INFECTIVE ENDOCARDITIS (IE).ppt
Transcript of INFECTIVE ENDOCARDITIS (IE).ppt
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De!nitionDe!nition
It"s a #edica$ e#er%enc&c'aracteried & t'e infection of t'ecardiac endot'e$i*#+ #acrosco,ica$$&
seen as ve%etations
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Virt*a$$& fata$ if *ntreated
Morta$it& rate even it' treat#ent is/01
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C$assi!cations of IEC$assi!cations of IE
Ac*te IE 2 fata$ in 3 4 ee5sSE 2 fata$ eteen 4 ee5s- 4
#ont's
C'ronic IE2 ,ersists 6 4 #ont's----------------------------------------------------
--Native va$ve endocarditisProst'etic va$ve endocarditisEndocarditis in I.V. dr*% *sersC*$t*re ne%ative endocarditis
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Predis,osin% factorsPredis,osin% factors
C7D 8 /91R7D 8 :91
V7D
I7D
MVP 8 ;9-::1
Prost'etic va$ves ;9-/91
IV dr*% a*se
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S,to#s of IES,to#s of IE
Fever (s,ecia$$& on cardiac ,atient)*t asent in e$der$&> *re#ia>
Fati%*e
?ei%'t $ossMa$aise
Ni%'t seats
M*sc*$ar PainsS*dden onset of CCF
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P'&sica$ si%nsP'&sica$ si%ns
Pro%ressive ,a$$orPetec'iae (/9-=91) fre@*ent$& on
con*nctiva+ ,a$ate+ *cca$ #*cosa+
*,,er eBtre#ities.S,$inter 'e#orr'a%es (;9-:91) 8
s*-*n%*a$+ $inear dar5 red strea5s
(DD tra*#a)Os$er"s nodes- s#a$$ tender nod*$es
on !n%ers> toe ,ads for 'o*rs-da&s
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P'&sica$ si%nsP'&sica$ si%ns
Cardiac #anifestations 8 CCF 001,atients+ #itra$ fo$$oed & aorticva$ve tric*s,id
A,,earance of a ne #*r#*r orc'an%in% of an eBistin% #*r#*r-s*s,ect IE
Ne*ro$o%ica$ #anifestations- cerera$e#o$i /91+ #enin%itis> rainascess 3 01
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Native va$ve endocarditisNative va$ve endocarditis
Co##onest or%anis# 8 stre,tococc*sviridans+ $ater S.san%*is+ S. #*tans+sta,'&$ococci+ enterococci+ etc.
Stre,tococci 49-91 and sta,'&$ococci/01
7ACEK %ro*, :1 - (7ae#o,'i$*s+
Actinoaci$$*s+ Cardioacteri*#+Ei5ene$$a Kin%e$$a) 8 %ra# 8veor%anis#s+ so#eti#es #oreco##ensa$s in
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Native va$ve endocarditisNative va$ve endocarditis
F*n%a$ endocarditis 8 candida +as,er%i$$*s
More in #a$es+ #ore in e$der$&
Most common valve Mitral thenAortic (on RHD)
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IE in dr*% a*sersIE in dr*% a*sers
More in &o*n% #a$es+ so*rce t'ro*%'s5in
Or%anis#s 8 S. a*re*s 091+ stre,tococci;01+ f*n%i (candida) %ra# 8ve
(,se*do#onas) ;9-;01
Va$ve aected 8 Tric*s,id 091+ Aortic/01+ #itra$ /91
Ac*te onset> #*$ti,$e or%anis#s co##onSe,tic ,*$. E#o$i ca*sin% ,ne*#onia-
co##on
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Prost'etic va$veProst'etic va$ve
endocarditisendocarditisAn& intra vasc*$ar> intra cardiac
device ,redis,oses for IE
Acco*nts for ;9-/91 of a$$ IE
Ris5 is si#i$ar in #ec'anica$ io,rost'esis
7i%'est ris5 34 # + 3 /# virt*a$$&nosoco#ia$
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Prost'etic va$veProst'etic va$ve
endocarditisendocarditisIntra vasc*$ar s*t*res+ ,ace#a5er
$ines+ teGon si$astic t*es 8 act as fociof infection
Aortic va$ve 6 #itra$ va$ve ,rost'esis
F*n%i acco*nt for ;9-;0 1+ 'as 'i%'
#orta$it&
Or%anis#s 8 S.e,ider#idis+ S. a*re*s+%ra# 8ve acteria+ f*n%i+ etc
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Non acteria$ EndocarditisNon acteria$ Endocarditis
(NE)(NE)C*$t*re ne%ative endocarditis 8 ;91
*s*a$$& & fastidio*s or%anis#s-f*n%i+ 7ACEK %ro*,+ aneroes+$e%ione$$a+ c'$a#&dia+ coBie$$ar*netti+ Hi#an"s Sa$5+ anti,'os,'o$i,id s&ndro#e+ infectionsafter ,revio*s antiiotics
Hate dia%nosis+ dic*$t to treat+so#eti#es ,oor ,ro%nosis
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Pat'o%enesisPat'o%enesis
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Pat'o%enesisPat'o%enesis
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Dia%nosis of IEDia%nosis of IE
S*s,icion of IE
- fever it' ,redis,osin%factors
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Investi%ationsInvesti%ations
Ro*tine $ood 8increased ?C+
decreased P$ate$et co*nt+
increased ESR
$ood c*$t*re 8 : sets of c*$t*res at: dierent vene,*nct*re eforeantiiotic *se+ for aeroic>aneroic>f*n%a$ c*$t*res
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Investi%ationsInvesti%ations
ECJ- non s,eci!c+ MI. tac'&cardia
C'est- ra& 8 ac*te CCF+ ,$e*ra$
e*sion + in!$trates
/D EC7O- ve%etations+ascess+ etc
identif&+ $oca$ise c'aracterise
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D*5e criteriaD*5e criteria
Maor 8 ,ositive $ood c*$t*reevidence of endocardia$ invo$ve#ent- L ve EC7O !ndin%- ne va$v*$ar re%*r%itations
Minor criteria 8 ,redis,osin% factors- fever 6: C-vasc*$ar ,'eno#enon
- #icroio$o%ica$ ,'eno#enon-EC7O
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Mana%e#ent of IEMana%e#ent of IE
Medica$ e#er%enc&- 'os,ita$iation 8 IC<
Antiiotic ( road s,ectr*#) dr*% ofc'oice
,enici$$in J ;/-;#i$$ion /= 'r B = ee5s
ceftriaBone /%# dai$& iv B = ee5s
JM; #%> 5% iv tid B / ee5s
vanco#&cin :9 #%>d id B = ee5s
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Proced*reProced*re
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?orst ,ro%nostic feat*res?orst ,ro%nostic feat*res
Non stre,tococca$ %ro*,A%e 6 9 &ears
Aortic va$ve invo$ve#ent
F*n%a$ IE
Har%e ve%etations
C*$t*re 8ve endocarditis
Prost'etic va$ve endocarditis
Deve$o,#ent of CCF on$&
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Co#,$ications of IECo#,$ications of IE
Ac*te CCF deat'Ascess ( ,ericadia$> aortic>
#&ocardia$)
Coronar& e#o$is#Va$ve re%*r%itation> stenosis
Se,ta$ ,erforation ( VSA)
S&ste#ic e#o$is#( 5idne&>s,$een>rain> $*n%s>retina>$i#s)
M&cotic anne*r&s#
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Thank you