[OS 213] LEC 11 Infective Endocarditis (a)

OS 213: Circulation and Respiration (Cardiovascular Module) LEC 11: INFECTIE EN!OC"R!ITIS O#T$INE Defnition %!t&o*enesis A Acute Acute vs. vs. Sub!c Sub!cute ute %resent!tions o+ /E En"oc!r"itis A C(in C(inic ic!( !( !ni !ni+e +est st!t !tio ions ns # $!tive $!tive vs. %rost&eti %rost&etic c # %erip erip&e &er! r!(( !n !ni+ i+es est! t!ti tion ons s '!(ve '!(ve En"oc!r"itis C &e &e Du Dues es C(in C(inic ic!( !( Cri Crite teri ri! ! C )i*&t )i*&t vs. vs. Le+t Le+t +or /E En"oc!r"itis  re!tment  re!tment %re"isposin* Con"itions '// '/ / rop& op&-(!3 (!3is Ri%t vs* $e't %Endocarditis Etio(o*ic icroor*!nisms icroor*!nisms A )is C! C!te*ories A. Streptococcus viri"!ns # 4p"!te" A5A #. Enterococ Enterococcus cus )ecommen"!tions )ecommen"!tions 20078 C. St!p&-(oc St!p&-(ococcu occus s D. r!m$e*!tive #!cteremi!

"eve(ops en"oc!r"itis 4su!(("erive" +rom peri peric! c!rr"ium "ium or bovi bovine ne m!teri!( /"entife" b- c&est c!rs !n" mec& ec&!ni !nic!( c!( c(i c(ics cs on !uscu(t!tion

•

•

RI0/T EN!OC"R!ITIS

/nvo(ves t&e tricuspi" !n"=or pu(monic v!(ves

$EFT EN!OC"R!ITIS •

/nvo( /nvo(ves ves t&e mitr! mitr!(( !n"=or !n"=or !ortic v!(ves

!EFINITION .RE!IS.OSIN0 CON!ITIONS FOR NE •

•

icrobi!( in+ection o+ t&e en"ot&e(ium o+ t&e &e!rt c!n !(so invo(ve t&e v!(ves, c&!mber 9!((s, !n" even t&e v!scu(!r tree8 o #ut en"oc!r"itis m!- !(so !rise 9it&out microbi!( invo invo(v (ve ement ment ust ust (i (ie in s-s s-stemi temic c (upu (upus s er-t&em!tosus m!nt!ric en"oc!r"itis8 c&!r!cter terist istic ic (esion (esion more more t&!n t&!n e%etation is t&e c&!r!c ;0< "i!*nostic o+ in+ective en"oc!r"itis=/E8 o An !mor !morp& p&ou ous s subs subst! t!nc nce e o+ v!ri v!ri!b !b(e (e size size cont!inin* p(!te(ets, fbrin, co!*u(!tion +!ctors, micr icroor*! or*!ni nism sms s us usu!(( u!((b!c b!cteri teri! !8 !n" in>!mm!tor- ce((s 5e!rt v!(ves !re most common(- invo(ve", t&ou*& !n- p!rt cont!inin* en"ot&e(ium is ! possib(e site o+  in+ecti in+ection oninte inter!t r!tri! ri!(( or interve interventri ntricu( cu(!r !r septum septum in ASD ASD or 'SD8 'SD8 9it& 9it& t&e &itral valve &ost o'ten in'ected (net is te aortic valve)

•

•

?ne o+ t&e most import!nt "ise!se entities one &!s to no9 9&en *oin* to t&e 9!r"s @ ver- import!nt to "i!*nose !n" tre!t $ot ver- common in t&e %&i(ippines, but t-pic!((- seen in t&ir"9or(" countries 9&ere prevention is (!cin* !n" !n" t&e t&e inci" inci"en ence ce o+ r&eu r&eum! m!ti tic c &e!r &e!rtt "ise "ise!s !se e promotes its occurrence

1.)&eum! 1.)&eum!tic tic 5e!rt 5e!rt Dise!s Dise!se e )5D8 )5D8 @ most most common common in %&i(ippines ;< o+ /E c!ses8 2.Con*enit!( &e!rt "ise!se e.*. bicuspi" !ortic v!(ve8 @ most common in "eve(ope" countries .itr!( v!(ve pro(!pse ne3t is #icuspi" !ortic v!(ve8 @ !(so common in "eve(ope" countries G.De*ener!tive &e!rt "ise!se Si*nifc Si*nifc!nt !nt in t&e e("er(e("er(- 0< 0< in 60 -e!r -e!ro(" o(" o p!tients8 o  &icenin* o+ t&e v!(ves !s p!rt o+ t&e !*in* process .%!renter!( "ru* !buse 1< o C!n C!n c!us c!use e /E even even in t&e t&e !bse !bsenc nce e o+ v!(ve v!(ve o prob(ems o 4se o+ p!renter!( nee"(es c!n "e(iver b!cteri! +oun" in t&e sin to t&e &e!rt !n" c!use /E o En"oc!r"it En"oc!r"itis, is, especi!((especi!((- t&ose on t&e tricuspi" tricuspi" v!(ve, !re o+ten o+ten c!use" b- str!ins o+ S. aureus 9&ic& !re met&ici((inresist!nt 6.?t&ers H.Spont!neous /E 2G< o Deve(op /E 9it&out pre"isposin* +!ctors o ETIO$O0IC OR0"NISMS

"cute vs* Su+,acute Endocarditis • •

5istor- !s m!in b!sis +or "ierenti!tion Dierenti!tion nee"e" +or !ppropri!te use o+ !ntibiotics "C#TE

