative organism, and may require surgery in cases of heart failure or uncontrolled infection.
Diagnosis and Management of Infective Endocarditis
Modified Dukes Criteria
Imaging Modalities
Standard Treatment Guidelines
Organism Specific Antibiotic coverage
Meningitis is always cerebrospinal infection. Meningitis is a rare infection that affects the delicate membranes -- called meninges -- that cover the brain and spinal cord.There are several types of this disease, including bacterial, viral, and fungal.
Infective endocarditis is an infection of the heart valves or endocardium. It has variable presentations ranging from acute and rapidly progressive to subacute and indolent. Key diagnostic criteria include identifying the infecting pathogen through blood cultures or other tests and detecting valvular vegetations or complications through echocardiography. Complications can involve the heart, brain, kidneys and other organs due to septic emboli. Treatment involves antibiotics and may require cardiac surgery.
Infective endocarditis is a condition where the inner lining of the heart (endocardium) becomes infected by bacteria or other microorganisms. It typically occurs where there is pre-existing heart valve damage. The infection can cause heart valve damage and formation of clumps (vegetations) that can break off and spread through the bloodstream (embolize). Presentation depends on the causative organism and can range from non-specific fever to new heart murmurs or signs of embolization. Diagnosis is based on blood cultures and echocardiography, while treatment involves prolonged antibiotic therapy and may require heart valve replacement surgery. Risk factors include rheumatic or congenital heart disease, prosthetic heart
Microbes affecting the Cardiovas Syst.pptxSuhaybCumar2
Viridans streptococci are a group of commensal bacteria that normally inhabit the mouth and gastrointestinal tract. They are a common cause of subacute bacterial endocarditis, in which the bacteria enter the bloodstream through small mucosal lesions and colonize on damaged heart valves, forming vegetations. While usually harmless commensals, certain species like S. gordonii and S. sanguis are pathogenic and known to cause subacute bacterial endocarditis. It is important to differentiate viridans streptococci from other streptococcal species like S. pneumoniae because they require different treatment approaches. Enterococci are another group of bacteria including E. faecalis and E. faecium
Infective endocarditis is a condition where the inner lining of the heart (endocardium) becomes inflamed due to a bacterial or fungal infection. It often involves the heart valves and can cause growths called vegetations that can break off and travel to other organs. It is classified based on the causative organism (bacteria, fungus) and whether the person has a normal or abnormal heart/valves. Common symptoms include fever, heart murmur, skin lesions, and potential complications involving the brain, lungs, kidneys, and spleen. Diagnosis involves blood cultures, echocardiography, and the modified Duke criteria.
Infective endocarditis is a microbial infection of the heart valves or endocardium. It is characterized by the formation of vegetations composed of platelets, fibrin, microorganisms, and inflammatory cells. It occurs more commonly in males and the elderly. Streptococci and Staphylococcus aureus are the most common causes. Diagnosis involves blood cultures, echocardiography, and applying the Duke criteria. Complications include embolisms, heart failure, and metastatic infections. Treatment involves prolonged antibiotic therapy targeted to the infecting organism. Surgery may be needed for complications or uncontrolled infection. Antibiotic prophylaxis is now restricted to highest risk patients undergoing highest risk procedures.
Infective endocarditis is a microbial infection of the heart valves or endocardium. It is characterized by the formation of vegetations composed of platelets, fibrin, microorganisms, and inflammatory cells. It occurs more commonly in males and the elderly. Streptococci and Staphylococcus aureus are the most common causes. Diagnosis involves blood cultures, echocardiography, and applying the Duke criteria. Complications include embolisms, heart failure, and metastatic infections. Treatment involves prolonged antibiotic therapy targeted to the infecting organism. Surgery may be needed for complications or uncontrolled infection. Antibiotic prophylaxis is now restricted to highest risk patients undergoing highest risk procedures.
This document provides information about infective endocarditis:
- Infective endocarditis involves infection of the heart valves and inner lining of the heart. Common causes are bacteria entering the bloodstream from dental, respiratory, or other procedures.
