Clinical presentation, etiology, and outcome of infective endocarditis in. Persistent or recurrent low grade fever is the most common symptom of ie. In most cases, the inflammation is related to a bacterial or fungal. Subacute bacterial endocarditis sbe is low virulence and mild to moderate illness a more indolent infection, usually occurring in a setting of prior valvular heart disease. Endocarditis infective endocarditis is an inflammation of the inner layer of the heart, the endocardium. The healthy cardiac endothelium is resistant to frequent bacteraemia caused by daily activities such as. Infective endocarditis cardiovascular disorders merck. Infective endocarditis acute toxic presentation progressive valve. Specific patient subgroups are at increased risk of infective endocarditis as a result of damaged cardiac endothelium, abnormal blood flow, intracardiac prosthetic material, immunosuppression, or recurrent bacteraemia box 1. The characteristic lesion, a vegetation, is composed of a collection of platelets, fibrin, microorganisms, and inflammatory cells. Some details of 544 episodes of infective endocarditis occurring in 541 patients during 1981 and 1982 are reported. Complications may include valvular insufficiency, heart failure, stroke, and kidney failure the cause is typically a bacterial infection and less commonly a fungal infection. Changing epidemiology, advances in blood culture techniques, and new diagnostics guide the application of laboratory testing for diagnosis of endocarditis.
Describe the clinical manifestations of infective endocarditis. Do patients at risk of infective endocarditis need. Prosthetic valves 725% of cases of infective endocarditis the rates of infection are the same at 5 years for both mechanical and bioprostheses, but higher for mechanical in first 3 months cumulative risk. Infective endocarditis is a lifethreatening disease whose pathophysiology is based on unique hostpathogen interaction.
Three groups of organisms cause a majority of infective endocarditis cases. Watch the complete lecture in the members area at endocarditis is inflammation of. Ppt infective endocarditis powerpoint presentation. The clinical picture of infectious endocarditis ieits microorganisms, diagnostic criteria duke and modified duke criteria,1,2 involved valve, native versus prosthetic valve, and complicationshas been well described. Update on infective endocarditis larry baddour, md university of tennessee pathogenesis disruption of the endocardial layer as a complication of abnormal blood flow. Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. Of the 544 episodes 347 63% were due to streptococci, 19% to staphylococci, and 14% to bowel organisms. Pathophysiology, epidemiology, clinical presentation. Laboratory diagnosis of infective endocarditis journal. Infective endocarditis pathology nve infection is largely confined to. Endocarditis refers to endothelial damage with thrombosis on endocardial surfaces, typically on the heart valves see the image below. Modified duke criteria for diagnosis of infective endocarditis. The ability of an organism to cause endocarditis is the result of an interplay between the predisposing structural abnormalities of the cardiac valve for bacterial adherence, the adhesion of circulating bacteria to the valvular surface, and the ability of the.
Infective endocarditis vegetations arrows due to viridans streptococcal endocarditis involving the mitral valve. Infective endocarditis ie is a major challenge for clinicians and a considerable burden for healthcare systems. Infective endocarditis is an infection of the inner surface of the heart, usually the valves. Infective endocarditis is an infection in the heart valves or endocardium. Challenging issues in infective endocarditis pathogenesis bacterial adherence to damaged valve. Mechanical lesions inflammatory lesions challenging issues in infective endocarditis challenging issues in infective endocarditis diagnosis prerequisite high index of suspicious early tee. Winner of the standing ovation award for best powerpoint templates from presentations magazine. Classic peripheral manifestations eg, oslers nodes may or may not occur. Esc guidelines 2015 esc guidelines for the management of infective endocarditis the task force for the management of infective endocarditis of the. The clinical presentation of infective endocarditis is highly variable and nonspecific, although a fever and murmur are usually present. Laboratory diagnosis of infective endocarditis journal of clinical. Pathophysiology of infective endocarditis springerlink.
