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Infective Endocarditis

2. ???? 1 . ?? 30 ???? ????? ?????? ??? ??? ??-?????? ?????? ?????? ????? ????. ???????: ???? ???????????: ?????, ?????-?? ?????.?????? ?????? ????????? ???? ????????.?????? ????? -????? ??????? ?- mitral stenosis ??????? ????? - ???? ????? ?? ??????? ???? ???. ????? 3 ?????? ?? -S. viridans. 3.

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Infective Endocarditis

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    1. 1 ???? ??????? ?? ???? ??? Infective Endocarditis ?"? ???? ???? ?????? ?????? ???????? ???? ????? ??-???? ???? ??????? ?? ???? ??? (???????????) ?? ??? ?????? ??????? ??? ?????????????, ??? ?? ????? ????? ???? ????? ?-DD ?? ???? ????? ?????? ????????? ??????? ??? ???? ????? ????? ?????.???? ??????? ?? ???? ??? (???????????) ?? ??? ?????? ??????? ??? ?????????????, ??? ?? ????? ????? ???? ????? ?-DD ?? ???? ????? ?????? ????????? ??????? ??? ???? ????? ????? ?????.

    2. 2 ???? 1 ???? 1: ?????. ????? ?? ????? ?????? ?????????. ?????? S. Viridans.???? 1: ?????. ????? ?? ????? ?????? ?????????. ?????? S. Viridans.

    3. 3 ???? 2 ???? 2: ??? ???? ????????? (????). ??? ?? ????? ????? ????? ??????????. ?????? ?? ?????? ????????. ??????? ?? ???? S. areus.???? 2: ??? ???? ????????? (????). ??? ?? ????? ????? ????? ??????????. ?????? ?? ?????? ????????. ??????? ?? ???? S. areus.

    4. 4 ???? 3 ???? 3: ????? ??????? ???? ?? ???? ?????? ????? ??? ????? ???? ?????? ???????. ??? ???? ??? ??-??????? ?????? ?? ?????. ?????? Enterococcus fecalis.???? 3: ????? ??????? ???? ?? ???? ?????? ????? ??? ????? ???? ?????? ???????. ??? ???? ??? ??-??????? ?????? ?? ?????. ?????? Enterococcus fecalis.

    5. 5 ???? 4 ???? 4: ??????? ?? ???????? ????? candida. ????? ?? ???? ??-?????? (?????????? ???-????????? ??????????). ??? ?????? ???? ?? ???????????, ?? ????????? ?????. ???? ?????? ?? ??? ??????? (?? ?????).???? 4: ??????? ?? ???????? ????? candida. ????? ?? ???? ??-?????? (?????????? ???-????????? ??????????). ??? ?????? ???? ?? ???????????, ?? ????????? ?????. ???? ?????? ?? ??? ??????? (?? ?????).

    6. 6 Infective endocarditis ???? ??????? ?? ???? ??? ??????? ??? ??????? ???? ?? ???????? ???? ??? ?????: ??? ??????? (?????? ?? ??? ?????). ??????? ?? ????? ????? ?????? ???????. ????? ????? ??? ??????????? ?? ???????, ?? ??? ???? ????? ?? ?? ??????? ?????? ????? ???, ?? ????? ??? ?????? ??????????? ?? ???? ???.??????? ??? ??????? ???? ?? ???????? ???? ??? ?????: ??? ??????? (?????? ?? ??? ?????). ??????? ?? ????? ????? ?????? ???????. ????? ????? ??? ??????????? ?? ???????, ?? ??? ???? ????? ?? ?? ??????? ?????? ????? ???, ?? ????? ??? ?????? ??????????? ?? ???? ???.

    7. 7 ??????? II (1) ??? ??????? ????? ?????? bi-cuspid aortic stenosis. ????? ?? ???????? (MS, MR). ????? ?? ?????????? (calcified aortic valve ??????? ???????, ?? mitral valve prolapse ?? ??????????). ???? ???? ???? ????????????, ??????? ???? ???? ?????.(1) ??? ??????? ????? ?????? bi-cuspid aortic stenosis. ????? ?? ???????? (MS, MR). ????? ?? ?????????? (calcified aortic valve ??????? ???????, ?? mitral valve prolapse ?? ??????????). ???? ???? ???? ????????????, ??????? ???? ???? ?????.

    8. 8 ??????? III ?????? ???? ??????? ?????? ?????? ??????? ?????? ?????. ??????????? ????? ??? ????? ???? ???????. ?? ????? ?? ?-sub-endothelial matrix ?????? ?? non-bacterial thrombotic endocarditis – ???? ??????? ????? ????????? ????????????. ?? ??????? ??????? ?????? ??? ???????, ?? ?? ????? (????) ???????? ??????? ?????? ????? ?????? ????.?????? ???? ??????? ?????? ?????? ??????? ?????? ?????. ??????????? ????? ??? ????? ???? ???????. ?? ????? ?? ?-sub-endothelial matrix ?????? ?? non-bacterial thrombotic endocarditis – ???? ??????? ????? ????????? ????????????. ?? ??????? ??????? ?????? ??? ???????, ?? ?? ????? (????) ???????? ??????? ?????? ????? ?????? ????.

    9. 9 ??????? IV (2) ??????? ?????? ?? ???????, ????' ?????? ???????????? ??? ????? ??????? ???????? ?????. ????? ?-low grade bacteremia, ???? ?? ???????? ???? ???? (?????????), ????? ?-100 ??????? ???"? (?????? ????? ?-106). ?? ?????? ???? ????, ?????? ?????? ?? ???????? ??????? ?? ??????. ??????? ???? ????? ??????? ??: ????' ????? viridans, ???????????, ????' ??? areus ?-coagulas.(2) ??????? ?????? ?? ???????, ????' ?????? ???????????? ??? ????? ??????? ???????? ?????. ????? ?-low grade bacteremia, ???? ?? ???????? ???? ???? (?????????), ????? ?-100 ??????? ???"? (?????? ????? ?-106). ?? ?????? ???? ????, ?????? ?????? ?? ???????? ??????? ?? ??????. ??????? ???? ????? ??????? ??: ????' ????? viridans, ???????????, ????' ??? areus ?-coagulas.

    10. 10 ??? ????? ?"? ?????? ?? ?????, ???? ???????? ?????? ??????, ?? ??????????? ?? ????????, ????? ?? ?????? ????????? (??? ??? ?? ??????? ?????? ????, ???? ????????, ????? ??????) ?????? ????????, ???????? ?????? ?????? ??????????, ?? ????? ?? ??????, ????? ?????? vegenatation – ??? ???????????? (?????? + ????? + ??????? ?"? ??? ?????). ??????????? ??? ?????? + ???????.??? ????? ?"? ?????? ?? ?????, ???? ???????? ?????? ??????, ?? ??????????? ?? ????????, ????? ?? ?????? ????????? (??? ??? ?? ??????? ?????? ????, ???? ????????, ????? ??????) ?????? ????????, ???????? ?????? ?????? ??????????, ?? ????? ?? ??????, ????? ?????? vegenatation – ??? ???????????? (?????? + ????? + ??????? ?"? ??? ?????). ??????????? ??? ?????? + ???????.

