Infective Endocarditis Prepared by Abdullah Mosluh Abdullah Academic

Infective Endocarditis Prepared by : Abdullah Mosluh Abdullah Academic No. : 426810123 Bader Nasser Al-Msaed Infective ENDOCARDITIS 1

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 2

pathogenesis Infective ENDOCARDITIS 3

pathogens cause infective endocarditis Who is at high risk of infection by this organism ? Infective ENDOCARDITIS 4

Clinical manifestation symptoms Constitutional Sweating Anroxia Weakness Chill Weight loss Myalgia Back pain Infective ENDOCARDITIS 5

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 Ig. G 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 6

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 7

The Roth Spot is a white-centered hemorrhage Infective ENDOCARDITIS 8

Osler Nodules Skin janeway lesion Infective ENDOCARDITIS 9

LABORATORY STUDIES & IMAGING Multiple blood cultures ESR& CRP↑ Leukocytosis, anemia & hematuria +ve rheumatoid factor ECHO Infective ENDOCARDITIS 10

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 11

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 12

PREVENTION Prosthetic cardiac valves Previous IE Unrepaired cyanotic congenital heart disease Valvular lesions in posttransplant pt. 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. Oral amoxicillin 50 mg/ kg ( 30 – 60 min ) Clindamycin or azithromycin ( allergic to β – lactam) Infective ENDOCARDITIS 13

THANK YOU Infective ENDOCARDITIS 14