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Infective Endocarditis

Infective Endocarditis. Infective Endocarditis. Prepared by : Abdullah Mosluh Abdullah Academic No. :426810123 Bader Nasser Al-Msaed. Definition . infection of the endocardial surface of the heart, which may include one or more heart valves, the mural endocardium, or a septal defect.

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Infective Endocarditis

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  1. Infective Endocarditis Infective Endocarditis Prepared by : Abdullah Mosluh Abdullah Academic No. :426810123 Bader Nasser Al-Msaed Infective ENDOCARDITIS

  2. Definition • infection of the endocardial surface of the heart, which may include one or more heart valves, the mural endocardium, or a septal defect. • Infectious endothelial lesions • Called Vegetation Primarily complication of congenital heart disease Infective ENDOCARDITIS

  3. pathogenesis Infective ENDOCARDITIS

  4. pathogens cause infective endocarditis Who is at high risk of infection by this organism ? Infective ENDOCARDITIS

  5. Clinical manifestation symptoms • Constitutional • Sweating • Anroxia • Weakness • Chill • Weight loss • Myalgia • Back pain Infective ENDOCARDITIS

  6. DUKE CRITERIA MAJOR CRITERIA include : • Microorganisms consistent with IE from persistently positive blood cultures defined as: • Two positive cultures of blood samples drawn >12 hours apart, or • All of 3 or a majority of 4 separate cultures of blood (with first and last sample drawn 1 hour apart) • Coxiella burnetii detected by at least one positive blood culture or antiphase I IgG antibody titer >1:800 • Evidence of endocardial involvement with positive echocardiogram defined as • Vegetation on valve • Abscess, or • new valvular regurgitation (worsening or changing of preexisting murmur not sufficient) Infective ENDOCARDITIS

  7. continue Minor criteria include: • Predisposing factor: known cardiac lesion, recreational drug injection • Fever >38°C • Evidence of embolism: arterial emboli, pulmonary infarcts, Janeway lesions, conjunctival hemorrhage • Immunological problems: glomerulonephritis, Osler's nodes roth spot rheumatoid factor • Positive blood culture (that doesn't meet a major criterion) or serologic evidence of infection with organism consistent with IE but not satisfying major criterion Infective ENDOCARDITIS

  8. The Roth Spot is a white-centered hemorrhage Infective ENDOCARDITIS

  9. Osler Nodules Skin janeway lesion Infective ENDOCARDITIS

  10. LABORATORY STUDIES & IMAGING • Multiple blood cultures • ESR& CRP↑ • Leukocytosis, anemia & hematuria • +ve rheumatoid factor • ECHO Infective ENDOCARDITIS

  11. TREATMENT • Acutely ill persons → empirical antibiotic therapy • Subacute disease → wait results of blood cultures • Bactericidal antibiotic → 4 to 8 weeks • IE ( viridans streptococci ) → monotherapy penicillin G for 4 weeks Infective ENDOCARDITIS

  12. Surgery will be indicated in the following conditions: • Unsuccessful medical treatment with persistant bacterimia • Fungal endocarditis • Valve annulus or myocardial abscess • Rupture of valve leaflet • Valvular insufficiency with acute or refractory heart failure • Recurrent serious embolic complications • Refractory prosthetic valve disease Infective ENDOCARDITIS

  13. High risk pt. for IE Should be received prophylactic antibiotics before & during all dental procedures as well as invasive procedure of resp. tract ,infected skin or muscle. PREVENTION • Prosthetic cardiac valves • Previous IE • Unrepaired cyanotic congenital heart disease • Valvular lesions in posttransplant pt. Oral amoxicillin 50 mg/ kg ( 30 – 60 min ) Clindamycin or azithromycin ( allergic to β – lactam) Infective ENDOCARDITIS

  14. THANK YOU THANK YOU Infective ENDOCARDITIS

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