    11. 11 ????? ?????? IE - INFECTIVE ENDOCARDITIS SBE - SUBACUTE BACTERIAL ENDOCARDITIS ABE - ACUTE BACTERIAL ENDOCARDITIS PVE - PROSTHETIC VALVE ENDOCARDITIS PVE - Early vs. Late CULTURE NEGATIVE ENDOCARDITIS SBE – ???? ???? ???? ?? ??? ?????, ????? ?????, ??? ????, ?????? ??????????? ?? FUO. ABE – ????? ?? ??????? ????? ?? ???, ?????, ????? ????. ??"? ?????? ???? ???????? ??? S. areus, ????? ????????, ???? ????? ???? ??????', ??? ?? ????????. ???? ???? ????? ?????? ??? ?-SBE ??-ABE ??? ????? ?????? ??? ?? Infective endocarditis – ???? ????? ????????? ???? ????? ????' ?????'. PVE – ?? ?? ???? ?? ????, ??????? ??? early ???? late ??? ??? ???? ???? ?????? ?????. Culture negative endocarditis – ???? ??????? ?????? ????????????, ???? ???? ?????? ??????? ?? ??? ??????? ????? ?????, ??? ????? ?? ????? ???? ?????.SBE – ???? ???? ???? ?? ??? ?????, ????? ?????, ??? ????, ?????? ??????????? ?? FUO. ABE – ????? ?? ??????? ????? ?? ???, ?????, ????? ????. ??"? ?????? ???? ???????? ??? S. areus, ????? ????????, ???? ????? ???? ??????', ??? ?? ????????. ???? ???? ????? ?????? ??? ?-SBE ??-ABE ??? ????? ?????? ??? ?? Infective endocarditis – ???? ????? ????????? ???? ????? ????' ?????'. PVE – ?? ?? ???? ?? ????, ??????? ??? early ???? late ??? ??? ???? ???? ?????? ?????. Culture negative endocarditis – ???? ??????? ?????? ????????????, ???? ???? ?????? ??????? ?? ??? ??????? ????? ?????, ??? ????? ?? ????? ???? ?????.

    12. ????????????? ??? ????? ?"? ??????. ?????? – ????? ????? ??????? ???????, ????? ??????? ??? ????????? ????? ??????? ?????? ????? ?? ??????? ????????? – ???????? 12 ????????????? – ?????? ?? ???????? ??????? ???? ???? ?"? ??????, ???????? ?? ????? ????? ?? ?????, ????? ??????? ?? – ???? ???? ???. ???? ?????????? ????? ???? ??????? ?? acute AR, acute MR, ??"?, ??????? ?????? – ??? ????? ?????? ????? ???. ???????? ???? (??? ???? ?? ??' ?"? ????? ???? ???) – ?? ??? ??? ???? ????, ??????? ??? ?????? ?????? ???? ??????? ??? ????.????????????? – ?????? ?? ???????? ??????? ???? ???? ?"? ??????, ???????? ?? ????? ????? ?? ?????, ????? ??????? ?? – ???? ???? ???. ???? ?????????? ????? ???? ??????? ?? acute AR, acute MR, ??"?, ??????? ?????? – ??? ????? ?????? ????? ???. ???????? ???? (??? ???? ?? ??' ?"? ????? ???? ???) – ?? ??? ??? ???? ????, ??????? ??? ?????? ?????? ???? ??????? ??? ????.

    13. 13 ?????? ????? – ?? ??'??? ???? ????? ??? ????? ??? veruce, ?????, ?"? ?????, ????? ??????? ??? ???? ???? ?????.?????? ????? – ?? ??'??? ???? ????? ??? ????? ??? veruce, ?????, ?"? ?????, ????? ??????? ??? ???? ???? ?????.

    14. 14 ??? ?????? ?????? ????? – ??????? ???? ????? ???????? ?? ??? ???? ???????.??? ?????? ?????? ????? – ??????? ???? ????? ???????? ?? ??? ???? ???????.

    15. ??????? ???????? ???????? ?? – ??? ????? ?????? ????? -> CHF ??? ?? ??? ?????-> Acute AR/MR ????? – ???? ???? - ???? Glomerulonephritis 15 ??: ??? ?????, ???. ?????: ????? ?????? ?? ?????? ????? ?????? ????? ???????????. ??????????????? – ????? ?? ???? ????? ????? ??????, ?? ??? ?????? ???????? (?? ?? ????????). ?? RF ???? ????? ????, C3, C4 ??????.??: ??? ?????, ???. ?????: ????? ?????? ?? ?????? ????? ?????? ????? ???????????. ??????????????? – ????? ?? ???? ????? ????? ??????, ?? ??? ?????? ???????? (?? ?? ????????). ?? RF ???? ????? ????, C3, C4 ??????.

    16. Mycotic aneurysm – ??? ??? ???? ????? ?? ???? ?????? ?? ???? ?????. ?????? – ????? ??????? ????? ????? ?????, ????? ???? ???? ?? ????? ??????? ????? ?vasa vasorum ????? IC ???? ????? ?????. ??? ??????? ?????? ?? ???? ?????? ????? ?????? "???" ?? ???? ??? ????. 16 Mycotic aneurysm – ???? ?????? ????????????. ??? ?????? ?-3 ????????: ????? ??????? ????? ????? ???? ????? – ???? ???? ????? ?????, ???? ??? ?? ???? ??? ????. ??? ???? ???? ?????? ????, ?? ???? ????? ?? ??????? ?????. ????? ??????? ?? ??? ???????????? ????? ??????? ?? ??? ???? ????? ?? ??? ?? ??? ??????????. ??????? ????? – ????? ???? ???? ?-vasa vasorum (??? ?? ????? ????? ?? ?????). ????? ?? ??? ???? ??? ?? ????? ??????. ????? ?? ????????? ???????? ????? ?????. ?????? ?? ??? ?????, ????? ?? ?????? ??????. ???? ?????? ????? ?????, ??????? ???? ?? ????? ????, ?? ???? ????. ?? ????? ?? ?????????? ?? ??? ??????.Mycotic aneurysm – ???? ?????? ????????????. ??? ?????? ?-3 ????????: ????? ??????? ????? ????? ???? ????? – ???? ???? ????? ?????, ???? ??? ?? ???? ??? ????. ??? ???? ???? ?????? ????, ?? ???? ????? ?? ??????? ?????. ????? ??????? ?? ??? ???????????? ????? ??????? ?? ??? ???? ????? ?? ??? ?? ??? ??????????. ??????? ????? – ????? ???? ???? ?-vasa vasorum (??? ?? ????? ????? ?? ?????). ????? ?? ??? ???? ??? ?? ????? ??????. ????? ?? ????????? ???????? ????? ?????. ?????? ?? ??? ?????, ????? ?? ?????? ??????. ???? ?????? ????? ?????, ??????? ???? ?? ????? ????, ?? ???? ????. ?? ????? ?? ?????????? ?? ??? ??????.