- The infection can cause growths (vegetations) on the heart valves that can break off and block blood vessels in the brain, lungs, kidneys or other organs.
- Risk factors include previous heart damage, dental and surgical procedures, and some reproductive or congenital conditions. Investigations include blood tests, cultures, ECG and echocardiography. Complications may require surgery to repair or replace damaged valves.
Similaire à infective endocarditis - KUTOSI Joseph.pptx (20)
Our backs are like superheroes, holding us up and helping us move around. But sometimes, even superheroes can get hurt. That’s where slip discs come in.
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central19various
Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central Clinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa CentralClinic ^%[+27633867063*Abortion Pills For Sale In Tembisa Central
Local Advanced Lung Cancer: Artificial Intelligence, Synergetics, Complex Sys...Oleg Kshivets
Overall life span (LS) was 1671.7±1721.6 days and cumulative 5YS reached 62.4%, 10 years – 50.4%, 20 years – 44.6%. 94 LCP lived more than 5 years without cancer (LS=2958.6±1723.6 days), 22 – more than 10 years (LS=5571±1841.8 days). 67 LCP died because of LC (LS=471.9±344 days). AT significantly improved 5YS (68% vs. 53.7%) (P=0.028 by log-rank test). Cox modeling displayed that 5YS of LCP significantly depended on: N0-N12, T3-4, blood cell circuit, cell ratio factors (ratio between cancer cells-CC and blood cells subpopulations), LC cell dynamics, recalcification time, heparin tolerance, prothrombin index, protein, AT, procedure type (P=0.000-0.031). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and N0-12 (rank=1), thrombocytes/CC (rank=2), segmented neutrophils/CC (3), eosinophils/CC (4), erythrocytes/CC (5), healthy cells/CC (6), lymphocytes/CC (7), stick neutrophils/CC (8), leucocytes/CC (9), monocytes/CC (10). Correct prediction of 5YS was 100% by neural networks computing (error=0.000; area under ROC curve=1.0).
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Osteoporosis - Definition , Evaluation and Management .pdfJim Jacob Roy
Osteoporosis is an increasing cause of morbidity among the elderly.
In this document , a brief outline of osteoporosis is given , including the risk factors of osteoporosis fractures , the indications for testing bone mineral density and the management of osteoporosis
Cell Therapy Expansion and Challenges in Autoimmune DiseaseHealth Advances
There is increasing confidence that cell therapies will soon play a role in the treatment of autoimmune disorders, but the extent of this impact remains to be seen. Early readouts on autologous CAR-Ts in lupus are encouraging, but manufacturing and cost limitations are likely to restrict access to highly refractory patients. Allogeneic CAR-Ts have the potential to broaden access to earlier lines of treatment due to their inherent cost benefits, however they will need to demonstrate comparable or improved efficacy to established modalities.
In addition to infrastructure and capacity constraints, CAR-Ts face a very different risk-benefit dynamic in autoimmune compared to oncology, highlighting the need for tolerable therapies with low adverse event risk. CAR-NK and Treg-based therapies are also being developed in certain autoimmune disorders and may demonstrate favorable safety profiles. Several novel non-cell therapies such as bispecific antibodies, nanobodies, and RNAi drugs, may also offer future alternative competitive solutions with variable value propositions.
Widespread adoption of cell therapies will not only require strong efficacy and safety data, but also adapted pricing and access strategies. At oncology-based price points, CAR-Ts are unlikely to achieve broad market access in autoimmune disorders, with eligible patient populations that are potentially orders of magnitude greater than the number of currently addressable cancer patients. Developers have made strides towards reducing cell therapy COGS while improving manufacturing efficiency, but payors will inevitably restrict access until more sustainable pricing is achieved.
Despite these headwinds, industry leaders and investors remain confident that cell therapies are poised to address significant unmet need in patients suffering from autoimmune disorders. However, the extent of this impact on the treatment landscape remains to be seen, as the industry rapidly approaches an inflection point.
