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34 Cards in this Set

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what bug is common in transient/spontaneous bacteremia?
viridans streptococci
what are the origins of Primary bacteremia?
IV or arterial line

usually normal flora of skin
What are the origins of Secondary bacteremia?
subsequent to a document infection (lesions/abscess)
what are the most common isolates in bacteremia?
staphylococci and gram-negative bacilli
What is SIRS's?
Systemic Inflammatory Response Syndrome
What is the definition of SIRS?
two or more of
Fever above 100.5, or below 97
HR above 90bpm
RR above 20
WBC's above 12,000 or below 4,000
What is the definition of septic shock?
sepsis plus:
MAP below 60mmHg

requires drugs to maintain BP
What is the definition of sepsis?
occurrence of SIRS due to microbes
What is the definition of severe sepsis?
sepsis (so SIRS + microbes) AND a sign of hypoperfusion or dysfunction
What are the three goals of treating septic shock?
resuscitate pt from shock

identify and treat source of infxn

maintain organ function
What are the general characteristics of infective endocarditis
valvular insufficiency
lots of infective emboli
immune complexes
Who usually gets infective endocarditis ?
men more commonly than women
What are some of the predisposing factors to infective endocarditis ?
Previous IE.
mitral valve prolapse
rheumatic fever
Calcific aortic stenosis
Prosthetic valves
How does ACUTE infective endocarditis present?
abrupt onset
FEVER
complications within one week- dyspnea, fatigue, wide spectrum of complications
What is the most common bug in acute infective endocarditis ?
staph aureus
what is the presentation of Subacute infective endocarditis ?
low grade fever

long onset to diagnosis about 6 weeks
what is the most common bug of subacute infective endocarditis ?
viridans strep (from the mouth)
what things lead to subacute infective endocarditis ?
indiscriminate use of antibiotics

immunosuppressed pts
What is the morphology of Strep Bovis?
G+, catalase -, non hemolytic
Where are HACEK organisms found and what do they cause?
these are typically upper respiratory bug

and they cause subacute infective endocarditis
What are the clinical manifestations of infective endocarditis ?
petechiae
subungual hemorrhages*
Osler nodes
Janeway lesions
Roth spots
What is the first step in infective endocarditis ?
the heart endothelium must be damaged before bacteria can attach.
What things causes the first stage of infective endocarditis ?
trauma, defective valves or septum, other random changes due to stress, renal failure, malnutrition, neoplasia
What are janeway lesions indicative of?
acute infective endocarditis
What are janeway lesions? where are they located?
flat painless red-blue macules on the Palms and Soles
What are splinter petechiae?
these are linear hemorrhages in the middle of the nail bed

associated with infective endocarditis
What causes flea-bitten kidneys?
this is glomerulonephritis due to circulating immune complexes in infective endocarditis
What are Oslers Nodes?
these are red painful nodules in the pads of fingers of toes.

made up of immune complexes
What does Oslers indicate?
infective endocarditis
What causes Roth spots in infective endocarditis ?
circulating immune complexes
What are the major criteria for infective endocarditis ?
positive blood culutre
evidence of endocardial involvement
What are the minor criteria for infective endocarditis ?
predisposed
fever
vascular stuff
immune stuff
microbes
echocardiograph is NOT major
how do you treat infective endocarditis
long term IV bacteriaCIDAL drugs
up to 4-6 weeks
if antibiotics fail, how do you treat infective endocarditis ?
surgery and prosthetic valves