    17. CNS – ???????? ?????? – ? 20% ??????? Stroke – ??????? ????? ?? ??? ?? Mycotic aneurysm. ???? ?????? ? 44%. ??? ?????. 17 CNS ???????? ??????. ??????? ?? ??? - ???? ?? ??? ?????? ????, ??????????? ??? ??? ??-DD. ??? ????? ?? UTI ?? ???? ????? ???? ???? ?? ????? ???? ??? ??? ???? ???, ????? ?? ????? ???? ?????, ?? ???? ????? ?? ????????????. ???? – ?????? ???? ?????? (???? 50% ????? ?? ???? ???). ???? ?? 78, ???? ??? ?????? ???? ????' ???????? ????? ???"? ???? ???????? ????. ??? ??? ????, ????? ?? ??????, ??????????, ?????? ??????, ??? ?????? 3-4 ???? ???? ?????. ??? ????? ?? ????? ??????, ???? ?????? ?? ????? 3-4 ??? ?????? ????? ???? ?? ????? ??????? (general deterioration). ??? ??? ???????? ?? ????? 7.6-7.4, ???????? ?? ?? ????? ?? ????? ???' ?-diphteroids, ????? ???? ??????? ???????, ??? ??"? ???????????? ???? ?? ????????. ????? ???? ??? ?? ????? ???? ?????? ?????, ????? ????. ?????? ??? ?????? ?? ???????? ???? ??? ?? FUO ????? ?? CT ??? – ????? ???? ???? ?????. ?????? ??? ?? ??????? ?????? ????? ????????????. ????? ???? ?????? ?????? ???? ???? ?? ????? ????, ?? ???? ??? ??????????? ?????? ????. ???? ?? ???? ?????? ?? ???? 3 ?"?, ????? ??????? ????? ??? ?????, ???? ??????? ?????? – ?? ??? ???? ???? ???? ?? ????. ?? ???? ????? ????? ?????? "????????, ??? ???????" – ??? ??? ???? ?????? ????? ????? ????? ???????????? ??????? ?? ???? ????? ??????! ???? ??? ???? ????? ?????? – ?? ?????.CNS ???????? ??????. ??????? ?? ??? - ???? ?? ??? ?????? ????, ??????????? ??? ??? ??-DD. ??? ????? ?? UTI ?? ???? ????? ???? ???? ?? ????? ???? ??? ??? ???? ???, ????? ?? ????? ???? ?????, ?? ???? ????? ?? ????????????. ???? – ?????? ???? ?????? (???? 50% ????? ?? ???? ???). ???? ?? 78, ???? ??? ?????? ???? ????' ???????? ????? ???"? ???? ???????? ????. ??? ??? ????, ????? ?? ??????, ??????????, ?????? ??????, ??? ?????? 3-4 ???? ???? ?????. ??? ????? ?? ????? ??????, ???? ?????? ?? ????? 3-4 ??? ?????? ????? ???? ?? ????? ??????? (general deterioration). ??? ??? ???????? ?? ????? 7.6-7.4, ???????? ?? ?? ????? ?? ????? ???' ?-diphteroids, ????? ???? ??????? ???????, ??? ??"? ???????????? ???? ?? ????????. ????? ???? ??? ?? ????? ???? ?????? ?????, ????? ????. ?????? ??? ?????? ?? ???????? ???? ??? ?? FUO ????? ?? CT ??? – ????? ???? ???? ?????. ?????? ??? ?? ??????? ?????? ????? ????????????. ????? ???? ?????? ?????? ???? ???? ?? ????? ????, ?? ???? ??? ??????????? ?????? ????. ???? ?? ???? ?????? ?? ???? 3 ?"?, ????? ??????? ????? ??? ?????, ???? ??????? ?????? – ?? ??? ???? ???? ???? ?? ????. ?? ???? ????? ????? ?????? "????????, ??? ???????" – ??? ??? ???? ?????? ????? ????? ????? ???????????? ??????? ?? ???? ????? ??????! ???? ??? ???? ????? ?????? – ?? ?????.

    18. 18 ????? ?????? ?????? ????? ?????? – ????? ???? ??????? ????????.????? ?????? ?????? ????? ?????? – ????? ???? ??????? ????????.

    19. ??????? ???, "????? ?????" ????????? – 2?' ?????? ???????? ???? ?"? – ?????? ??????? ?? ????? ???????? ???????? ?????? ?????? ????? ??????? ?????? ?? ????? ??????. ?????? ???????? – Immune complex ??????? ????? ????? ?? ?????. 19 ??????? ??? ??????? ????? ????? ???????? ????? ?? ????? ??????? ??????????: ?????? ??????, ????? ????? ????, ????????????. ????? ?????? (??? ???? ?? ?????? ????? ?? ???) ??? ??????? ??????????. ?????? ??????? ??? ???: ??????? ????? - ?????? ??????? ?? ????? ????????. ???????? ?????? ?????? ?????. ??????? ?????? ?? ????? ??????. ?????? ???????? – Immune complex. ??????? ??? ??????? ????? ????? ???????? ????? ?? ????? ??????? ??????????: ?????? ??????, ????? ????? ????, ????????????. ????? ?????? (??? ???? ?? ?????? ????? ?? ???) ??? ??????? ??????????. ?????? ??????? ??? ???: ??????? ????? - ?????? ??????? ?? ????? ????????. ???????? ?????? ?????? ?????. ??????? ?????? ?? ????? ??????. ?????? ???????? – Immune complex.

    20. ??????? - ????????? ???- 80% ????? – 40% ???? ????? – 40% ????? ????? – 25% Stroke – 20% ??? ??? – 20% ??? ?? – 10% 20 ????? ?????? ??: ??? (??"? ?? ????). ????? – ????? ???? ?? ???????, ????? ??????. ???? ?????. ??????? ?????? (20%) – ????? ???? ???? ??? ??? ????. ??? ??? – ?? ?????. ??? ?? – ?? ??? ??????. ??? ???? ??? ?????? ??? ???? ?????? ?????.????? ?????? ??: ??? (??"? ?? ????). ????? – ????? ???? ?? ???????, ????? ??????. ???? ?????. ??????? ?????? (20%) – ????? ???? ???? ??? ??? ????. ??? ??? – ?? ?????. ??? ?? – ?? ??? ??????. ??? ???? ??? ?????? ??? ???? ?????? ?????.

    21. ??????? - ?????? ??? – 90% ?????? – 85% ?????? ???? 3-5% ?????? ???????? - >50% Osler nodes – 10-23% Splinter hemorrhage – 15% ?????? – 20-40% 21 ?????? ???????????? ??? – ?-hallmark ?? ?????. ???? ??? ???, ???? ????? ?? ??????????? (10%). ?-85% ??????? ???? ??????. ??? ??????? ?????? ????? ??? ????. ?????? ??? ???? ???? ??? ???? ???? ???? ?? ????? ?????? ????????????? (???? ?????? ???). ???? ?? ??? ??????? ???? – ?? ?????, ?? ??"? ?? ?????? ???? ????. ?????? ???????? ?????? ?-50%: Osler nodes (10-23%) – ??? ???? ?? ??? ???. ?? ????, ?????? ?? ????? ???? ???? ???? ????? ??????????. ????: ????? ?? ????????? ????????. Splinter hemorrhages – ???????? ??????. ?????? – ???????? ??? ????. Janeway’s lesions. ?????? ??? ???????? ??? ???????????? – ?? ???? ?? ??????????? ?-DD ????? ??????, ?? ?? ?????? ?????. ?????? – ????????? ????? ?? ????????.?????? ???????????? ??? – ?-hallmark ?? ?????. ???? ??? ???, ???? ????? ?? ??????????? (10%). ?-85% ??????? ???? ??????. ??? ??????? ?????? ????? ??? ????. ?????? ??? ???? ???? ??? ???? ???? ???? ?? ????? ?????? ????????????? (???? ?????? ???). ???? ?? ??? ??????? ???? – ?? ?????, ?? ??"? ?? ?????? ???? ????. ?????? ???????? ?????? ?-50%: Osler nodes (10-23%) – ??? ???? ?? ??? ???. ?? ????, ?????? ?? ????? ???? ???? ???? ????? ??????????. ????: ????? ?? ????????? ????????. Splinter hemorrhages – ???????? ??????. ?????? – ???????? ??? ????. Janeway’s lesions. ?????? ??? ???????? ??? ???????????? – ?? ???? ?? ??????????? ?-DD ????? ??????, ?? ?? ?????? ?????. ?????? – ????????? ????? ?? ????????.

    22. Janeway lesions - <10% Splenomegaly – 20-57% Clubbing – 10-20% Mycotic aneurysm – 2-10% 22 Mycotic – ??? ????, ???. ???? ????? ? SAH.Mycotic – ??? ????, ???. ???? ????? ? SAH.

