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41 Cards in this Set
- Front
- Back
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what is infective endocarditis |
Infection of the lining of the heart chambers |
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Infective endocarditis is ............ is not treated aggressively |
-leathal |
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IE can become systemic via... |
bacterial sheding |
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what is the primary risk factor for IE? |
Chronic rheumatoid heart disease |
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In HICs new at risk groups have emerged these are? |
-IV drug abusers -Pateient with prostetic heart valves -patients with intravenous catheters -individual undergoing haemodialysis -Elderlypeople with degenerative valve lesions |
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Types of IE - clinical |
- left sided native valve IE (most common) -left sided prostetic valve IE (most sever) -right sided IE (mostly drug abusers) normally effect tripcuspid valve |
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Health care assosiated I.E |
on the rise >30% of I.E in HICs |
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Types of I.E - microbiological -positive blood cultures |
mostly: - Staphylococci - streptococci -Enterococci |
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Types of I.E - microbiological -negative blood cultures due to antibiotic treatment |
most often: - oral streptococci -coagulase negative staphlococci |
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Types of I.E - microbiological -negative blood cultures - |
Usually due to HACEK group (fastidious G-ive baccili) -Brucella -Fungi -nutritionally variant streptococci (abiotrophia & granulicatella) |
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Types of I.E - microbiological - constantly negative blood cultures - |
mostly due to: -intracellular bacteria (coxiella, bartonella & chylamidia) |
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The main causative organism of I.E is : |
S. aureus, Streptococcus and enterococcus |
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I.E is sometime caused by HACEK group organisms: |
Haemophillus, aggregatibacter, cardiobacterium & kingella |
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Other (minority) causative organisms include: |
Coliformes, Pseudomonas, Fungi & atypical coxiella burnetti |
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Pathogenesis stages 1) |
bacteria gain (transient) access to bloodstream |
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Pathogenesis stages 2) |
(arrival via blood) Adherence to injured of inflamed valve surface |
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Pathogenesis stages 3) |
Proliferation at primary site |
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Pathogenesis stages
4) after vaegetation |
dissemination from primary site |
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cells and componentsinvolved at I.E site of infection : |
-Bacteria -activated platelets -Fibrin (proteins) - Endothelial cells (all underlines by sub-endotherlial matrix) |
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endothelial damage is caused by what? |
-Turbulent blood flow - solid particles -inflammation -other infections |
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Pre-existing cardiac lesions can lead to ...... |
Endothelial damage |
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Endothelial damage can then lead to .......... |
Sterile thrombus (non bacterial thrombocytic endocarditis) |
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- Sterile thrombus (non bacterial thrombocytic endocarditis) + - transient bacteria can lead to .............. |
Adherance of bacteria |
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Adherance of bacteria can then lead to .......... |
micro-colony formation |
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micro-colony formation then leads to......... |
vegetation of colony (growth) |
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vegetation of colony, then leads to........ |
a) local destructive effects b) embolism, focal infection & host responses related to complications |
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symptoms of I.E are? |
-fever -malaise -fatigue -loss of appetite - night sweats -New/altered heart murmur |
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S.aureus infections cause what? (in terms of symptoms) |
more acute presentation |
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peripheral signs of I.E are? |
-Splinter haemorrhage (fingernails) - Roth spots (eyes) - Olser nodes - Janeway lesions (palm of hands) |
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Systemic signs of I.E are? |
-Valvular regurgitation -major emboli - renal and splenic infacts (damage and haemorrhage) -Fatal intracranial infarcts or haemorrhage -valvular insufficiency --> heart failure--> death |
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laboratory diagnosis.. -culturing procedure |
-2, preferably 3x blood cultures (extend incubation 14 days) |
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laboratory diagnosis.. -serology looks for |
Anti-coxiella burnetti antibodies |
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laboratory diagnosis.. test urine for ? why? |
Red blood cells - monitor kidney infarction/damage) |
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laboratory diagnosis.. antimicrobial testing using ? |
MIC |
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Treatments -HIgh dose antibiotics, why? -administered how? |
bactericidal to sterilise vegetation
IV (intravenously) |
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Streptococci viridans should be treated with ? |
Penicilin & Gentamycin |
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Enterococcus should be treated with? |
-Ampicillin or Vacomycin -& Gentamycin |
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Coagulase -ive staphylococcus should be treated with? |
Vancomycin/ Genotmycin |
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Treatments -surgical? |
Debridements oof injured material & replacement of heart valve if neccessary |
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Prevention - antibiotics prophylaxis before medical and dental procedures in at risk patients, such as........... e.g. heart problems |
-tooth extraction -Endoscopy - Upper respiratory tract procedures - Obstetics/gynaecolgy & G.I procedures |
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prophylactic treatments before midical and dental procedures is no longer recommended by ..... |
NICE (National institutes of clinical excellence) |