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd...Donc Test
TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version TEST BANK For Community and Public Health Nursing: Evidence for Practice, 3rd Edition by DeMarco, Walsh, Verified Chapters 1 - 25, Complete Newest Version Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Chapters Download Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Download Stuvia Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Study Guide Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Ebook Download Stuvia Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Questions and Answers Quizlet Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Studocu Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Quizlet Test Bank For Community and Public Health Nursing: Evidence for Practice 3rd Edition Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Chapters Download Community and Public Health Nursing: Evidence for Practice 3rd Edition Pdf Download Course Hero Community and Public Health Nursing: Evidence for Practice 3rd Edition Answers Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Ebook Download Course hero Community and Public Health Nursing: Evidence for Practice 3rd Edition Questions and Answers Community and Public Health Nursing: Evidence for Practice 3rd Edition Studocu Community and Public Health Nursing: Evidence for Practice 3rd Edition Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Pdf Chapters Download Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Pdf Download Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Study Guide Questions and Answers Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Ebook Download Stuvia Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Questions Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Studocu Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Quizlet Community and Public Health Nursing: Evidence for Practice 3rd Edition Test Bank Stuvia
2. EXPECTATIONS OF THIS PRESENTATION
• Introduction ( definition and important notes )
• Epidemiology
• Risk factors
• Etiology and pathophysiology
• Signs and symptoms
• Diagnosis [ Modified dukes criteria and ESC- criteria)
• Management and prognosis.
• Prevention.
• Q & A session and supplements.
3. INTRODUCTION
• Infective endocarditis is infection of the endocardium, usually with bacteria (commonly, streptococci
or staphylococci) or fungi.
• It may cause fever, heart murmurs, petechiae, anemia, embolic phenomena, and endocardial
vegetations.
• Vegetations may result in valvular incompetence or obstruction, myocardial abscess, or mycotic
aneurysm.
• Diagnosis requires demonstration of microorganisms in blood and usually echocardiography.
• Treatment consists of prolonged antimicrobial treatment and sometimes surgery.
4. INTRODUCTION
• Endocarditis usually refers to infection of the endocardium (ie, infective
endocarditis).
• The term can also include noninfective endocarditis, in which sterile
platelet and fibrin thrombi form on cardiac valves and adjacent
endocardium.
• Noninfective endocarditis sometimes leads to infective endocarditis.
• Both can result in embolization and impaired cardiac function.
• The diagnosis of infective endocarditis is usually based on a
constellation of clinical findings rather than a single definitive test result.
5. EPIDEMIOLOGY OF INFECTIVE
ENDOCARDITIS
• In the United States, the incidence of IE is approximately 12.7 cases per
100,000 persons per year.
• The incidence of IE in other countries is similar to that in the United States.
• The proportion of patients with intracardiac devices has increased from
13.3% to 18.9%, whereas the proportion of cases with a background of HIV
infection or IV drug abuse has fallen.
• The mean age of patients has increased from 58.6 to 60.8 years and
continues to rise; more than 50% of patients are older than 50 years
• Infective endocarditis is 3 times more common in males than in females. It
exhibits no racial predilection.
Adapted from medscape mobile app [latest version Feb 2023].
6. EPIDEMIOLOGY OF INFECTIVE
ENDOCARDITIS IN AFRICA: A SYSTEMATIC
REVIEW AND META-ANALYSIS. 2022.
• Rheumatic heart disease was the most common risk factor for infective endocarditis in adults - 52%,
whereas congenital heart disease was the most common risk factor for infective endocarditis in
children (44·7%)
• Microbiological testing (mostly blood cultures) was positive in 48·6% of patients with infective
endocarditis, with Staphylococcus species 41.3% and Streptococcus species (34·0% ) the most
commonly identified microorganisms.
• The pooled rate of surgical treatment of infective endocarditis was 49·1%.
• The pooled in-hospital mortality rate was 22·6%.