    23. 23 Splinter hemorrhages – ????. ?? ???? ????? ?? ???????? ????? ??, ?????? ?? ?? ???? ???????????? ??? ?????????. ?? ?????? ??? ???????????Splinter hemorrhages – ????. ?? ???? ????? ?? ???????? ????? ??, ?????? ?? ?? ???? ???????????? ??? ?????????. ?? ?????? ??? ???????????

    24. 24 Splinter hemorrhages ???????????? ????????. ???? ????? ??????? ??"? ????? ?? ???, ???? ?? ??????? ???? ?????. ?? ???? ??????? ????????????.Splinter hemorrhages ???????????? ????????. ???? ????? ??????? ??"? ????? ?? ???, ???? ?? ??????? ???? ?????. ?? ???? ??????? ????????????.

    25. 25 Osler nodes – ??????? ?? ????? ????? (?????) ???????. ??????? ?????? ????? ??' ?"?. ????? ??? ????-????. ???? ????? ?????. ?? ??????- ???? ?? ? SLEOsler nodes – ??????? ?? ????? ????? (?????) ???????. ??????? ?????? ????? ??' ?"?. ????? ??? ????-????. ???? ????? ?????. ?? ??????- ???? ?? ? SLE

    26. 26 ?????? ???????, ?? ??????, ????? ?? ???? ????? ???????. ????? ??' ????. ???- ??????- ???? ? SA.?????? ???????, ?? ??????, ????? ?? ???? ????? ???????. ????? ??' ????. ???- ??????- ???? ? SA.

    27. 27 Janeway’s lesions – ??? ?????? ???? ???? ?????? ?? ???? ?????? ???????. ???? ?? ????? ????? ?????? - ?? ?????? ?????????? ?? ???? ?????? ??????, ????? ????? (cocsaki), ??????? (??????? ???????? ??????). ??????? ???? ???? – ?????? ??????.Janeway’s lesions – ??? ?????? ???? ???? ?????? ?? ???? ?????? ???????. ???? ?? ????? ????? ?????? - ?? ?????? ?????????? ?? ???? ?????? ??????, ????? ????? (cocsaki), ??????? (??????? ???????? ??????). ??????? ???? ???? – ?????? ??????.

    28. 28 ?????? - ???????? ??????? ????. ?????? ?? ???????? ??????????.?????? - ???????? ??????? ????. ?????? ?? ???????? ??????????.

    29. 29 ?????? ?????? ???????, ???????? ???? ???? ??????? (????? ????? ????? ??????? ?? ????????), ??????? ??? (?????? ???????). ?????? –????? ?????. ???? ???????, ????? ???, ??? ??????. ???? ??????? ??????. ?????? ??? 2-3 ????.?????? ?????? ???????, ???????? ???? ???? ??????? (????? ????? ????? ??????? ?? ????????), ??????? ??? (?????? ???????). ?????? –????? ?????. ???? ???????, ????? ???, ??? ??????. ???? ??????? ??????. ?????? ??? 2-3 ????.

    30. 30 ?????? ???????.?????? ???????.

    31. 31 ????????? ?????????, ?????? ?? ???? ?? ??????? ??? ??? ????? ????????????. ??????? ?????????? ??????? ?? ???? ????? ???????, ??"? ?????? ?????. ????? ?? ???? ????? ????? ?????? – ?? ??????? ?? ??.????????? ?????????, ?????? ?? ???? ?? ??????? ??? ??? ????? ????????????. ??????? ?????????? ??????? ?? ???? ????? ???????, ??"? ?????? ?????. ????? ?? ???? ????? ????? ?????? – ?? ??????? ?? ??.

    32. 32 ????? ?????? ?????? ?? ??????????? – ?????? ???? ????? ?? ?? ?????????? ??? roth’s spots. ????? ????? ????????? ???? ?? ???? ?????.????? ?????? ?????? ?? ??????????? – ?????? ???? ????? ?? ?? ?????????? ??? roth’s spots. ????? ????? ????????? ???? ?? ???? ?????.

    33. 33 roth’s spots – ????? ????????????, ?? ?? DD (??????? ?? ????????). ???? ?? ??? ???????????? – ?????? ?????????? ????? ??? ??????? (roth’s spots), ????? ??? ???? ???????, ????? ???, ????? ????? ???? ??? ?? ???? ???? ???? ????? ?????? – ?????? ????????, ???????, janeway, ?????. ?? ??? ???????? ???? ??????????, ???? ????? (??? ??? ?? ???), ?? ??? ???? ????.roth’s spots – ????? ????????????, ?? ?? DD (??????? ?? ????????). ???? ?? ??? ???????????? – ?????? ?????????? ????? ??? ??????? (roth’s spots), ????? ??? ???? ???????, ????? ???, ????? ????? ???? ??? ?? ???? ???? ???? ????? ?????? – ?????? ????????, ???????, janeway, ?????. ?? ??? ???????? ???? ??????????, ???? ????? (??? ??? ?? ???), ?? ??? ???? ????.

    34. ????? ????? - 70-90% ???????????? – 20-30% (????? ????? ??) ?.? ????? – 90-100% ?????????????????? ???? ??? – ???????????, ??????? 34 ????? ??? ?? ??????: ????? – ???? ????? ???? ???. ???????????? – ????? ????? ????? ?????? ?????? ?????, ?? ???????? ??? low grade, ???? ????? ???????????? ??? ???. ????? ?? ????? ????????? – ???? (???????????, MM)! ?????????????????? – ?? DD (MM ??? ??? ???, ???????????). ???? ??? – ???? ????? ??????????? ???????? ??? ????? ??????????.????? ??? ?? ??????: ????? – ???? ????? ???? ???. ???????????? – ????? ????? ????? ?????? ?????? ?????, ?? ???????? ??? low grade, ???? ????? ???????????? ??? ???. ????? ?? ????? ????????? – ???? (???????????, MM)! ?????????????????? – ?? DD (MM ??? ??? ???, ???????????). ???? ??? – ???? ????? ??????????? ???????? ??? ????? ??????????.

