infectious endocarditis

Question 1

what is it?

Answer 1

infection of the endothelium of the heart valves (left side)

Question 2

predisposing features?

Answer 2

• heart valve abnormality
• prosthetic heart valves
• IV drug user
• IV line
• dental treatment
• previous rheumatic fever
• recent surgery

Question 3

causes of infectious endocarditis?

Answer 3

Bacteria (most common)

• strep viridans
• staph aureus
• enterococcus
• staphylococcus epidermis

Atypical organisms:

• HACEK (gram neg orgnaisms)
• coxiella burnetti
• chlamydia
• legionella
• mycoplasma

Fungi
-candida aspergillus

Question 4

causes of non infectious endocarditis?

Answer 4

• rheumatic fever
• SLE
• non bacterial thrombotic endocarditis
• carcinoid heart disease

Question 5

symptoms of infectious endocarditis?

Answer 5

• fever
• malaise
• weight loss
• breathlessness
• tiredness

Question 6

signs of infectious endocarditis?

Answer 6

• fever
• new/changing heart murmur
• finger clubbing
• splinter haemorrhages
• roth spots
• janeway lesions
• Osler nodes
• septic emboli

Question 7

what investigations will take place for infective endocarditis?

Answer 7

• blood cultures
• antibiotic serology (for atypical organisms)
• echocardiogram (to show vegetation)
• CT (to look for emboli)

Question 8

what is used for diagnosing infectious endocarditis?

Answer 8

Duke criteria (2 major or 1 major and 3 monor or 5 minor)

Question 9

how must the blood cultures be taken?

Answer 9

3 sets (2 bottles each) taken with >6 hours between them, prior to antibiotics

Question 10

treatment for staphylococcus aureus (MSSA)

Answer 10

Flucloaxicillin IV

Question 11

treatment for viridians streptococci?

Answer 11

Benzylpenicillin IV and gentamycin IV for 4 weeks

Question 12

treatment for enterococcus sp?

Answer 12

amoxicillin/vancomycin and gentamycin IV

Question 13

treatment for staphylococcus epidermis?

Answer 13

vancomycin and gentamycin IV and rifampicin treat for 6 weeks

Question 14

treatment for fungi?

Answer 14

surgery