• Other frequent complications included heart failure (47·0%), acute kidney injury (22·8), and embolic
events (31·1% ).
Adapted from https://www.thelancet.com/journals/langlo/article/PIIS2214-109X(21)00400-9/fulltext
7. RISK FACTORS OF INFECTIVE
ENDOCARDITIS
• Infective endocarditis can occur at any age.
• Men are affected about twice as often as women.
• Incidence of infection and mortality increase with increasing age.
• Patients who use illicit intravenous drugs, immunocompromised patients, patients with prosthetic
heart valves and other intracardiac devices are at highest risk.
• There is also an increased risk in patients with indwelling intravascular catheters.
8. ETIOLOGY AND PATHOPHYSIOLOGY
• The normal heart is relatively resistant to infection. Bacteria and fungi do
not easily adhere to the endocardial surface, and constant blood flow
helps prevent them from settling on endocardial structures. Thus, 2
factors are typically required for endocarditis:
1.A predisposing abnormality of the endocardium
2.Microorganisms in the bloodstream (bacteremia)
Important to note that Massive bacteremia or particularly virulent
microorganisms (eg, Staphylococcus aureus) cause endocarditis on normal
valves.
9. ETIOLOGY AND PATHOPHYSIOLOGY OF
INFECTIVE ENDOCARDITIS
The disease develops in 3 stages:
Bacteremia: Microorganisms are present in the blood
Adhesion: The microorganism adheres to abnormal or damaged
endothelium via surface adhesions
Colonization: Proliferation of the organism together with inflammation,
leading to a mature vegetation
Many of the causative microorganisms produce polysaccharide biofilms
that shield them from host immune defences and impede antibiotic
penetration.
10. ETIOLOGY AND PATHOPHYSIOLOGY OF
INFECTIVE ENDOCARDITIS
• The normal heart is relatively resistant to infection. Bacteria and fungi do
not easily adhere to the endocardial surface, and constant blood flow
helps prevent them from settling on endocardial structures.
Two factors are typically required for endocarditis:
1. A predisposing abnormality of the endocardium
2. Microorganisms in the bloodstream (bacteremia)
Massive bacteremia or particularly virulent microorganisms (eg, S. aureus)
cause endocarditis on normal valves.
11. ETIOLOGY AND PATHOPHYSIOLOGY
[ENDOCARDIAL FACTORS]
• Usually involves the heart valves
• Congenital heart defects, rheumatic valvular
disease, bicuspid aortic valves, calcific aortic
valves, mitral valve prolapse, hypertrophic
cardiomyopathy, and prior endocarditis.
• Prosthetic valves and other intracardiac
devices.
• Occasionally, mural thrombi, ventricular septal
defects, and patent ductus arteriosus sites
become infected.
• The nidus for infection is usually a sterile fibrin-
platelet vegetation formed when damaged
endothelial cells release tissue factor.
• Infective endocarditis occurs most often on the
left side (eg, mitral or aortic valve).
• About 10 to 20% of cases are right-sided
(tricuspid or pulmonic valve).
• Patients who use illicit intravenous drugs have
a much higher incidence of right-sided
endocarditis (about 30 to 70%
12. ETIOLOGY AND PATHOPHYSIOLOGY OF
INFECTIVE ENDOCARDITIS
The disease develops in 3 stages:
1.Bacteremia: Microorganisms are present in the
blood
2. Adhesion: The microorganism adheres to
abnormal or damaged endothelium via surface
adhesions
3. Colonization: Proliferation of the organism
together with inflammation, leading to a mature
vegetation
Many of the causative microorganisms produce
polysaccharide biofilms that shield them from host
immune defences and impede antibiotic
penetration.
• Causative organisms vary by site of
infection, source of bacteremia, and host
risk factors (eg, IV illicit drug use), but
overall, streptococci and Staphylococcus
aureus cause 80 to 90% of cases.