    35. ?????? ?? Continuous low grade bacteremia 3 ?????? ?? ?????? ? 24 ????. ??? ????? 10cc ?? ?????? ????????? ???????? ???????? - 64% ?????? ??????? ??????? ? 100% ??? ???????????. ???? ?????? ?????? ?????? ??????????. ????? ? 3 ?????? ?????? ?? ?? ???? ?????? ??????????? ??? ?????? ??! ??????? ???? ??????? ??? NBTE (non bacterial thrombotic endocarditis) – ??? ???? ?????, ????? ????? ???? ?????????, ??? ?????, marantic endocarditis (???? ????? ????? ??????? ????? ??????). Continuous low grade bacteremia – ???? ????? ????. ?????? ??' ?????? ?? ??? ???? ???? ??????. ????? ????? ??? ???? ?????, ?? ????? ?????? ????? ?????? ??? intra-vascular infection ????? ????? ???????????. ?????? ?? ?????? ???? ??????? ?? ???? (?????? ??), ?? ?????? 2 ??"? ?????? ?? (????? ??????), ??????? ???? 10 ??"?, ?? ?? ???? yield ??? ???. ?? ?????? ???? ????? ???? ????? ?? ??? – ???? ???? ???? ???????? (??? ????? ????????? ?-IL). ???? ???????? ???? ???? ?????, ????? ??? ??? ????? ??????. ?? ??? ???? ???, ???? ????? ?? ???? ?????, ??????? ????? ???' ?????? (?????, ?????? ?????) – ??' ??????. ??? ???????????? ??? ???????? ???????? ??? ?????????? – ???? ???? ????? ??? ?? ????? ?????? ????????? ???? (??? ?? ?????), ??? ?????? ????? ?????? ?? ?????????. ???? ?????? ???????? ??????. ?? ????? ???? ????', ?-yield ???? ???????? ?-64%, ???? ?? ???? ???? ?-3 ??????, ??? ????? ????? ?? ????????. ?? ????? ?? ??? ???? ??? ?? ?? ???? ?????? ?? ????? ?? FUO – ?? ??????? ?? ????? ????', ??? ????? ???? ????? ?????? ???????. ?? ???????? ??????? 3 ??????, ??? ???????? ??????? ??? (??????) ?????.?????? ?? ?? ???? ?????? ??????????? ??? ?????? ??! ??????? ???? ??????? ??? NBTE (non bacterial thrombotic endocarditis) – ??? ???? ?????, ????? ????? ???? ?????????, ??? ?????, marantic endocarditis (???? ????? ????? ??????? ????? ??????). Continuous low grade bacteremia – ???? ????? ????. ?????? ??' ?????? ?? ??? ???? ???? ??????. ????? ????? ??? ???? ?????, ?? ????? ?????? ????? ?????? ??? intra-vascular infection ????? ????? ???????????. ?????? ?? ?????? ???? ??????? ?? ???? (?????? ??), ?? ?????? 2 ??"? ?????? ?? (????? ??????), ??????? ???? 10 ??"?, ?? ?? ???? yield ??? ???. ?? ?????? ???? ????? ???? ????? ?? ??? – ???? ???? ???? ???????? (??? ????? ????????? ?-IL). ???? ???????? ???? ???? ?????, ????? ??? ??? ????? ??????. ?? ??? ???? ???, ???? ????? ?? ???? ?????, ??????? ????? ???' ?????? (?????, ?????? ?????) – ??' ??????. ??? ???????????? ??? ???????? ???????? ??? ?????????? – ???? ???? ????? ??? ?? ????? ?????? ????????? ???? (??? ?? ?????), ??? ?????? ????? ?????? ?? ?????????. ???? ?????? ???????? ??????. ?? ????? ???? ????', ?-yield ???? ???????? ?-64%, ???? ?? ???? ???? ?-3 ??????, ??? ????? ????? ?? ????????. ?? ????? ?? ??? ???? ??? ?? ?? ???? ?????? ?? ????? ?? FUO – ?? ??????? ?? ????? ????', ??? ????? ???? ????? ?????? ???????. ?? ???????? ??????? 3 ??????, ??? ???????? ??????? ??? (??????) ?????.

    36. ??????? Streptococci – 60-80% S. Viridans -30-40% Enterococci – 5-18% other Strep – 15-25% Staphylococci – 20-35% S. aureus – 10-27% S. coagulase negative – 1-3% 36 ???????? ??????? Strep – ??? ????: viridans ??? ????????. Staph – areus ?-coagulase negative (?? ????).???????? ??????? Strep – ??? ????: viridans ??? ????????. Staph – areus ?-coagulase negative (?? ????).

    37. Gram negative bacilli – 2-13% Fungi – 2-4% Culture negative – 5-24% 37 ?? ???? ??? ???? ??????? ?-culture negative.?? ???? ??? ???? ??????? ?-culture negative.

    38. 38 ?????? ?-2003 ????? ??? strep ????? ??????, ?? ???????? ??? ???? ?????????? ?-S. Viridans. ????? staph ??? ??????.?????? ?-2003 ????? ??? strep ????? ??????, ?? ???????? ??? ???? ?????????? ?-S. Viridans. ????? staph ??? ??????.

    39. ??? ?? TransThoracic Echocardiography – ?????? 60-65%. ?????? ??????, ???? ?????, ???? ????. ?????? ???? ? IE ?? ?? ????. TransEsophageal Echocardiography- ?????? ?? 95% ?????? ??????? ?????? ????? ????? ????. 39 ??? ?? ????? ?????? ?? ???? ??? – ???? ?? ?? ?? ??? ??????? ?"? ??? ??. ?? ??? ?????: TTE (transthoracic echo). TEE (transesophageal echo) – ??? ???? ??? ?????, ???? ????? ??? ????? ????????. TTE – ????? ?-60-65%. ??? ????? ??? ???? ???? ???, ????? ?? ???? ????. ??? ???? ???? ?????? ?? ????, ????? ???? ???? ???? (tri-cuspid endocarditis). ???? ?????? ????? TEE ?? ?????? ?? 95% ?????? ??????? (????? ?????). ????? ???? ?????? ????' ?? ???? ????. ??????? ?? ??? ????? ?? ????? ??????? ????? ???? ?????????? ????? ???????.??? ?? ????? ?????? ?? ???? ??? – ???? ?? ?? ?? ??? ??????? ?"? ??? ??. ?? ??? ?????: TTE (transthoracic echo). TEE (transesophageal echo) – ??? ???? ??? ?????, ???? ????? ??? ????? ????????. TTE – ????? ?-60-65%. ??? ????? ??? ???? ???? ???, ????? ?? ???? ????. ??? ???? ???? ?????? ?? ????, ????? ???? ???? ???? (tri-cuspid endocarditis). ???? ?????? ????? TEE ?? ?????? ?? 95% ?????? ??????? (????? ?????). ????? ???? ?????? ????' ?? ???? ????. ??????? ?? ??? ????? ?? ????? ??????? ????? ???? ?????????? ????? ???????.

    40. ????? ?????? ?????? ??????? – ??? ????, ???? ????? ?????. ???? cost-effective ?????? ?? ??? ???? ? IE. 40 TEE ??? ?? ????? ?????? ?????? ??????? – ???????? ?????? ????? ????? ?? ???? ?????, ??????????, ???????? ????? ?????. ???? ??? ?????? ????? TTE (???? ???? ????? ??? ???? ???) ??? ?????? ?-TEE (?? ?? ????? ??????).TEE ??? ?? ????? ?????? ?????? ??????? – ???????? ?????? ????? ????? ?? ???? ?????, ??????????, ???????? ????? ?????. ???? ??? ?????? ????? TTE (???? ???? ????? ??? ???? ???) ??? ?????? ?-TEE (?? ?? ????? ??????).

    41. 41 ????? ?????? ????.????? ?????? ????.

    42. 42 ??????.??????.

    43. 43 ??????????? - ????? ??????? ??? ?????? - ???? ???? ??????????? ??????:  ?????? ?? ?????? ?????? PERSISTENT BACTEREMIA    TEE ?????? ??????

