1 / 29

ENDOCARDITIS The Etiology and the Laboratory Studies

ENDOCARDITIS The Etiology and the Laboratory Studies. Reşat Özaras, MD, Professor, Infectious Diseases Dept. Definition. Endocarditis: it is an inflammation of the inner layer of the heart, the endocardium. Clinical Features. Whom to consider IE Injection drug users

danil
Télécharger la présentation

ENDOCARDITIS The Etiology and the Laboratory Studies

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. ENDOCARDITISThe Etiology and the Laboratory Studies Reşat Özaras, MD, Professor, Infectious Diseases Dept.

  2. Definition • Endocarditis: it is an inflammation of the inner layer of the heart, the endocardium.

  3. Clinical Features • Whom to consider IE • Injection drug users • Prostethic heart valve • Prior IE • Bacteremia • Hemodialysis • HIV infection

  4. Clinical Features • Wide spectrum of signs&symptoms • Fatigue • Anorexia • Weight loss • Prolonged fever • Dizziness • Dyspnea • …..

  5. PE • Murmur • Splenomegaly • Findings of complications (emboli etc..)

  6. IE: Clinical Classification Acute IE Main etiology: S. aureus Mortality (untreated) : < 2 months, 100% Subacute—chronic IE Main etiology: Viridans streptococci Mortality (untreated) : < 1 year, 100%

  7. Classification According to the Valve • Native Valve Endocarditis • Prosthetic Valve Endocarditis

  8. Clinical criteria Using specific definitions : • 2 major criteria OR • 1 major and 3 minor criteria OR • 5 minor criteria • Possible IE • 1 major criterion and 1 minor criterion OR 3 minor criteria

  9. Major Diagnostic Criteria • Positive blood culture for typical infective endocarditis • Echocardiography findings • with oscillating intracardiac mass • abscess

  10. Search Google for echo videos! • http://www.echojournal.org/video/379/Aortic-valve-vegetation-1-of-2

  11. Minor Diagnostic Criteria  • Predisposing heart condition or intravenous drug use      • Temp > 38.0° C • Vascular phenomena: arterial emboli, pulmonary infarcts, mycotic aneurysms, intracranial bleed, conjunctival hemorrhages, Janeway lesions      • Immunologic phenomena: glomerulonephritis, Osler nodes, Roth spots, rheumatoid factor      • Microbiological evidence: positive blood culture but does not meet a major criterion    • Echocardiographic findings: consistent with endocarditis but do not meet a major criterion

  12. Clinical criteria Using specific definitions : • 2 major criteria OR • 1 major and 3 minor criteria OR • 5 minor criteria • Possible IE • 1 major criterion and 1 minor criterion OR 3 minor criteria

  13. IE: Etiology NV PV 1-Streptococci: ~%50 ~40% 2-S. aureus: 3-Enterococci: 4-Coagulase-neg Staph: ~%5 ~70% 5-Gram-Neg Bacilli: 6-Fungus (Candida): 7-Diphteroids: 8-Polymicrobial: 9-Culture-neg./HACEK:

  14. Our cases with IE 1-Viridans streptococci (8) (40%) 2-S. aureus (MSSA) (4) (20%) 3-Enterococci (2) (10%) 4-MSSE (1) (5%) 5-Anaerobs (1) 6-S. typhi (1) 7-Brucella (1) 8-Culture-negative (2)

  15. IE: Streptococci Viridans streptococci (-hemolytic) (the most frequent ones) 1-S. sanguis 2-S. mutans 3-S. mitis S. bovis (non-hemolytic)

  16. Staphylococci S. aureus S. epidermidis

  17. DiagnosticsClinical Samples Blood Serum (for serology) Embolus, abscess, or removed infected valve (for microbiological and histolgical studies)

  18. IE: S. aureus Fever+S.aureus: consider IE (echo.) Fever+S.aureus in injectiondruguser: considerrightside (tricuspid) IE (echo.)

  19. Culture-negative IE Failuretoyieldanym.o. withautomatedbloodculturesystemswithin 7 days ~5% Use of antibiotics CoxiellaburnetiiandBartonella

  20. IE: Serology 1-Brucella 2-Coxiella burnetii 3-Bartonella

  21. Treatment • Antibiotics • Surgery may be needed

  22. IE: Mortality is ~30 Major systemic emboli Heart Failure Septic shock

  23. Complications • Cardiac • Septic • Embolic • Neurologic • Musculoskeletal • Renal • Associated with medical treatment

  24. Complications • Embolic (eg, cerebral infarct) • Local spread of infection (eg, heart valve destruction) • Metastatic infection (eg, vertebral osteomyelitis) • Immune-mediated damage (eg, glomerulonephritis

More Related