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Infective Endocarditis (Clinical Manifestations (Fever, Chills, Heart…
Infective Endocarditis
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Risk factors:
IV catheter use
Direct vascular insertion and potential in-sterility can cause a direct bacterial infection to the bloodstream
Injection drug use
Unsanitary needle use for vascular access can carry an extensive amount of bacteria to the bloodstream
Skin, wound, lung, or genitourinary infections
- Skin infections (mouth, tongue) are easy access for bacteria to enter the blood stream
- infections in the lungs or GU systems can result in bacteria breaking free & traveling through the blood to the heart
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Congenital heart disease
CHD renders a higher need for cardiac devices, surgery, and prevalence of rheumatic disease
Rheumatic heart disease
This is a streptococcal infection of the heart, directly impacting the risk for endocarditis
Male gender
Men are twice as likely to get endocarditis than men, because of their higher prevalence in heart disorders & disease
Age > 60 years old
Older adults have a higher incidence due to their need for more invasive procedures & cardiac device insertions
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Incidence & Prevalence
On average, there are between 1.5-11.6 cases per 100,000 people per year
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Pathophysiology
- Direct damage to the heart occurs
Examples:
- congenital heart disease
- cardiac device insertion
- valvular disorders
- trauma
- Endocardial damage
(valves, chambers, other anatomical structures)
- Inflammation of the endocardium
(localized swelling, redness, and warmth of the membrane)
- Portal entry to bloodstream via IV injection, injection drug use, dental procedure, etc.
- Fibrin & thrombus form
(blood clots, platelets, protein matricies)
- Vegetation forms
(bacteria proliferate and colonize)
- Onset of manifestations begin
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Diagnostics
Labs:
- elevated WBC
- low RBC
- elevated C-Reactive protein
- elevated sedimentation rate
Echocardiogram:
identifies damaged tissue, holes, structural changes to valves, and vegetations
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Imaging:
can detect enlarged heart
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Treatment
Antibiotics:
these help to kill off bacteria present, most patients are immediately put on IV antibiotics after diagnosed
3 months, 6 weeks of penicillin
- initially, vancomycin or ampicillin with a aminoglycoside
If cardiac device present, antibiotics alone are not enough. Device and surrounding material are surgically removed
Anticoagulant therapy is contraindicated, should be stopped for at least first two weeks
Surgery indicated for:
- persistent infection
- IE caused by fungus
- replacement of damaged valve
Sources
Bayer, A. S., Bolger, A. F., Bolger, A. F., Taubert, K. A., Taubert, K. A., Wilson, W., … Stanford T. Shulman Search. (1998, December 22). Diagnosis and Management of Infective Endocarditis and Its Complications. Retrieved from https://www.ahajournals.org/doi/full/10.1161/01.CIR.98.25.2936
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Holland, T. L., Baddour, L. M., Bayer, A. S., Hoen, B., Miro, J. M., & Fowler, V. G. (2016, September 1). Infective endocarditis. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5240923/
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