Dissemination of infection to ot her tissue sites and elicitation of systemic findings valvular endothelium mucous membranes other peripheral tissue pathogenesis of infective endocarditis trauma damage at tissue surface congenital abnormalities, turbulent blood flow nonbacterial thrombus, native valves transient bacteremia adherence and. Introduction the management of infective endocarditis ie includes prompt diagnosis, treatment with antimicrobial therapy, and in some cases of complicated ie, surgical management. Infective endocarditis ie is a rare, lifethreatening disease that has. Infective endocarditis harrisons principles of internal. Infective endocarditis pathology nve infection is largely confined to leaflets pve infection commonly extends beyond valvering into annulusperiannular tissue ring abscesses septal abscesses fistulae prosthetic dehiscence invasive infection more common in aortic positionand if onset is early62120 dr. Symptoms may include fever, small areas of bleeding into the skin, heart murmur, feeling tired, and low red blood cell count. The pathophysiology of infective endocarditis comprises at least three critical elements. The causes and epidemiology of the disease have evolved in recent decades. Bacterial endocarditis refers to infection of the endocardial surface of the. Theyll give your presentations a professional, memorable appearance the kind of sophisticated look that todays audiences expect. Antibiotic prophylaxis is not recommended for local anaesthetic injections in noninfected tissues, treatment of superficial caries, removal of sutures, dental xrays. View pathology endocarditis ppts online, safely and virusfree. Infective endocarditis definitions and historical perspective epidemiology pathogenesis clinical presentation and diagnosis therapy prevention the pathogenetic basis for the clinical manifestations of infective endocarditis valvular destruction and local intracardiac complications bland or septic embolization of. Discuss the epidemiology and pathogenesis of infective endocarditis.
Blood cultures remain the standard test for microbial diagnosis, with directed serological testing i. Vegetations may result in valvular incompetence or obstruction, myocardial abscess, or mycotic aneurysm. It may cause fever, heart murmurs, petechiae, anemia, embolic phenomena, and endocardial vegetations. Preventive measures including antimicrobial prophylaxis may reduce the risk of initial and recurrent ie for patients with relevant risk factors. This apparent paradox is explained by a progressive evolution in risk factors. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st. Explain issues related to the diagnosis and management of infective endocarditis. Infective endocarditis is infection of the endocardium, usually with bacteria commonly, streptococci or staphylococci or fungi. Pathology of infective endocarditis dr sampurna roy md. Although recognized as prognostically important, the pathologic description has often been limited to the. A free powerpoint ppt presentation displayed as a flash slide show on id. We previously reported a stringent responselike state in enterococcus faecalis isolated from a rabbit foreign body abscess model and showed that e. The clinical presentation of infective endocarditis is highly variable and.
They should be essential in everyday clinical decision making. Rheumatic fever and rheumatic heart disease 5 determinants of the disease burden of rheumatic fever and rheumatic heart disease 7 references 8 3. Pathogenesis includes preexisting endocardial lesions or inflammation that leads to endothelial cells and platelets activation, coagulation and thrombus formation. The clinical presentation of subacute ie is variable, but the presentation of acute ie is more. Infective endocarditis american academy of pediatrics. Infective endocarditis, a microbial infection of the endocardial surface of the heart instagram drsampyroy it has been classified as acute or subacute chronic on the basis of severity of the clinical presentation and the progression of the untreated disease. Pathogenesis of rheumatic fever introduction streptococcal mprotein 14 streptococcal superantigens 14 the role of the human host in the development of rheumatic fever and rheumatic heart disease 15. Pathophysiology and causes of endocarditis oxford medicine. Infectious endocarditis results from bacterial or fungal infection of the endocardial surface of the heart and is associ ated with significant morbidity and mortality.
The prototypic lesion of infective endocarditis, the vegetation, is a mass of platelets, fibrin, microcolonies of microorganisms, and scant inflammatory cells. Esc clinical practice guidelines aim to present all the relevant evidence to help physicians weigh the benefits and risks of a particular diagnostic or therapeutic procedure on infective endocarditis. Management empirical treatment depends on the mode of presentation, suspected organism whether the patient has a prosthetic valve. Pathogenesis of endocarditis bacteraemia of oral origin 21 after a period of popularity of the theory of focal infection, leading to the application of so. This may include heart valves, mural endocardium or the endocardium that covers implanted material, such as prosthetic valves, pacemakerdefibrillator leads and catheters. Pathogenesis of endocarditis bacteraemia of oral origin. A wide variety of other organisms were responsible for a few cases, and 10% were. The microbiology and pathogenesis of infective endocarditis. Pathogenesis of experimental endocarditis clinical. The prototypic lesion of infective endocarditis, the vegetation, is a mass of platelets, fibrin, microorganisms, and scant inflammatory cells.
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