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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

Infective Endocarditis

Infective Endocarditis

Prepared by :

Abdullah Mosluh Abdullah

Academic No. :426810123

Bader Nasser Al-Msaed

Infective ENDOCARDITIS

definition
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

pathogenesis
pathogenesis

Infective ENDOCARDITIS

pathogens cause infective endocarditis
pathogens cause infective endocarditis

Who is at high risk of infection by this organism ?

Infective ENDOCARDITIS

clinical manifestation
Clinical manifestation

symptoms

  • Constitutional
  • Sweating
  • Anroxia
  • Weakness
  • Chill
  • Weight loss
  • Myalgia
  • Back pain

Infective ENDOCARDITIS

duke criteria
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

continue
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

slide9

Osler Nodules

Skin janeway lesion

Infective ENDOCARDITIS

laboratory studies imaging
LABORATORY STUDIES & IMAGING
  • Multiple blood cultures
  • ESR& CRP↑
  • Leukocytosis, anemia & hematuria
  • +ve rheumatoid factor
  • ECHO

Infective ENDOCARDITIS

treatment
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

slide12

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

prevention

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

slide14

THANK YOU

THANK YOU

Infective ENDOCARDITIS

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