• Enterococci, gram-negative bacilli,
HACEK organisms (Haemophilus
species, Actinobacillus
actinomycetemcomitans,
Cardiobacterium hominis, Eikenella
corrodens, and Kingella kingae), and
fungi cause most of the rest.
13. ETIOLOGY AND PATHOPHYSIOLOGY OF INFECTIVE
ENDOCARDITIS
Local consequences.
• Myocardial abscesses with tissue destruction and
sometimes conduction system abnormalities (usually
with low septal abscesses)
• Sudden, severe valvular regurgitation, causing heart
failure and death (usually due to mitral or aortic valve
lesions)
• Aortitis due to contiguous spread of infection
• Prosthetic valve infections are particularly likely to
involve valve ring abscesses, obstructing vegetations,
myocardial abscesses, and mycotic aneurysms
manifested by valve obstruction, dehiscence, and
conduction disturbances.
Systemic consequences
• Systemic consequences of endocarditis are primarily due
to
• Embolization of infected material from the heart valve
• Immune-mediated phenomena (primarily in chronic
infection)
• Right-sided lesions produce septic pulmonary emboli,
resulting in pulmonary infarction, pneumonia, or
empyema.
• Left-sided lesions may embolize to any tissue,
particularly the kidneys, spleen, and central nervous
system.
• Mycotic aneurysms can form in any major artery.
• Cutaneous and retinal emboli are common.
• Diffuse glomerulonephritis may result from immune
complex deposition.
14. CLASSIFICATION OF INFECTIVE
ENDOCARDITIS
• Infective endocarditis may have an indolent, subacute course or a more
acute, fulminant course with greater potential for rapid decompensation.
• Classification is based on this and wether or not there is a prothethis, i.e
1. Sub acute Bacterial endocarditis
2. Acute bacterial endocarditis
3. Prosthetic valve endocarditis
15. SUBACUTE BACTERIAL ENDOCARDITIS
(SBE).
• Although aggressive, usually develops insidiously and progresses slowly
(ie, over weeks to months).
• Often, no source of infection or portal of entry is evident. SBE is caused
most commonly by streptococci (especially viridans, microaerophilic,
anaerobic, and nonenterococcal group D streptococci and enterococci).
• Less commonly by S. aureus, Staphylococcus epidermidis, Gemella
morbillorum, Abiotrophia defectiva (formerly, Streptococcus defectivus),
Granulicatella species, and fastidious Haemophilus species.
• SBE often develops on abnormal valves after asymptomatic bacteremia
due to periodontal, gastrointestinal, or genitourinary infections.
16. ACUTE BACTERIAL ENDOCARDITIS (ABE)
• Acute Bacterial endocarditis usually develops abruptly and progresses
rapidly (ie, over days).
• A source of infection or portal of entry is often evident.
• When bacteria are virulent or bacterial exposure is massive, ABE can
affect normal valves.
• It is usually caused by S. aureus, group A hemolytic streptococci,
pneumococci, or gonococci.
17. PROSTHETIC VALVULAR ENDOCARDITIS
(PVE)
• Develops in 2 to 3% of patients within 1 year after valve replacement and in 0.5%/year
thereafter.
• It is more common after aortic than after mitral valve replacement and affects
mechanical and bioprosthetic valves equally.
• Early-onset infections (< 2 months after surgery) are caused mainly by contamination
during surgery with antimicrobial-resistant bacteria (eg, S. epidermidis, diphtheroids,
coliform bacilli) or by fungi (eg, Candida species, Aspergillus species).
• Late-onset infections are caused mainly by contamination with low-virulence
organisms during surgery or by transient asymptomatic bacteremias, most often with
streptococci; S. epidermidis; diphtheroids; and the fastidious gram-negative bacilli,
Haemophilus species, Actinobacillus actinomycetemcomitans, and Cardiobacterium
hominis.
18. TYPES OF INFECTIVE ENDOCARDITIS
• Endocarditis has evolved into several variations, keeping it near the top
of the list of diseases that must not be misdiagnosed or overlooked.