Dur!tion

S#-,"C#TE

Be9 "!-s to +e9 9ees 5i*&*r!"e +ever 'er- to3ic !n" sic p!tient

S-mptoms

 re!tmen  re!tmentt

•

ees to mont&s • • • •

Etio(o*ic ?r*!nism

•

Lo9*r!"e +ever Lin*erin* i((ness !(!ise Depresse" !ppetite

Staphylococcus aureus

Streptococcus viridans

ent!micin ent!micin  "!-s8 F $!+ci((in=?3!ci((in= '!ncom-cin +or G 9ees

ent!micin 2 9ees8 F %enici((in  or Ampici((in G 9ees8

•

)esu(ts o+ b!cteri!( cu(ture +or /E t!es G "!-s to come out, t&us prop&-(!3is is *iven b!se" on 9&!t t&e or*!nism most (ie(- is Etio Etio(o (o*i *ic c or*! or*!ni nism sm is usu! usu!(( ((- "epe "epen" n"en entt on t&e t&e circumst!nces o+ t&e p!tient, e.*. "ent!( proce"ure I S. viridians ost common !ssoci!te" !ssoci!te" etio(o*ic or*!nism +or sub !cute /E 1. Str Strepto eptoc cocci cci 2. Enterococci . St!p& !u !ureus G. Co!*u(!se (!sene*!tive ive St!p& Staphylococcus epidermidis 8 . r!m r!m ne*! ne*!tiv tive e b!c b!cte teri ri! ! 6. Bun*i H. Cu(t Cu(tur ure e ne*! ne*!ti tive ve For NE

?t&er C&!r!cterist ics

•

ore v!(vu(!r "estruction !n" met!st!tic (esions=in+ections

•

•

)!re(- c!uses met!st!tic (esions $onspecifc s-mptoms m!e it &!r" to "i!*nose

Native vs* .rostetic alve Endocarditis N"TIE "$E EN!OC"R!ITIS (NE)

'!(ves !(ves -ou 9ere 9ere born born 9it& 9it& 9i(( "eve(op in+ection

Fres /anna 4a&ie

.ROST/ETIC "$E "$E EN!OC"R!ITIS (.E) •

ec&!ni ec&!nic!( c!( or biopro bioprost&e st&etic tic v!(v v!(ve e use" use" to rep(! ep(!ce ce "!m! "!m!*e *e" " n!ti n!tive ve v!(v v!(ve e

•

• •

•

J1 Streptococci viridans 8: G6< J2 Enterococci: 7< Staplococci aureus 8:  G0< J2 i+ 9it& &istor- o+  /' !buse8 Bun*i

•

For .E Earl postoper!tion (12 &os*8: Co!*u(!se

ne*!tive st!p&-(ococci /n+ections occurrin* K 2 mos !+ter oper!tion !re *ener!((- t&e resu(t o+ intr! oper!tive cont!min!tion o+ prost&esis or b!cteremic post oper!tive comp(ic!tion o $osocomi!( in n!ture, o

#.CM 2516": '/, !(!n*

M!p!nt!-N

1 o' 6

OS 213: Circulation and Respiration (Cardiovascular Module) LEC 11: INFECTIE EN!OC"R!ITIS (!r*e(- t&e conseOuence o+ /' c!t&eters $ate postoper!tion (712 &os*8:

•

•

•

Streptococci •

Streptococcus Viridans • • •

• • • •

•

•

06< o+ $'E unre(!te" to "ru* use $orm!( in&!bit!nts o+ t&e orop&!r-n3 ost common sub!cute /E $ot ! species but ! *roup o+ species: Streptococci mitior 1o9 + rom 9it&in &im.] @ 4on :3,3J 5e!rtbe!t +or C&rist Luzon Con+erence. S!ve t&e "!te: Octo+er 26,2 2512* isse" L!"- e"^ Don_t miss out on SC_s ne3t #/ E'E$N

OR

00m*

A((er*ic !n" un!b(e to t!e or!(

">itro&c in or claritro& cin Ce'a>olin or ce'triaone

#. Colle%e o' MedicineKs FIRST .E. R"$$;L 1m*=* / or /'

1* / or /'

0m*=* / or /'

S&o9 some pri"eN Support -our !t&(etesN 5!ve ! *oo" timeN SEE `?4 5E)E !n" SA` 4$ED B?) ?)E 4%DAESN #rou*&t to -ou b- t&e 6t& SC_s EE)$AL ABBA/)S C?/EEN

OR Clinda&ci n

$?'E#E) 2012

600 m* / or /'

20m*=* / or /'

IE .roplais and Oter .rocedures •

•

$o

(on*er recommen"e" +or *!strointestin!( or *enitourin!r- tr!ct proce"ures /n t&e !bsence o+ in+ection, not necess!r- +or non "ent!( proce"ure t&!t "o not penetr!te t&e mucos! suc& !s: o  r!nsesop&!*e!( ec&oc!r"io*r!p&o Ec&oc!r"io*r!p&o Di!*nostic bronc&oscopo Esop&!*o*!stroscopo Co(onoscopIs there such a thing as viral endocarditis? So far, no reports. here could be viral infection of the myocardium &hich could invade the &hole muscle layer of the heart and may e/tend to the endocardium but a viral infection limited to the endocardium has not  been reported.

ne= loo9* ne= desi%ns* sa&e scool prideL ?r"er no9N C&ec out t&e "esi*ns !t t&e SC oTce 12nn to 1pm or pm to 6pm8N #rou*&t to -ou b- t&e 6 t& SC !-s V e!ns Committee.

 [[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[[ [[[[[[[[[[[[[[[[[[[ 

Fres /anna 4a&ie

#.CM 2516": '/, !(!n*

M!p!nt!-N

6 o' 6