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51 Cards in this Set
- Front
- Back
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What kind of infection is IE?
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Endovascular
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Where does it infect?
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Cardiac valves
Atrial and ventricular endocardium Large intrathoracic vessles Intracardiac foreign bodies (Prosthetic valves, Pacemaker leads, surgical conduits) |
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What 2 factors does Infective endocarditis depend on?
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1. Presence of bacteria in the bloodstream
2. Abnormal cardiac endothelium facilitating their adherence and growth |
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When might bacteraemia occur?
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Poor dental hygiene
IV drug use Soft tissue infection |
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What diagnostic/ therapeutic proceedures is IE associated with?
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Dental treatment
IV cannulae Cardiac surgery Permanent pacemakers |
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What does damaged endocardium promote?
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Platelet and fibrin deposition
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What does platelet and fibrin deposition allow?
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Organisms to adhere and grow = infected vegetation
Valvular lesions may create non- laminar flow |
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Which valves are most commonly involved?
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Aortic and Mitral
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Which side is associated with IV drug users?
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Right side
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What organisms are commonly associated with the mouth causing IE?
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Alpha haemolytic streptococcus viridans
(Strep mutans/ Strep sanguis/ Strep oralis/ Strep milleri) |
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Which bacteria are associated with IV drug users?
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Staph aureus
Candida |
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IE caused by bacteria from the gut and perineum is associated with what?
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Underlying genitourinary disease/ proceedures
Prolonged hospitalisation |
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What bacteria is associated with IE from the gut or perineum?
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Enterococci e.g Faecalis
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What do 1/5 of the cases have?
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Urinary sepsis
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What bacteria is associated with bowel malignancy?
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Strep Bovis
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What bacteria are associated with early prosthetic valve endocarditis?
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Staph aureus
Staph epidermis |
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What is the most common bacteria associated with late prosthetic valve endocarditis?
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Strep Viridans (50-70%)
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What is associated with soft tissue infections and IE?
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Diabetes
IV drug users Patients with long standing and poorly cared for IV catheters |
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What bacteria is associated with soft tissue infections?
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Staph
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What is the acronym used for rare causes of IE?
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HACEK
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What does HACEK stand for?
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(Slow growing, gram negative bacteria)
1. Haemophillus 2. Actinobacillus 3. Cardiobacterium nominis 4. Eikenella Corrodens 5. Kingella |
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What other 6 bacteria are associated with rare causes of IE?
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1. Q fever
2. Brucellolis (Mediterranean fever) 3. Tropheryma (Whipple's) 4. Bartonella 5. Capnocytophagia 6. Mycobacteria |
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What percentage of IE is culture negative?
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5-10%
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Why does culture negative IE occur?
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Due to prior antibiotic therapy
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However, there are some fastidious organisms that fail to grow in normal blood cultures. What are these? (4)
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1. Coxiella Burnetti (cause of Q fever)
2. Chlamydia species 3. Bartonella species (cause trench fever and cat scratch disease) 4. Legionella |
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Name 4 skin lesions that occur in IE?
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1. Splinter haemorrhages
2. Janeway lesions 3. Petechiae (50%) 4. Osler's nodes |
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What are the neurological features that occur with IE?
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Mycotic aneurysm
Cerebral emboli |
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What changes can be seen in the eyes?
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Roth spots
Conjunctival splinter haemorrhages |
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Name 8 other clinical features of IE
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1. Pyrexia (90%)
2. Haematuria (70%) 3. Arthralgia 4. Splenomegaly 5. Malaise 6. Clubbing 7. Murmurs 8. Heart failure (50%) |
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What is clinical presentation dependent on?
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The organisms and the presence of predisposing cardiac conditions
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What types of infection is IE?
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Acute and fulminating
OR Chronic/ subacute with low grade fever and non-specific symptoms |
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What are Osler's nodes?
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Painful, red, raised lesions on hands and feet
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What are Janeways lesions?
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Non tender, small erythematous or haemorrhagic macular/ nodular lesions
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What are petechiae?
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Small red/ purple spot caused by a minor haemorrhage
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What are Roth spots?
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Retinal haemorrhages with white/ pale centres composed of coagulated fibrin
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What changes would IE cause on the ECG?
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PR prolongation
Heart block Both associated with aortic root abscesses |
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Why is a transthoracic echocardiography performed?
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To show abscesses
To show ventricular function Shows valvular dysfunctions Demonstrates vegetations (1st line) |
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Why is a transoesophageal echocardiography performed?
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Greater sensitivity and specificity
Useful in suspected aortic root abscesses Essential in prosthetic valve endocarditis (2nd line) |
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What changes does IE cause on a CXR?
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Pulmonary oedema in left sided disease
Pulmoary emboli/ abscesses in right sided disease |
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What will an FBC show?
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Increased WBC
Decreased Hb Decreased platelets |
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What will U and Es show?
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Increased urea and creatinine
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What will LFTs show?
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Increased serum ALP
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What will be present in the urine?
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Proteinuria
Haematuria |
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How is IE treated?
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Prolonged course of ABx
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What Abx serum levels must be monitored?
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Gentamicin and Vancomycin
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What Abx should be used if the patient has a penicilin allergy?
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Glycopeptide- Vancomycin or Teicoplanin
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What antibiotics should be used in clinical endocarditis with no staph?
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Penicilin 1.2g 4hourly
Gentamicin 80mg 12hourly |
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What antibiotics should be used when there is suspected staph?
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Vancomycin 1g 12hourly
Gentamicin 80-120mg 8hourly |
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What antibiotics should be used in strep endocarditis?
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Penicilin 1.2g 4hourly
Gentamicin 80mg 12hourly |
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What antibiotics should be used in enterococcal endocarditis?
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Ampicillin/ Amoxicillin 2g 4hourly
Gentamicin 80mg 12hourly |
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What antibiotics should be used in staph endocarditis?
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Vancomycin 1g 12hourly
OR Flucloxacillin 2g 4hourly OR Benzylpenicillin 1.2g 4hourly PLUS Gentamicin 80-120mg 8hourly |
