infective endocarditis (ie).ppt

8/18/2019 INFECTIVE ENDOCARDITIS (IE).ppt

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De!nitionDe!nition

It"s a #edica$ e#er%enc&c'aracteried & t'e infection of t'ecardiac endot'e$i*#+ #acrosco,ica$$&

seen as ve%etations

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Virt*a$$& fata$ if *ntreated

Morta$it& rate even it' treat#ent is/01


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C$assi!cations of IEC$assi!cations of IE

Ac*te IE 2 fata$ in 3 4 ee5sSE 2 fata$ eteen 4 ee5s- 4

#ont's

C'ronic IE2 ,ersists 6 4 #ont's----------------------------------------------------

--Native va$ve endocarditisProst'etic va$ve endocarditisEndocarditis in I.V. dr*% *sersC*$t*re ne%ative endocarditis


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Predis,osin% factorsPredis,osin% factors

C7D 8 /91R7D 8 :91

V7D

I7D

MVP 8 ;9-::1

Prost'etic va$ves ;9-/91

IV dr*% a*se


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S,to#s of IES,to#s of IE

Fever (s,ecia$$& on cardiac ,atient)*t asent in e$der$&> *re#ia>

Fati%*e

?ei%'t $ossMa$aise

Ni%'t seats

M*sc*$ar PainsS*dden onset of CCF


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P'&sica$ si%nsP'&sica$ si%ns

Pro%ressive ,a$$orPetec'iae (/9-=91) fre@*ent$& on

con*nctiva+ ,a$ate+ *cca$ #*cosa+

*,,er eBtre#ities.S,$inter 'e#orr'a%es (;9-:91) 8

s*-*n%*a$+ $inear dar5 red strea5s

(DD tra*#a)Os$er"s nodes- s#a$$ tender nod*$es

on !n%ers> toe ,ads for 'o*rs-da&s


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P'&sica$ si%nsP'&sica$ si%ns

Cardiac #anifestations 8 CCF 001,atients+ #itra$ fo$$oed & aorticva$ve tric*s,id

A,,earance of a ne #*r#*r orc'an%in% of an eBistin% #*r#*r-s*s,ect IE

Ne*ro$o%ica$ #anifestations- cerera$e#o$i /91+ #enin%itis> rainascess 3 01


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Native va$ve endocarditisNative va$ve endocarditis

Co##onest or%anis# 8 stre,tococc*sviridans+ $ater S.san%*is+ S. #*tans+sta,'&$ococci+ enterococci+ etc.

Stre,tococci 49-91 and sta,'&$ococci/01

7ACEK %ro*, :1 - (7ae#o,'i$*s+

Actinoaci$$*s+ Cardioacteri*#+Ei5ene$$a Kin%e$$a) 8 %ra# 8veor%anis#s+ so#eti#es #oreco##ensa$s in


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Native va$ve endocarditisNative va$ve endocarditis

F*n%a$ endocarditis 8 candida +as,er%i$$*s

More in #a$es+ #ore in e$der$&

Most common valve Mitral thenAortic (on RHD)


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IE in dr*% a*sersIE in dr*% a*sers

More in &o*n% #a$es+ so*rce t'ro*%'s5in

Or%anis#s 8 S. a*re*s 091+ stre,tococci;01+ f*n%i (candida) %ra# 8ve

(,se*do#onas) ;9-;01

Va$ve aected 8 Tric*s,id 091+ Aortic/01+ #itra$ /91

Ac*te onset> #*$ti,$e or%anis#s co##onSe,tic ,*$. E#o$i ca*sin% ,ne*#onia-

co##on


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Prost'etic va$veProst'etic va$ve

endocarditisendocarditisAn& intra vasc*$ar> intra cardiac

device ,redis,oses for IE

Acco*nts for ;9-/91 of a$$ IE

Ris5 is si#i$ar in #ec'anica$ io,rost'esis

7i%'est ris5 34 # + 3 /# virt*a$$&nosoco#ia$


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Prost'etic va$veProst'etic va$ve

endocarditisendocarditisIntra vasc*$ar s*t*res+ ,ace#a5er

$ines+ teGon si$astic t*es 8 act as fociof infection

Aortic va$ve 6 #itra$ va$ve ,rost'esis

F*n%i acco*nt for ;9-;0 1+ 'as 'i%'

#orta$it&

Or%anis#s 8 S.e,ider#idis+ S. a*re*s+%ra# 8ve acteria+ f*n%i+ etc


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Non acteria$ EndocarditisNon acteria$ Endocarditis

(NE)(NE)C*$t*re ne%ative endocarditis 8 ;91

*s*a$$& & fastidio*s or%anis#s-f*n%i+ 7ACEK %ro*,+ aneroes+$e%ione$$a+ c'$a#&dia+ coBie$$ar*netti+ Hi#an"s Sa$5+ anti,'os,'o$i,id s&ndro#e+ infectionsafter ,revio*s antiiotics

Hate dia%nosis+ dic*$t to treat+so#eti#es ,oor ,ro%nosis


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Pat'o%enesisPat'o%enesis


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Pat'o%enesisPat'o%enesis


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Dia%nosis of IEDia%nosis of IE

S*s,icion of IE

- fever it' ,redis,osin%factors

- P


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Investi%ationsInvesti%ations

Ro*tine $ood 8increased ?C+

decreased P$ate$et co*nt+

increased ESR

$ood c*$t*re 8 : sets of c*$t*res at: dierent vene,*nct*re eforeantiiotic *se+ for aeroic>aneroic>f*n%a$ c*$t*res


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Investi%ationsInvesti%ations

ECJ- non s,eci!c+ MI. tac'&cardia

C'est- ra& 8 ac*te CCF+ ,$e*ra$

e*sion + in!$trates

/D EC7O- ve%etations+ascess+ etc

identif&+ $oca$ise c'aracterise


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D*5e criteriaD*5e criteria

Maor 8 ,ositive $ood c*$t*reevidence of endocardia$ invo$ve#ent- L ve EC7O !ndin%- ne va$v*$ar re%*r%itations

Minor criteria 8 ,redis,osin% factors- fever 6: C-vasc*$ar ,'eno#enon

- #icroio$o%ica$ ,'eno#enon-EC7O


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Mana%e#ent of IEMana%e#ent of IE

Medica$ e#er%enc&- 'os,ita$iation 8 IC<

Antiiotic ( road s,ectr*#) dr*% ofc'oice

,enici$$in J ;/-;#i$$ion /= 'r B = ee5s

ceftriaBone /%# dai$& iv B = ee5s

JM; #%> 5% iv tid B / ee5s

vanco#&cin :9 #%>d id B = ee5s


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Proced*reProced*re


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?orst ,ro%nostic feat*res?orst ,ro%nostic feat*res

Non stre,tococca$ %ro*,A%e 6 9 &ears

Aortic va$ve invo$ve#ent

F*n%a$ IE

Har%e ve%etations

C*$t*re 8ve endocarditis

Prost'etic va$ve endocarditis

Deve$o,#ent of CCF on$&


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Co#,$ications of IECo#,$ications of IE

Ac*te CCF deat'Ascess ( ,ericadia$> aortic>

#&ocardia$)

Coronar& e#o$is#Va$ve re%*r%itation> stenosis

Se,ta$ ,erforation ( VSA)

S&ste#ic e#o$is#( 5idne&>s,$een>rain> $*n%s>retina>$i#s)

M&cotic anne*r&s#


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Thank you

infective endocarditis (ie).ppt

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