    44. 44 ?????????? ?????? ??????????? I DUKE CRITERIA Durack DT, Am J Med 1994;96:200-209 MAJOR SIGNS 1. ?????? ?? ??????? ???????? ???????????? ?. ????? ?? ????? ??????? ???? ?????? ??????: Viridans Strep, Strep bovis, Staph aureus, Enterococcus, HACEK group ?? ?. ???? ???????? ?????? ?"? ????????????? ?????:        ·   ????? ???? ?????? ????? ?? ????? 12 ???? ?? ???.        ·   ????? ? 3/3 ?????? ?? ???? ??????? ???? ???? ?? ???? ????? ??? ?????? ???? ??? ?? ????? ??? ???. ?? ?. ????? ?? ?????? ? C.burnetii ?? Anti phase 1 >1:800 2. ???? ????? ???????? ???? ????? ???????????? - ??????, ????? ,?????? ???? ?? ???? ???? ,?? ????? ???? ?? ????. ?????????? ?????? – duke criteria ?????? ?????? ???? ??????. Major criteria ??????? ????? ????? ??????? ???? ?????? ?????? ????? (?????? ?? ???????? ??????? ?????? ????????: viridans, bovis, s. Areus, ??????????, HACEK – ??????? ?????? ???, ????? ?????, ??????, ?????????????). ????? ?????? continous bacteremia, ?? s. Areus ???? ????? ??? ??????? ?????, ??? ??? ???? ?? ?????? ???. ?? ???? ???????? ?????? ?"? ????? – ????? ???? ?????? ????? ?? 12 ????. ????? ?? 3/3 ?? ???? ??????? ?? ???? ?????? ??????? – ????? ?????? ??????? ??????. ?????? ?? ??????? ?? ???????? ?????? ?-coxiella burneti (????? ?-Q-fever ??????) – ???? ??????? ??????? ?????. ???? ?????? ?????? ?????????? ??? major ?? ???????????, ???? ?? ????? ?????. ???? ????? ?? ???????? – ???? ????? ???? ??.?????????? ?????? – duke criteria ?????? ?????? ???? ??????. Major criteria ??????? ????? ????? ??????? ???? ?????? ?????? ????? (?????? ?? ???????? ??????? ?????? ????????: viridans, bovis, s. Areus, ??????????, HACEK – ??????? ?????? ???, ????? ?????, ??????, ?????????????). ????? ?????? continous bacteremia, ?? s. Areus ???? ????? ??? ??????? ?????, ??? ??? ???? ?? ?????? ???. ?? ???? ???????? ?????? ?"? ????? – ????? ???? ?????? ????? ?? 12 ????. ????? ?? 3/3 ?? ???? ??????? ?? ???? ?????? ??????? – ????? ?????? ??????? ??????. ?????? ?? ??????? ?? ???????? ?????? ?-coxiella burneti (????? ?-Q-fever ??????) – ???? ??????? ??????? ?????. ???? ?????? ?????? ?????????? ??? major ?? ???????????, ???? ?? ????? ?????. ???? ????? ?? ???????? – ???? ????? ???? ??.

    45. 45 ?????????? ?????? ??????????? II DUKE CRITERIA MINOR SIGNS ????????????: ???? ???? ????? ?? ????? ????? ???? ?????? ??? ??? C 380 ?????? ?????????: ???????? ???????, ?????? ????? ?????, ????????? ???????, ???? ??? ????, ???? ???????, ???? ?"? JANEWAY ?????? ????????????: ???????????????, ?????? ?"? OSLER, ROTH SPOTS, Rheumatic factor ???? ???????????: ?????? ?? ????? ??????? ?- MAJOR SIGNS ?? ???? ???????? ?????????????? ????? ???????????? ??????????? ?????? ???????????? ??? ???? - MAJOR SIGNS Minor criteria ???? ?? ???-????????? – ????? ????? ?? ?? ???? ??????. ??? ??? 38. ?????? ?????????? ??? ???????? ??????? ?? ?????? ??????, ????????? ???????, ????? ??? ????, ????? ???????, ???? ?"? janeway. ??????? ??? ???? ?? ??? ????? ??????, ??????? ??? ???? ???? ?????, ??? ???'. ????????? ???? ???????? ???? ?? ??????? ??. ?????? ???????????? - ???????????????, roth’s spots, RF. ???? ??????????? - ???????? ????? ??????? ?-major, ??? 2/3 ?? E. Coli, ?? ???? ???????? ?????????????? ????? ????????????. ??? ????? ????? ?-major – ?? ???? ?? ?? ???? ???????.Minor criteria ???? ?? ???-????????? – ????? ????? ?? ?? ???? ??????. ??? ??? 38. ?????? ?????????? ??? ???????? ??????? ?? ?????? ??????, ????????? ???????, ????? ??? ????, ????? ???????, ???? ?"? janeway. ??????? ??? ???? ?? ??? ????? ??????, ??????? ??? ???? ???? ?????, ??? ???'. ????????? ???? ???????? ???? ?? ??????? ??. ?????? ???????????? - ???????????????, roth’s spots, RF. ???? ??????????? - ???????? ????? ??????? ?-major, ??? 2/3 ?? E. Coli, ?? ???? ???????? ?????????????? ????? ????????????. ??? ????? ????? ?-major – ?? ???? ?? ?? ???? ???????.

    46. 46 ?????????? ?????? ??????????? III ???????? ???????? 1. ????? ??????????: ????? ????? ???????? ?? ????? ?? ???? ??????????. 2. ????? ??????: ??? ?????????? MAJOR, ?? ??? MAJOR+????? MINOR ?? ????? MINOR 3. ????? ??????: ??? Major + ??? Minor 3 Minor 4. ????? ?????: ????? ????? ?????? ??????, ??????? ?????? ???? 4 ??? ???? ????????? ??? ???? ???????????? ????? PM ???? 4 > ??? ???? ????? ?????????? – ?? ????? ??? ???????? ?? ???? ??????????. ????? ?????? – ??? major (??? + ?????? ??) ?? major ??? ?????? minors (??????, ????? ??? ?? ?????, ?? ?? ???, ?????? ?? roth’s spots) ?? ????? ?????????? minor. ????? ?????? – ?? ???????. ?? ????? ???? ?????? ??????????? – ??? ???.????? ?????????? – ?? ????? ??? ???????? ?? ???? ??????????. ????? ?????? – ??? major (??? + ?????? ??) ?? major ??? ?????? minors (??????, ????? ??? ?? ?????, ?? ?? ???, ?????? ?? roth’s spots) ?? ????? ?????????? minor. ????? ?????? – ?? ???????. ?? ????? ???? ?????? ??????????? – ??? ???.

    47. 47

    48. 48 Culture negative endocarditis 5-10% ???????. ??? ????? ????? ????' (????' ?????? ???????? ?????, ????? ?? ???? ???????). ???? ?????? ???? ??? ????? ?? ??????. ?????? – ?? ???? ??????. ?????? ????? ??????????? ????? ?? ?-50% ???????. ?????? ????? ????? ??????? ?? – ???????, ?????????, ???????, ??????, ?? ?? Q-fever ????? ???? ?? ??? ??????? (?? ?? ?? ???? ?????? – ????? ?? ?? ???? ???? ???????????? ?? ????? ??????). ?? ??????? ??????? ???? ???? ???????. Culture negative endocarditis 5-10% ???????. ??? ????? ????? ????' (????' ?????? ???????? ?????, ????? ?? ???? ???????). ???? ?????? ???? ??? ????? ?? ??????. ?????? – ?? ???? ??????. ?????? ????? ??????????? ????? ?? ?-50% ???????. ?????? ????? ????? ??????? ?? – ???????, ?????????, ???????, ??????, ?? ?? Q-fever ????? ???? ?? ??? ??????? (?? ?? ?? ???? ?????? – ????? ?? ?? ???? ???? ???????????? ?? ????? ??????). ?? ??????? ??????? ???? ???? ???????.