• Endocarditis can be broken down into the following categories
1. Native valve endocarditis (NVE), acute and subacute
2. Prosthetic valve endocarditis (PVE), early and late
3. Intravenous drug abuse (IVDA) endocarditis.
4. Other terms commonly used to classify types of IE include pacemaker
IE and nosocomial IE (NIE)
19. SIGNS AND SYMPTOMS OF INFECTIVE
ENDOCARDITIS
• Symptoms and signs vary based on the classification but are usually
nonspecific.
In Sub acute bacterial endocarditis
Initially, symptoms of SBE are vague.
• low-grade fever (< 39° C), night sweats, fatigability, malaise, and weight loss.
• Chills and arthralgias may occur.
Symptoms and signs of valvular insufficiency may be a first clue.
• Initially, ≤ 15% of patients have fever or a murmur, but eventually almost all
develop both.
• Physical examination may be normal or include pallor, fever, change in a
preexisting murmur or development of a new regurgitant murmur, and
tachycardia.
20. SIGNS AND SYMPTOMS
• Retinal emboli can cause round or oval hemorrhagic retinal lesions with small white
centers (Roth spots).
• Cutaneous manifestations include petechiae (on the upper trunk, conjunctivae,
mucous membranes, and distal extremities), painful erythematous subcutaneous
nodules on or near the tips of digits (Osler nodes), nontender hemorrhagic macules or
papules on the palms or soles (Janeway lesions), and splinter hemorrhages under the
nails.
• About 35% of patients have central nervous system (CNS) effects, including transient
ischemic attacks, stroke, toxic encephalopathy (due to infective microemboli), and, if a
mycotic CNS aneurysm ruptures, brain abscess and subarachnoid hemorrhage.
• Renal emboli may cause flank pain and, rarely, gross hematuria.
• Splenic emboli may cause left upper quadrant pain. Prolonged infection may cause
splenomegaly or clubbing of fingers and toes.
21. SIGNS AND SYMPTOMS
Acute bacterial endocarditis and prosthetic valvular endocarditis.
• Symptoms and signs of acute bacterial endocarditis and prosthetic valvular
endocarditis are similar to those of subacute bacterial endocarditis, but the course is
more rapid.
• Fever is almost always present initially, and patients appear toxic; sometimes septic
shock develops.
• Heart murmur is present initially in about 50 to 80% and eventually in > 90%.
• Rarely, purulent meningitis occurs.
Right-sided endocarditis
• Septic pulmonary emboli may cause cough, pleuritic chest pain, and sometimes
hemoptysis. A murmur of tricuspid regurgitation is typical.
25. COMPLICATIONS OF INFECTIVE
ENDOCARDITIS
• Myocardial infarction, pericarditis, cardiac arrhythmia
• Cardiac valvular insufficiency
• Congestive heart failure
• Sinus of Valsalva aneurysm(an abnormal dilatation of the aortic root located between the aortic valve
annulus and the sinotubular junction)
• Aortic root or myocardial abscesses
• Arterial emboli, infarcts, mycotic aneurysms
• Arthritis, myositis
• Glomerulonephritis, acute renal failure
• Stroke syndromes
• Mesenteric or splenic abscess or infarct
26. DIAGNOSIS OF INFECTIVE
ENDOCARDITIS
• Because symptoms and signs are nonspecific, vary greatly, and may
develop insidiously, diagnosis requires a high index of suspicion.
• Endocarditis should be suspected in patients with fever and no obvious
source of infection, particularly if a heart murmur is present.
Diagnosis involves;
1. Blood culture
2. Echocardiography and sometimes other imaging modalities
3. Clinical criteria
27. BLOOD CULTURES
• Identification of the organism and its antimicrobial susceptibility is vital to guide
treatment.
• Three ( 3 ) blood samples for culture (20-mL each) should be obtained, ideally > 6
hours apart (if presentation suggests acute bacterial endocarditis, 2 cultures within the
first 1 to 2 hours).
