Infective Endocarditis Ie

INFECTIVE ENDOCARDITIS
(IE)
Dr. Raveendra K R
Asst . Prof of Medicine
BMCRI
Definition
Its a medical emergency characterized by
the infection of the cardiac endothelium,
macroscopically seen as vegetations
------------------------------------------------------
Virtually fatal if untreated
Mortality rate even with treatment is 25%

Classifications of IE
Acute IE : fatal in < 6 weeks
SBE : fatal between 6 weeks- 6
months
Chronic IE: persists > 6 months
------------------------------------------------------
Native valve endocarditis
Prosthetic valve endocarditis
Endocarditis in I.V. drug users
Culture negative endocarditis
Predisposing factors
CHD 20%
RHD 30%
VHD
IHD
MVP 10-33%
Prosthetic valves 10-20%
IV drug abuse
Unknown 20-40%
Symptoms of IE
Fever (specially on cardiac patient) but
absent in elderly/ uremia/
Fatigue
Weight loss
Malaise
Night sweats
Muscular Pains
Sudden onset of CCF
Physical signs
Progressive pallor
Petechiae (20-40%) frequently on
conjunctiva, palate, buccal mucosa, upper
extremities.
Splinter hemorrhages (10-30%) sub-
ungual, linear dark red streaks
(DD trauma)
Oslers nodes- small tender nodules on
fingers/ toe pads for hours-days
Physical signs
Janeway lesions(<5%) small hemorrhagic
nodules over palms & soles non tender
Clubbing (10-20%)
Roths spots (<5%) oval retinal
hemorrhages with clear pale centre
Spleenomegaly ( 25-60%)
Arterial embolism - femoral in fungal
endocarditis, pulmonary embolism in drug
abusers
Physical signs
Cardiac manifestations CCF 55%
patients, mitral followed by aortic valve &
tricuspid
Appearance of a new murmur or changing

of an existing murmur- suspect IE
Neurological manifestations- cerebral

emboli 20%, meningitis/ brain abscess
< 5%
Commonest organism streptococcus viridans,
later S.sanguis, S. mutans, staphylococci,
enterococci, etc.
Streptococci 60-80% and staphylococci 25%
HACEK group 3% - (Haemophilus,

Actinobacillus, Cardiobacterium, Eikenella &
Kingella) gram ve organisms, sometimes
more commensals in URT
Fungal endocarditis candida , aspergillus
More in males, more in elderly
Most common valve Mitral then Aortic

(on RHD)
IE in drug abusers
More in young males, source through skin
Organisms S. aureus 50%, streptococci
15%, fungi (candida) & gram ve
(pseudomonas) 10-15%
Valve affected Tricuspid 50%, Aortic 25%,
mitral 20%
Acute onset/ multiple organisms common
Septic pul. Emboli causing pneumonia-
common
Any intra vascular/ intra cardiac device
predisposes for IE
Accounts for 10-20% of all IE
Risk is similar in mechanical & bioprosthesis
Highest risk <6 m , < 2m virtually

nosocomial
Intra vascular sutures, pacemaker lines, teflon
silastic tubes act as foci of infection
Aortic valve > mitral valve prosthesis
Fungi account for 10-15 %, has high mortality
Organisms S.epidermidis, S. aureus, gram

ve bacteria, fungi, etc
Non bacterial Endocarditis (NBE)
Culture negative endocarditis 10%
usually by fastidious organisms- fungi,
HACEK group, anerobes, legionella,
chlamydia, coxiella brunetti, Libmans Salk,
anti phospholipid syndrome, infections
after previous antibiotics
Late diagnosis, difficult to treat,

sometimes poor prognosis
Pathogenesis
Invasions of micro-organisms to heart
Localizations of micro-organisms
Sterile vegetation formations ( platelets+ fibrin)

Pathogenesis
Organisms invade / infect the vegetations
Septic foci spread local (abscess) & emboli
Heal-scar- stenosis/ regurgitation

Diagnosis of IE
Suspicion of IE
- fever with predisposing factors
- PUO
- acute CCF
- appearance of a new murmur
- changing murmurs
Investigations
Routine blood
increased WBC,
decreased Platelet count,
increased ESR
Blood culture 3 sets of cultures at 3

different venepuncture before antibiotic use,
for aerobic/anerobic/ fungal cultures
Investigations
ECG- non specific, MI. tachycardia
Chest- X ray acute CCF, pleural effusion ,

infiltrates
2D ECHO- vegetations,abscess, etc

identify, localise & characterise
Duke criteria
Major positive blood culture
evidence of endocardial
involvement
- + ve ECHO finding
- new valvular regurgitations
Minor criteria predisposing factors

- fever >38 C
-vascular phenomenon
- microbiological
phenomenon
-ECHO
Management of IE
Medical emergency- hospitalization ICU
Antibiotic ( broad spectrum) drug of choice

penicillin G 12-18million U/24 hr x 4 weeks
ceftriaxone 2gm daily iv x 4 weeks
GM 1 mg/ kg iv tid x 2 weeks
vancomycin 30 mg/d bid x 4 weeks
Procedure
Usually pen + GM x 4 weeks
Or ceftriaxone+ GM x 4 weeks
Broad spectrum penicillin

Or third generation cephalosporins used
After sensitivity report the antibiotics

may be changed appropriately
Anti- fungal for fungal IE

Surgery in IE
Uncontrolled CCF (valve dysfunction)
Fungal IE
Large vegetations
Myocardial/ valve abscess/ fistula
Unstable prosthetic valves
Culture ve endocarditis
Worst prognostic features
Non streptococcal group
Age > 70 years
Aortic valve involvement
Fungal IE
Large vegetations
Culture ve endocarditis
Development of CCF only
Complications of IE
Acute CCF death
Abscess ( pericadial/ aortic/ myocardial)
Coronary embolism
Valve regurgitation/ stenosis
Septal perforation ( VSA)
Systemic embolism ( kidney/spleen/brain/
lungs/retina/ limbs)
Mycotic anneurysm
Thank you

Infective Endocarditis Ie

Uploaded by

Copyright:

Available Formats

Infective Endocarditis Ie

Uploaded by

Document Information

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Infective Endocarditis Ie

Uploaded by

Copyright:

Available Formats

What are the classifications of infective endocarditis?

What are the classifications of infective endocarditis?

What are some of the predisposing factors for infective endocarditis?

What are some of the predisposing factors for infective endocarditis?

INFECTIVE ENDOCARDITIS

Mortality rate even with treatment is 25%

Appearance of a new murmur or changing

Neurological manifestations- cerebral

Streptococci 60-80% and staphylococci 25%

HACEK group 3% - (Haemophilus,

More in males, more in elderly

Most common valve Mitral then Aortic

Accounts for 10-20% of all IE

Risk is similar in mechanical & bioprosthesis

Highest risk <6 m , < 2m virtually

Aortic valve > mitral valve prosthesis

Fungi account for 10-15 %, has high mortality

Organisms S.epidermidis, S. aureus, gram

Late diagnosis, difficult to treat,

Invasions of micro-organisms to heart

Sterile vegetation formations ( platelets+ fibrin)

Septic foci spread local (abscess) & emboli

Heal-scar- stenosis/ regurgitation

Blood culture 3 sets of cultures at 3

Chest- X ray acute CCF, pleural effusion ,

2D ECHO- vegetations,abscess, etc

Minor criteria predisposing factors

Antibiotic ( broad spectrum) drug of choice

Broad spectrum penicillin

After sensitivity report the antibiotics

Anti- fungal for fungal IE

You might also like