    49. Prosthetic Valve Endocarditis ?????? ????? ???? ??????? ???? ?????? – 1-3% ????? PVE. ?????? ????? ??? ??? ??? ???? ???? ????????. ????? ? 15 ????, ? 17% ????? PVE. 49 Prosthetic valve endocarditis ????? ?????' ?? ???. ?????? ?????? ???? ??????????? ?? ???? ???? ??? ???? ??????? (3%, ?? ???, ?????? ????). ?????? ???? ???? ????? ????? ??????, ??"? ?????? ?????? ????? ?????? ??????. ?-15 ????, 17% ????? ??????????? – ?? ????, ???? ??? ?????? ????? ??? 3 ??????, ?????? ???. ?????? ??? ????? – ???? ????? ???? ????? ????? ???, ?? ??????????? ????? ??????? ???.Prosthetic valve endocarditis ????? ?????' ?? ???. ?????? ?????? ???? ??????????? ?? ???? ???? ??? ???? ??????? (3%, ?? ???, ?????? ????). ?????? ???? ???? ????? ????? ??????, ??"? ?????? ?????? ????? ?????? ??????. ?-15 ????, 17% ????? ??????????? – ?? ????, ???? ??? ?????? ????? ??? 3 ??????, ?????? ???. ?????? ??? ????? – ???? ????? ???? ????? ????? ???, ?? ??????????? ????? ??????? ???.

    50. ????? Early – ?? ??????? ???? ?????? Intermediate – 2-12?' ???? ?????? Late – ??? ??? ???? ?????? 50 Early – ?? ??????? ???? ??????: staph coagulase negative (????? ?? ???, ?? ?????? ??????), staph areus. Intermediate – 2-12 ?????? ???? ??????. Late – ??? ??? ???? ??????: ?????? ?? ??????????? ???? + staph coagulase negative (???? ????? ???? ?"? ?????, ?? ???? ????? ?? ??? ???? ??????) – ????? ?? ??? ????????? (??? ????????????), ???? ?? ??? ???? ?????? ??? ?? ?? ??????, ?? ????? ?????? ???? ???? ????? – ?? ??? ???????????.Early – ?? ??????? ???? ??????: staph coagulase negative (????? ?? ???, ?? ?????? ??????), staph areus. Intermediate – 2-12 ?????? ???? ??????. Late – ??? ??? ???? ??????: ?????? ?? ??????????? ???? + staph coagulase negative (???? ????? ???? ?"? ?????, ?? ???? ????? ?? ??? ???? ??????) – ????? ?? ??? ????????? (??? ????????????), ???? ?? ??? ???? ?????? ??? ?? ?? ??????, ?? ????? ?????? ???? ???? ????? – ?? ??? ???????????.

    51. ?????? Early – Staph. 40-60% (SCN–35%), GNB, Fungi Intermediate – Staph., Strep., Enterococci Late – like NVE + SCN. 51

    52. ????? – ?????? ?? + TEE ??????? ????? – ????? ?????? ??????? ?????? ??????. ???????? – ????? ????? ? Early ?? late. ????? – 10-30% 52 ?????? - ?????? ?? ?-TEE (TTE ?? ???? ?????). ????? ???? ????? – ??????? ????? ?? ????', ????? ?????? ?????? ??????. ?? ????? ?? ?????? 10-30%, ???? ???? ????? ????? ?????? ????.?????? - ?????? ?? ?-TEE (TTE ?? ???? ?????). ????? ???? ????? – ??????? ????? ?? ????', ????? ?????? ?????? ??????. ?? ????? ?? ?????? 10-30%, ???? ???? ????? ????? ?????? ????.

    53. ?????? ???? - IVDU ??? ???????? ?????? -> ??? ???? ? IE ? 2/3 ??? ???? ?????? ????. ???, ????? ?? TCV. ?? ? 35% ????? ?????? ??? ?????. ??????- ??? ????????. ?????? ???- Septic pulmonary emboli ???? 2/3 ??? ?????? ????. 53 ?????? ???? (IV drug users) ???' ??????? ?? ?? ???, ?? ?? ????? ?????? (??????, ??????? ?????? ????????????). ?????????? ?? ?????? ???? ???? ?????? ?????: ??? ???????? ??????? ?-IVDU – ??? ???? ???? ?? ????? ??? – ?? ????? ????? ???? ?????, ?? ????? ??????? ??? ????? ???? ??????. ???? ?????? ??? ???? ?????? ???? (?? ??? ??? ???????). ?? ?-35% ?? ?????? ????????? ????, ??? ????? ?? ????? ??? tri-cuspid regurgitation. ?????? - ??? ???????? ??? ???????? ??????, ????? ????? ???????????? ?????? ???? ??? ????. ?????? ??? ????? septic pulmonary emboli. ??? 2/3 ?? ??? ?????? ???? - ????? ???? ?? S. Areus ?? strep ???? ?????? ????????.?????? ???? (IV drug users) ???' ??????? ?? ?? ???, ?? ?? ????? ?????? (??????, ??????? ?????? ????????????). ?????????? ?? ?????? ???? ???? ?????? ?????: ??? ???????? ??????? ?-IVDU – ??? ???? ???? ?? ????? ??? – ?? ????? ????? ???? ?????, ?? ????? ??????? ??? ????? ???? ??????. ???? ?????? ??? ???? ?????? ???? (?? ??? ??? ???????). ?? ?-35% ?? ?????? ????????? ????, ??? ????? ?? ????? ??? tri-cuspid regurgitation. ?????? - ??? ???????? ??? ???????? ??????, ????? ????? ???????????? ?????? ???? ??? ????. ?????? ??? ????? septic pulmonary emboli. ??? 2/3 ?? ??? ?????? ???? - ????? ???? ?? S. Areus ?? strep ???? ?????? ????????.

    54. IVDU 2 ?????? S.aureus – 60% Streptococci – 16% Pseudomonas – 13% Polymicrobial – 8% Candida 54 ???????: s. Areus. Strep – ?? ?? ?? viridans ??? group A (????? ????) ????? ?? ????. ????? ????? ?????? ?? ?????? ????????. Pseudomonas – ??? ??????? ???????? (?? ????' ?????). Polymicrobial. Candida.???????: s. Areus. Strep – ?? ?? ?? viridans ??? group A (????? ????) ????? ?? ????. ????? ????? ?????? ?? ?????? ????????. Pseudomonas – ??? ??????? ???????? (?? ????' ?????). Polymicrobial. Candida.

    55. 55 ????? ??? ?????? ?? septic emboli.????? ??? ?????? ?? septic emboli.

    56. 56 ?????? ???????????? ????? ??????? ??????: ??? ????? ??? ??? ??? ??. ?? ???? ?? ?????' ?????? ??????? – ???? ???? ????? ???? ???? ??? ???? (4 ??????). ????? ???? 6-8 ??????, ??? ????? ???? ????' ?????. ?????? ?????, ????????? ?? ??????????? ?????? ?? ????? – ????? ????? ??? ??? ??????. ??? ??????? ????, ??? ????? ???????????? ????? ??? ??????!?????? ???????????? ????? ??????? ??????: ??? ????? ??? ??? ??? ??. ?? ???? ?? ?????' ?????? ??????? – ???? ???? ????? ???? ???? ??? ???? (4 ??????). ????? ???? 6-8 ??????, ??? ????? ???? ????' ?????. ?????? ?????, ????????? ?? ??????????? ?????? ?? ????? – ????? ????? ??? ??? ??????. ??? ??????? ????, ??? ????? ???????????? ????? ??? ??????!

    57. 57 ????????? ?????? ??"? – ???? ????? ????? ??????? ????? ?????. ?????? ???????????? – ???? ????. ?????? ???????? ???????? ?? ???? 7 ??? ?????, ?? ???? ?? ??????? ?????? ??????? ?????? ???????. ??????? ?????? - ???? ?????? 7-10 ???? ???????????? ?????? ???? ????, ???? ???? ???? ????? ??????? ??? ?????. ?????? ??? ?????' ???? ????? – s. Areus ???? ???????, candida, Q-fever, VRE, KPC.????????? ?????? ??"? – ???? ????? ????? ??????? ????? ?????. ?????? ???????????? – ???? ????. ?????? ???????? ???????? ?? ???? 7 ??? ?????, ?? ???? ?? ??????? ?????? ??????? ?????? ???????. ??????? ?????? - ???? ?????? 7-10 ???? ???????????? ?????? ???? ????, ???? ???? ???? ????? ??????? ??? ?????. ?????? ??? ?????' ???? ????? – s. Areus ???? ???????, candida, Q-fever, VRE, KPC.

