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What are the steps of endocardidtis formation?
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Bacteremia- gram + are most important
Turbulent blood flow-usually from damaged valve fibrin platelet aggregates- forms nidus for infection adherence to endocardium- organisms grow on endocardium with little host defense because of little inflammatory response |
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How is the immune response to endocardidtis different locally and systemically?
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Very little local inflammatory markers or PMNS locally. Systemically you can have large amounts of antibody complexes formed which could lead to glomerulonephritis or rheumatic fever.
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What type of bacteria most commonly form endocarditis?
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Gram + , they are the most common causes because they require PMN's to clear up the infection and PMN's dont reach the inside of the heart well. This includes Staph, Strep, and enterococci
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What type of activities might lead to a Pseudomonas Aeruginosa derived endocarditis?
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Needle use (IVDA, diabetes). P. Aeruginosa typically reside on skin and can enter blood stream through chronic puncture.
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Why do certain heart defects predispose patients to endocardidtis?
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Heart disesase, such as valvular insufficiency increase turbulent flow in the heart, which is a requirement for endocardidtis.
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Is endocarditis typically have right of left sided origin?
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Most endocardidtis is seen in the left side of the heart in the mitral or aortic valves. Right sided endocarditis(tricuspid valve) may indicated IVDA because the bacteria has venous origin.
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What type of bacteria are typically seen in subacute vs. acute endocarditis?
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Subacute-lasts weeks to months, caused by S. Viridans
acute- lasts days, S. Aureus |
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What are some common signs/symtoms of endocarditis.
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Night sweats (subacute), tachycardia, short of breath, murmur, internal jugular visible, systemic signs of embolism (conjuctival petechia, organ infarcts-spleen, osler's nodes on toes)
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What role do blood cultures play in diagnosing endocarditis?
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The bacteria in the heart are in constant contact with blood and will yield positive cultures. You need to have multiple positive cultures from different areas to diagnose the disease. You do this because culture's could be contaminated and the results of the cultures could mean serious treatment including surgery or valuvular replacement.
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Aside from blood cultures, how else can you diagnose endocarditis?
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Look for anemia, hematuria, rheumatic fever and other inflammatory markers to increase suspicion. You can view vegetations by use of echocardiography
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What happens in untreated endocarditis?
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100% mortality(malignant), leads to sepsis CHF, emboli to vital organs, and immune complexes in vital organs (glomerulonephritis)
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What type of antibiotics do you want to use to treat endocarditis?
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Broadly: IV, bacteriocidal; narrowly: some infections, such as enterococci and pseudomonas require 2 drugs (aminoglycoside+ beta lactam) that act synergistically.
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When is surger suggested in endocarditis?
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Resistan infections need to be cut out. abscesses need to be opened and drained, and valves need to be replaced.
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What steps are taken to prevent endocarditis in patients with prosthetic valves?
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Prophylaxis with short course ampicillin
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