{"id":9553,"date":"2021-12-26T22:23:57","date_gmt":"2021-12-26T20:23:57","guid":{"rendered":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/infective-endocarditis\/"},"modified":"2022-01-20T01:46:10","modified_gmt":"2022-01-19T23:46:10","slug":"infective-endocarditis","status":"publish","type":"page","link":"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/infective-endocarditis\/","title":{"rendered":"Infective endocarditis"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\">Infective endocarditis (IE) is the infection of the endocardium, most often by bacteria.<\/p>\n\n\n\n<ul class=\"wp-block-list\"><li>Presents with fever, arthralia, myalgia, chest pain, and abdominal pain, typically appearing within 2 weeks of the bacteremia.<\/li><li>The micro-organisms form vegetations on the endocardium, damaging it, along with the valves, and may break off and form emboli.<ul><li>The mitral and aortic valve are often affected, and the <strong>tricuspid valve is common in IV drug users<\/strong>. May cause mitral\/aortic regurgitation.<\/li><\/ul><ul><li>The emboli are rich in the infective agent, and may cause septic infarctions in the vessels they end up in.<\/li><\/ul><\/li><li>Congenital and acquired abnormalities of the cardiovascular system are a risk factor as they increase the interaction of becteria with the endocardium.<ul><li>Other risk factors include prosthetic valves, older age, IV drug use, and bad oral hygiene.<\/li><\/ul><\/li><\/ul>\n\n\n<span class=\"block-heading\" id=\"header_1\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Classification and agents<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_1\">\n\n\n<p class=\"wp-block-paragraph\">Classified into <strong>acute <\/strong>(more dangerous) and <strong>subacute<\/strong>, and <strong>prosthetic valve <\/strong>endocarditis.<\/p>\n\n\n\n<ul class=\"wp-block-list\" id=\"block-361b2fb4-0765-49dd-be2c-14a4a1b2be6a\"><li>Acute IE is fatal within 6 weeks if left untreated, it is typically caused by <strong>S. aureus<\/strong>, occuring in normal valves.<\/li><li>Subactive IE is much more subtle, typically caused by less virulent agents such as <strong>streptococcus viridans<\/strong> and <strong>enterococci<\/strong>, occuring in damaged valves.<\/li><li>Prosthetic valve IE is usually caused by <strong>S. epidermitis<\/strong>.<\/li><\/ul>\n\n\n\n<p class=\"wp-block-paragraph\">Other agents include the<strong> HACEK group<\/strong>: Haemophilus, Actinobacillus, Cardiobacterium, Eikenella, and Kingella, found in the oral cavity, and can infect in case of poor oral hygiene.<\/p>\n\n\n<\/span><span class=\"block-heading\" id=\"header_2\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Diagnosis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_2\">\n\n\n<ul class=\"wp-block-list\"><li>Physical examination<ul><li>Murmurs<\/li><li><strong>Roth spots<\/strong> (retinal hemorrhage)<\/li><li><strong>Osler nodes<\/strong> (painful nodules in the fingers and toes)<\/li><li><strong>Janeway lesions<\/strong> (erythema in the hands and feet)<\/li><\/ul><\/li><li>Blood cultures (3 samples)<\/li><li>Echocardiography<\/li><li><strong>ESC <\/strong>or <strong>modified Duke criteria<\/strong> based on bacteremia, echocardiography, fever, among other factors that may indicate IE.<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_3\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Treatment<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_3\">\n\n\n<ul class=\"wp-block-list\"><li>IV antibiotics for 4-6 weeks<ul><li>Culture should be taken <strong>before<\/strong> the start of the antibiotic treament<\/li><li>Until the identification of the agent and sensitivity tests, empirical treatment with vancomycin + gentamicin<\/li><\/ul><\/li><li>Removal of pacemakers\/ICDs<\/li><li>Valve debribement\/repair\/replacement<\/li><li>Dental treatment<\/li><\/ul>\n\n\n<\/span><span class=\"block-heading\" id=\"header_4\">\n<h4 class=\"wp-block-heading\" class=\"wp-block-heading\" class=\"title_collection title1\">Prophylaxis<\/h4>\n<\/span><span class=\"block-content\" id=\"contents_4\">\n\n\n<p class=\"wp-block-paragraph\">In patients at risk, antibiotics may be given in case of procedures that may lead to bacteremia.<\/p>\n<\/span><div id=\"the_titles\" style=\"display:none;\"><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Classification and agents<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Diagnosis<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Treatment<\/h4><h4 class=\"wp-block-heading\" class=\"wp-block-heading\">Prophylaxis<\/h4><\/div>","protected":false},"excerpt":{"rendered":"<p>Infective endocarditis (IE) is the infection of the endocardium, most often by bacteria. Presents with fever, arthralia, myalgia, chest pain, and abdominal pain, typically appearing within 2 weeks of the bacteremia. The micro-organisms form vegetations on the endocardium, damaging it, along with the valves, and may break off and form emboli. The mitral and aortic [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":410,"menu_order":6,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-9553","page","type-page","status-publish","hentry"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.9 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>Infective endocarditis &#8211; Meddists<\/title>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/meddists.com\/learn\/clinical\/internal-medicine\/cardiology\/infective-endocarditis\/\" \/>\n<meta name=\"twitter:label1\" content=\"Est. reading time\" \/>\n\t<meta name=\"twitter:data1\" content=\"2 minutes\" \/>\n<script type=\"application\/ld+json\" class=\"yoast-schema-graph\">{\"@context\":\"https:\\\/\\\/schema.org\",\"@graph\":[{\"@type\":\"WebPage\",\"@id\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/cardiology\\\/infective-endocarditis\\\/\",\"url\":\"https:\\\/\\\/meddists.com\\\/learn\\\/clinical\\\/internal-medicine\\\/cardiology\\\/infective-endocarditis\\\/\",\"name\":\"Infective endocarditis &#8211; 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