Prepared by : Abdullah Mosluh Abdullah Academic No. :426810123

Bader Nasser Al-Msaed1Infective ENDOCARDITIS

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

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pathogenesis

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pathogens cause infective endocarditis

Who is at high risk of infection by this organism? 4Infective ENDOCARDITIS

Clinical manifestationsymptomsConstitutionalSweating AnroxiaWeaknessChillWeight lossMyalgia Back pain

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DUKE CRITERIAMAJOR 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 >1:800Evidence of endocardial involvement with positive echocardiogram

defined as Vegetation on valve

Abscess, ornew valvular regurgitation (worsening or changing of preexisting

murmur not sufficient)

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continueMinor criteria include:Predisposing factor: known cardiac lesion,

recreational drug injectionFever >38°CEvidence of embolism: arterial emboli, pulmonary

infarcts, Janeway lesions, conjunctival hemorrhageImmunological 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

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The Roth Spot is a white-centered hemorrhage

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Osler Nodules Skin janeway lesion

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

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TREATMENTAcutely ill persons → empirical antibiotic therapySubacute disease → wait results of blood culturesBactericidal antibiotic → 4 to 8 weeksIE ( viridans streptococci ) → monotherapy penicillin G for 4

weeks

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Surgery will be indicated in the following conditions:

Unsuccessful medical treatment with persistant bacterimiaFungal endocarditisValve annulus or myocardial abscessRupture of valve leafletValvular insufficiency with acute or refractory

heart failureRecurrent serious embolic complicationsRefractory prosthetic valve disease

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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)

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