MANIFESTATION OF BACTERIAL ENDOCARDITIS

4. RISK FACTORS

1. DEFINITION

1.

Bacterial endocarditis is
the:

Heart valves
Septal defects.
Mural endocardium.

2. SITE: Aortic valve > Mitral

2.
3.
4.
5.
6.

Rheumatic heart disease: Mitral, Aortic

valve
Prosthetic cardiac valves.
Congenital heart disease: VSD, PDA, PS,
Tetralogy of Fallot
History of RF

defined as inflammation of

[most common]

Hemodialysis
IV drug user

valve

3. ETIOLOGY
1.
2.
3.
4.

STREPTOCOCCI: Viridian / a-hemolytic streptococci

(70% of cases)
STAPHYLOCOCCUS: Aureus, Coagulase-negative
(20% of cases)
ENTEROCOCCI : E.feacalis, E.faecium
GRAM VE RODS: HACEK, E.coli, Klebsiella, Neisseria gonorrhoae

*Its usually occurs on top of underlying heart disease, but also can occur on top of a normal heart.
5. MANIFESTATIONS

SYMPTOMS
Low-grade fever
(common)
Headache
Sweating
Malaise
Loss weight
Pain in back, muscle joint

INVOLVEMENT
CARDIAC

SIGNS
General look: Earthy look, Pallor, Toxic face.
Hyperpyrexia.
Tachycardia, arrhythmia
Skin:
PETICHEAL HEMORRHAGES: On the legs & chest wall
SPLINTER HEMORRHAGES: Under the nails.
OSLERS NODES: On pads of fingers & toes, and thenar &
hypothenar eminences.
JANEWAY LESIONS: Hemorrhagic raised lesions in palms & soles.
Clubbing of the fingers & toes: In long-standing cases.
Absent pulsations (Embolic).
Eyes: Subconjunctival hemorrhages, Roth spots (Retinal petichae),
Unilateral blindness (embolic).
Spleen: Splenomegaly

CLINICALLY
Appearance new murmur
Change in previous murmur
Pericarditis

EYE
SKIN

Increase intracranial pressure

Neurological deficits
Petechiae
Petechiae

KIDNEY
SPLEEN

Hematuria
Splenomegaly

NEUROLOGICAL

6.INVESTIGATION
1.
2.

Blood: FBC, ESR, CRP, culture

Echo:

PATHOLOGICALLY
Endocardial: Vegetations.
Myocardial: Myocarditis, abscess, MI
Pericardial: Pericarditis
Rupture of: cusps, chordae, and/or papillary
muscles

Cerebral infarction & hemorrhage

Mycotic aneurysm
Roth spot
Oslers nodes
Janeway lesions
(pathognomonic)
Infarction
Infarction, abscess

3.

Transthoracic echo: Specificity 98% but poor sensitivity, non-invasive

Transesophageal echo: Sensitivity 95%, invasive

Rheumatoid factor
DUKE CRITERIA

1.
2.

MAJOR CRITERIA
Blood culture positive for typical IEcausing microorganism
Evidence of endocardial involvement

1.
2.
3.
4.
5.

MINOR CRITERIA
Predisposition heart condition or i.v. drug abuse
Fever temp. >38 C
Vascular phenomena arterial emboli etc.
Immunologic phenomena glomerulonephritis, Oslers nodes,
Roths spots
Microbiological evidence positive blood cultures but do not
meet major criteria

RESULT:

2 major criteria

1 major and 3 minor criteria

5 minor criteria

Pathology/histology findings

7. THERAPY

1. ANTIMICROBIAL THERAPY
Bactericidal regimen depends on organism

2. SURGERY

INDICATION: Congestive heart failure, uncontrolled infection despite antimicrobial therapy, large
vegetation, major embolus, heart block