• Each set of cultures should be obtained from a separate, fresh venipuncture site.
• When endocarditis is present and no prior antibiotic therapy was given, all 3 blood
cultures usually are positive because the bacteremia is continuous; at least one culture
is positive in 99%.
• Premature use of empiric antibiotic therapy should be avoided in patients with
acquired or congenital valvular or shunt lesions to avoid culture-negative endocarditis.
• If prior antimicrobial therapy was given, blood cultures should still be obtained, but
results may be negative.
28. OTHER LABORATORY INVESTIGATIONS
• Other than positive blood cultures, there are no specific laboratory
findings.
• Established infections often cause a normocytic-normochromic anemia,
elevated WBC , increased ESR, increased immun IG levels, the presence
of circulating immune complexes and RF's, but these findings are not
diagnostically helpful.
• Urinalysis often shows microscopic hematuria and, occasionally, red
blood cell casts, pyuria, or bacteriuria.
29. IMAGING STUDIES
• Transthoracic echocardiography (TTE) should be done initially and has
sensitivity of 50 to 90% and specificity > 90%. Transesophageal
echocardiography (TEE) can reveal vegetations too small to be seen on TTE
with a sensitivity of 90 to 100%.
• Transesophageal echocardiography should be done when
1. Patients have a prosthetic valve (where TTE sensitivity is limited)
2. Transthoracic echocardiogram is nondiagnostic
3. Diagnosis of infective endocarditis has been established clinically (done to
detect perforations, abscesses, and fistulas)
NOTE ; Serial TEE enables diagnosis of complications that evolve during
treatment, such as increasing vegetation size or abscess formation.
30. IMAGING STUDIES
• CT-Scan can fully define paravalvular abscesses and detect mycotic
aneurysms.
• Positron emission tomography (PET) scanning improves the sensitivity of the
modified Duke criteria without compromising specificity.
• PET scanning also detects extracardiac infection, such as septic emboli, and
is an emerging tool for the diagnosis of endocarditis originating in prosthetic
and intracardiac devices.
• CT and PET abnormalities are now included as major criteria in the European
guidelines.
• Routine brain imaging has been proposed because up to 60% of patients
have clinically silent lesions. It’s utility for prognosis and management is yet
to be defined.
31. DIAGNOSTIC CRITERIA
• Infective endocarditis is definitively diagnosed when microorganisms are
seen histologically in (or cultured from) endocardial vegetations
obtained during cardiac surgery, embolectomy, or autopsy.
• Because vegetations are not usually available for examination, there are
various clinical criteria for establishing a diagnosis.
• They include ;
1. Modified Duke Criteria —with a sensitivity and specificity > 90%, and
2. The European Society of Cardiology (ESC) 2015 modified criteria.
32. MODIFIED DUKES CRITERIA
Endocarditis is felt to be present in the following
conditions:
Direct evidence of endocarditis based upon
histological findings (a pathological criterion)
Positive Gram stain results or cultures of
specimens obtained from surgery or autopsy (a
pathological criterion)
-2 major clinical criteria
-1 major and any 3 minor clinical criteria
-5 minor clinical criteria
Possible endocarditis’ is defined by 1 major and 1
or 2 minor clinical criteria, OR 3 minor clinical
The diagnosis of endocarditis is ‘rejected’ in any
of the following cases:
- a firm alternate diagnosis is made
- clinical manifestations resolve after ≤4 days of
antibiotic therapy
- no pathological evidence of infective
endocarditis is found at surgery or autopsy after
antibiotic therapy for ≤4 days
- fail to meet criteria for for possible or definite
infective endocarditis
34. THE EUROPEAN SOCIETY OF
CARDIOLOGY CRITERIA
• The ESC criteria are similar to the modified Duke criteria but include
expanded imaging results as major criteria as follows:
1. Vegetation, abscess, pseudoaneurysm, intracardiac fistula, valvular
perforation or aneurysm, or new partial dehiscence of prosthetic valve
identified by echocardiography
2. Abnormal activity around a prosthetic valve (implanted > 3 months
earlier) detected by PET/CT or single-photon emission computed
tomography (SPECT)/CT with radiolabeled leukocytes
3. Paravalvular lesions identified by cardiac
• The ESC also differs from the modified Duke minor criteria by specifying that
detecting silent vascular phenomena by imaging only is sufficient.