    58. 58 ????? ??? ????? – ????? ???, ???? ???? ??? ??????? ???? ???? ?????.????? ??? ????? – ????? ???, ???? ???? ??? ??????? ???? ???? ?????.

    59. 59 ???????? ????? ??? ????? – 100%. ????? ?????? ??? ?????? ????? ??? ??. ???? ?????? ??? 20%. ????? ???? ???????: ??"?. ??"?. ????????. ??????? ??????.???????? ????? ??? ????? – 100%. ????? ?????? ??? ?????? ????? ??? ??. ???? ?????? ??? 20%. ????? ???? ???????: ??"?. ??"?. ????????. ??????? ??????.

    60. ????? IE ???? IE ????? ???? ????? ?"? ??????? S.viridans ????? ????? ?????? ????? ????? ????? ????? ???????? ???? ?????? ?????? ?????? ?????? ?? ????? ?? ???? ?????? ????? IE ???? ????? ?????? 60 ????? ??????????? ????? guidelines ????? ????? ?? ????? ?? ???. ???? ????? ?? ???????? (?? ????? ??????? ?? ???? ?????) – ???? ??? ???????? ????? ??????? ????????, ??? ?????? ??????. ???? ???? ?-s. Viridans ??? ???? ???? ?????? ?????? (???? ?????? ??? ???? ??? ???? ??????? ???). ?? ?????? ?? ????? ????? ?????? ?????? ??????????? ???? ????? ?? ????? ??????. ?? ?? ???? ??????.????? ??????????? ????? guidelines ????? ????? ?? ????? ?? ???. ???? ????? ?? ???????? (?? ????? ??????? ?? ???? ?????) – ???? ??? ???????? ????? ??????? ????????, ??? ?????? ??????. ???? ???? ?-s. Viridans ??? ???? ???? ?????? ?????? (???? ?????? ??? ???? ??? ???? ??????? ???). ?? ?????? ?? ????? ????? ?????? ?????? ??????????? ???? ????? ?? ????? ??????. ?? ?? ???? ??????.

    61. ?????? ???"? ???? ?? ???? ????? IE ?"? ????? ????????? ????? ????????? ???? ????? ?????? ???? ??????? ????? ????????? ???????? ?? ???? ????-> ???? IE 61 ?????? ???"? ???? ????? ????? ??????????? ?"? ????? ????????? ???? ?? ???? ????? ?????? ????????? ?????, ??? ???? ??????? ????????????.?????? ???"? ???? ????? ????? ??????????? ?"? ????? ????????? ???? ?? ???? ????? ?????? ????????? ?????, ??? ???? ??????? ????????????.

    62. ????? ?? ???? ?? ????? ???? ????? ?????? IE ??????. ?? ???? ?? ????? ???? ??? ???? IE ??????? ???? ?????? ?????? ?????? ???? ???? ?????? (?? ???? ???? ?????) ??? ???? ????? ??????. ?????? ???? IE ???? ?????? ?????? ?????? ???? ???? ?? 154000 ??????? ?????? ??. 62 ??? ?? ?????? ?? ??????? ???? ?????? ????? ?? ?????? ????????????. ???? ????? ????? ?? ????? ?? ?? ???????, ??????? ???????????? ???? ???? ?? 154,000 ?????? ?????? ????? ???? ???? ????? ??...??? ?? ?????? ?? ??????? ???? ?????? ????? ?? ?????? ????????????. ???? ????? ????? ?? ????? ?? ?? ???????, ??????? ???????????? ???? ???? ?? 154,000 ?????? ?????? ????? ???? ???? ????? ??...

    63. ????? ???? ??????? ?????? ?????????? ????? ???? ??????? ???? ?? ????. ????? ???????????? ???? ??????? ????? ????? ??????? ???? ????? ?? ????? ????? ????? ???? 63 ?? ???? ???? ???? ????? ??????, ?? ?? ??????????????, ????????? ????? ??? ???????, ????? ?????????. ?? ?????? ????? ???? ????' (??? ?????????? ?????????). ??????? ?? ??? ?????? ????? ?????? ??????????? – ????? ?? ????? ???? (???? ??'??? ???), ?????? ???? ???????????? ??????? ????? ????? ?? ??????? ?? ?????. ?? ?? ?????? ??????? ???? ???? ?? ???????????.?? ???? ???? ???? ????? ??????, ?? ?? ??????????????, ????????? ????? ??? ???????, ????? ?????????. ?? ?????? ????? ???? ????' (??? ?????????? ?????????). ??????? ?? ??? ?????? ????? ?????? ??????????? – ????? ?? ????? ???? (???? ??'??? ???), ?????? ???? ???????????? ??????? ????? ????? ?? ??????? ?? ?????. ?? ?? ?????? ??????? ???? ???? ?? ???????????.

    64. ????? ????? ??? ?? ??? ????? ???? ???? ???? ??? ??? ????? ???? ???? ? IE ????? ?? ???? ?? ???????? (????????? ??? ?????, ????? ? 6?' ????????) ?????? ?? ?? ????? ?????? ??? ?????? 64 ?????? ????? ???? ??? ??? ?????? ????? ????? ???? – ?? ???? ?????? ??? ???. ????? ???? ???? ????????????. ???? ?? ????????, ?? ?? mitral valve prolapse ?? MR. ?????? ?? ?? ????? ?????? ??? ??????.?????? ????? ???? ??? ??? ?????? ????? ????? ???? – ?? ???? ?????? ??? ???. ????? ???? ???? ????????????. ???? ?? ????????, ?? ?? mitral valve prolapse ?? MR. ?????? ?? ?? ????? ?????? ??? ??????.

    65. ?????? ??? ???? ????? ???? ?????? ?????? ??? ?? ????? ?????? ??????. ???? ????? – ???? ?? ????? ?? ??????. ??' ????? – ???? ?? ????? ?????? ?????? ???????? ????? ???. ??' ??? ???? – ???????? ??? ??????. 65 ?????????? ???? ?????????? ?????? ??? ??? ?????? ??? ???????: ??????? ??????, ????? ????? ???? ?????? ????????, ???????????? ?? ???????, ?????? ????? ??? ????????? ????????? (??? ?????????).?????????? ???? ?????????? ?????? ??? ??? ?????? ??? ???????: ??????? ??????, ????? ????? ???? ?????? ????????, ???????????? ?? ???????, ?????? ????? ??? ????????? ????????? (??? ?????????).

    66. 66 ?????? ??????? ???? ??? moxipen (amoxicillin) 2 ??' ??? ???? ?????? (??? ?? ???????????, ??????? ???? ????' ????? ?????). ???????? ???? ??? V-ampicillin. ?? ????.?????? ??????? ???? ??? moxipen (amoxicillin) 2 ??' ??? ???? ?????? (??? ?? ???????????, ??????? ???? ????' ????? ?????). ???????? ???? ??? V-ampicillin. ?? ????.

    67. 67 ?????????? ?? ?-GI ?????? ????? ?-ampicillin ?-gentamycin. ??? ?????? ???? strep bovis ?????????.?????????? ?? ?-GI ?????? ????? ?-ampicillin ?-gentamycin. ??? ?????? ???? strep bovis ?????????.

    68. ??? 68

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