infective endocarditis - semmelweis

Infective Endocarditis

Zoltán Pozsonyi, MD3rd Dep. of Internal Medicine

Semmelweis UniveryityBudapest, Hungary

Definition

• Microbal infection of the endothelial surface of the heart

• Mainly valves• Mainly valves– but ASD, VSD

Incidence

• About 4-6/100000 in a year

• The age of the patients is increasing

• Valvularheartdiseas: predisposingfactor• Valvularheartdiseas: predisposingfactor

• Risk is higher in males

• >45 y

Prosthetic valve endocarditis

• 10-30 % of all cases

• Early: in one year following the operation– Staphylococcus– Staphylococcus

• Periannular complictions are common– leak, regurgitation, abscess, fistula

Microorganisms

• Viridans streptococci– in the oropharinx, susceptible to penicillin

• Streptococcus bovis• Streptococcus bovis– in the GI tract, susceptible to penicillin

• Enterococci– part of the GI flora– resistant to cephalosporin, oxacillin,

aminoglicoside

Microorganisms

• Staphylococci– S. aureus, S. epidermidis

– implanted devices, nosocomial settings– implanted devices, nosocomial settings

– resistant penicillin, ampicillin

– susceptible to oxacillin, first gen. cephalosporins

– but: MRSA

– toxic febrile illness, complications (S. aureus)

HACEK

• Gram gen bacteria– Haemophilus

– Actinobacillus– Actinobacillus

– Cardiobacterium

– Eikenella

– Kingella

• large vegetations, emboli

Other organisms• Corynebacterium• Lysteria monocytogenes• Tropheryma whippeli• rickettsia Coxiela burnetti (Q fever)• Bartonella quintana and henselae

• Funghi ( Candida, Histoplasma, Aspergillus)– rare

Pathogenesis

• Bacteremia endocarditis

• factors:– endocardial injury– endocardial injury

– high velocity jet

– devices

Pathophysiology

• Clinical manifestations:– local destructive effects

– embolization resulting in infarction– embolization resulting in infarction

– haematogenous seeding of remote sites during continous bacteraemia

– antibody response• subsequent tissue injury; IC; antigenes deposits in

tissues

Diagnosis

• Echocardiography– TTE, TEE, depends on the risk

• Blood cultures• Blood cultures

– Laboratory tests• CRP, Sedimentation rate

• IC, RF

• Urinanalysis

TTE

TEE

Complications

• Heart failure

• Uncontrolled infection– Persisting infection

– Local propagation (fistula, abscess)

• Systemic embolism– Stroke (ishemic)

– Infectious (mycotic) embolism

– Spleen

• Arrhythmia

• Renal failure

Stroke

Treatment- antimicrobal therapy

• should erdicate the microba

• should be not toxic

• Native valve therapy=prosthetic valve • Native valve therapy=prosthetic valve therapy – Exept Staphylococcus