35. MANAGEMENT
• IV antibiotics.
• Sometimes valve debridement, repair, or replacement
• Dental evaluation and treatment.
• Removal of potential source of bacteremia.
• Withholding anticoagulation in patients with cerebral embolism
36. UGANDA CLINICAL GUIDELINES (UCG) ANTIBIOTICS FOR
INFECTIVE ENDOCARDITIS
Initial empirical antibiotic therapy
• Benzylpenicillin 5 MU IV every 6 hours for 4 weeks
• Plus gentamicin 1 mg/kg IV every 8 hours for 2 weeks.
If staphylococcus suspected, (acute onset) add:
• Cloxacillin IV 3 g every 6 hours.
If MRSA (Multi-Resistant Staphylococcus aureus).
• Vancomycin 500 mg IV every 6 hours for 6 weeks.
37. PROGNOSIS
Overall, the in-hospital mortality rate for endocarditis is 15 to 20%, with a 1-year mortality rate approaching 40%.
Untreated, infective endocarditis is always fatal. Even with treatment, death is more likely and the prognosis is generally poorer for
older people and people who have
• Infection with resistant organisms
• An underlying disorder
• A long delay in treatment
• Aortic valve or multiple valve involvement
• Large vegetations
• Polymicrobial bacteremia
• Prosthetic valve infections
• Mycotic aneurysms
• Valve ring abscess
• Major embolic events
38. PROGNOSIS
• Septic shock is more likely in patients with diabetes, acute kidney injury,
S. aureus infection, vegetation size > 15 mm, and signs of persistent
infection.
• The mortality rate for viridans streptococcal endocarditis without major
complications is < 10% but is virtually 100% for Aspergillus endocarditis
after prosthetic valve surgery.
• The prognosis is better with right-sided than left-sided endocarditis
because tricuspid valve dysfunction is tolerated better, systemic emboli
are absent, and right-sided S. aureus endocarditis responds better to
antimicrobial therapy.
39. PREVENTION OF INFECTIVE
ENDOCARDITIS
• Preventive dental examination and therapy before surgery to repair heart valves or congenital heart
lesions is recommended.
• Measures to reduce health care–acquired bacteremia aim to curb the rising incidence of iatrogenic
bacteremia and subsequent endocarditis are also recommended.
• During implantation of prosthetic devices, prophylaxis often involves use of amoxicillin/clavulanic acid.
• Dental and cutaneous hygiene is recommended for the general population but particularly for patients at
intermediate risk (those with native valve disease) and high-risk.
40. PREVENTION OF INFECTIVE
ENDOCARDITIS.
• Prosthetic heart valves, including transcatheter implanted prostheses
• Prosthetic material used for heart valve repair (eg, annuloplasty rings,
chords)
• Previous infective endocarditis
• Certain congenital heart diseases (CHD): Unrepaired cyanotic CHD
(including palliative shunts and conduits), completely repaired CHD
during the first 6 mo after surgery if prosthetic material or device was
used, repaired CHD that has residual defects at or adjacent to the site of
repair
• Heart transplant recipients with valvulopathy
41. LIBAN SACKS ENDOCARDITIS
• Non infection related endocarditis associated with Systemic lupus
erytheramatosus
• Antigen-antibody complexes.
• Affects mainly the mitral valve, but can affect both atrial and ventricular
endocardium.
42. THANK YOU NOTE AND REFERENCES
Thank you for paying attention, may you be able to prevent infective
endocarditis and efficiently manage patient presenting with the condition.
References
1.Davidsons
2. Uganda clinical guidelines (UCG)
3. Merck manuals (MSD) 2022.