Preventive measures including antimicrobial prophylaxis may reduce the risk of initial and recurrent ie for patients with relevant risk factors. Infective endocarditis vegetations arrows due to viridans streptococcal endocarditis involving the mitral valve. Vegetations may result in valvular incompetence or obstruction, myocardial abscess, or mycotic aneurysm. Infective endocarditis acute toxic presentation progressive valve. Bacterial endocarditis refers to infection of the endocardial surface of the. Often affects damaged heart valves if not treated, usually fatal by one year often due to streptococci this classification is now discouraged. Blood cultures remain the standard test for microbial diagnosis, with directed. Infective endocarditis is an infection in the heart valves or endocardium. Challenging issues in infective endocarditis pathogenesis bacterial adherence to damaged valve. 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. The prototypic lesion of infective endocarditis, the vegetation, is a mass of platelets, fibrin, microcolonies of microorganisms, and scant inflammatory cells. The clinical presentation of subacute ie is variable, but the presentation of acute ie is more. Persistent or recurrent low grade fever is the most common symptom of ie.
Infective endocarditis harrisons principles of internal. Clinical presentation, etiology, and outcome of infective endocarditis in. 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. Infective endocarditis is infection of the endocardium, usually with bacteria commonly, streptococci or staphylococci or fungi. Infective and non infective related causes must be distinguished. The diagnosis of infective endocarditis requires the integration of clinical, laboratory, and echocardiographic findings. 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. Infectious endocarditis results from bacterial or fungal infection of the endocardial surface of the heart and is associ ated with significant morbidity and mortality. Ppt infective endocarditis powerpoint presentation. Endocarditis is defined as an inflammation of the endocardial surface of the heart. Infective endocarditis american academy of pediatrics.
Infective endocarditis arises when an adherent plateletfibrin nidus becomes secondarily infected and produces vegetations, which in turn may directly damage the endocardial tissue andor valves. Describe the clinical manifestations of infective endocarditis. Infective endocarditis ie is a major challenge for clinicians and a considerable burden for healthcare systems. Complications may include valvular insufficiency, heart failure, stroke, and kidney failure the cause is typically a bacterial infection and less commonly a fungal infection.
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. Three groups of organisms cause a majority of infective endocarditis cases. Watch the complete lecture in the members area at endocarditis is inflammation of. In most cases, the inflammation is related to a bacterial or fungal.
Clinical presentation, etiology, and outcome of infective endocarditis in the 21st. They should be essential in everyday clinical decision making. Laboratory diagnosis of infective endocarditis journal of clinical. Management empirical treatment depends on the mode of presentation, suspected organism whether the patient has a prosthetic valve. Esc guidelines 2015 esc guidelines for the management of infective endocarditis the task force for the management of infective endocarditis of the. This may include heart valves, mural endocardium or the endocardium that covers implanted material, such as prosthetic valves, pacemakerdefibrillator leads and catheters. Numerous important observations concerning the pathogenesis of infective endocarditis have been made over the past 18 years. Update on infective endocarditis larry baddour, md university of tennessee pathogenesis disruption of the endocardial layer as a complication of abnormal blood flow. Mechanical lesions inflammatory lesions challenging issues in infective endocarditis challenging issues in infective endocarditis diagnosis prerequisite high index of suspicious early tee. Pathophysiology, epidemiology, clinical presentation. Blood cultures remain the standard test for microbial diagnosis, with directed serological testing i.
Infective endocarditis is a lifethreatening disease whose pathophysiology is based on unique hostpathogen interaction. Discuss the epidemiology and pathogenesis of infective endocarditis. Do patients at risk of infective endocarditis need. Theyll give your presentations a professional, memorable appearance the kind of sophisticated look that todays audiences expect. View pathology endocarditis ppts online, safely and virusfree. Infection most commonly involves heart valves but may also occur on the lowpressure side of a ventricular septal defect, on mural endocardium damaged by aberrant jets of blood or foreign bodies, or on intracardiac devices themselves. A free powerpoint ppt presentation displayed as a flash slide show on id. Endocarditis infective endocarditis is an inflammation of the inner layer of the heart, the endocardium. Pathophysiology and causes of endocarditis oxford medicine. Infective endocarditis cardiovascular disorders merck. 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. This apparent paradox is explained by a progressive evolution in risk factors.
Symptoms may include fever, small areas of bleeding into the skin, heart murmur, feeling tired, and low red blood cell count. The alarmone pppgpp mediates the stringent response and has a recognized role in bacterial virulence. 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 pathology nve infection is largely confined to. Winner of the standing ovation award for best powerpoint templates from presentations magazine. Pathogenesis of endocarditis bacteraemia of oral origin.
Classic peripheral manifestations eg, oslers nodes may or may not occur. Although recognized as prognostically important, the pathologic description has often been limited to the. 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. Many of these observations have been obtained with animal models of endocarditis in which an indwelling catheter has been used to produce predisposing endocardial lesions for subsequent infection. The characteristic lesion, a vegetation, is composed of a collection of platelets, fibrin, microorganisms, and inflammatory cells. 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. A wide variety of other organisms were responsible for a few cases, and 10% were. The healthy cardiac endothelium is resistant to frequent bacteraemia caused by daily activities such as. Pathology of infective endocarditis dr sampurna roy md. The causes and epidemiology of the disease have evolved in recent decades.
Of the 544 episodes 347 63% were due to streptococci, 19% to staphylococci, and 14% to bowel organisms. The clinical presentation of infective endocarditis is highly variable and nonspecific, although a fever and murmur are usually present. Rheumatic fever and rheumatic heart disease 5 determinants of the disease burden of rheumatic fever and rheumatic heart disease 7 references 8 3. 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. Pathophysiology of infective endocarditis springerlink. Despite improvements in health care, the incidence of infective endocarditis has not decreased over the past decades. 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. Worlds best powerpoint templates crystalgraphics offers more powerpoint templates than anyone else in the world, with over 4 million to choose from. Pathogenesis includes preexisting endocardial lesions or inflammation that leads to endothelial cells and platelets activation, coagulation and thrombus formation. Infective endocarditis ie is a rare, lifethreatening disease that has. Infective endocarditis ie is an uncommon infection, occurring as a complication in varying percentages of bacteremic episodes. 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. 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.
The pathophysiology of infective endocarditis comprises at least three critical elements. The prototypic lesion of infective endocarditis, the vegetation, is a mass of platelets, fibrin, microorganisms, and scant inflammatory cells. Some details of 544 episodes of infective endocarditis occurring in 541 patients during 1981 and 1982 are reported. Antibiotic prophylaxis is not recommended for local anaesthetic injections in noninfected tissues, treatment of superficial caries, removal of sutures, dental xrays. Infective endocarditis is an infection of the inner surface of the heart, usually the valves. Pathogenesis of experimental endocarditis clinical. The microbiology and pathogenesis of infective endocarditis. We previously reported a stringent responselike state in enterococcus faecalis isolated from a rabbit foreign body abscess model and showed that e.1569 111 1169 1039 158 673 1079 1317 456 677 210 730 1643 1344 1234 196 414 1499 457 1270 1687 1383 596 1002 510 188 1095 1134 700 369 962 438 671 752 237 1110 1103 982