REPUBLICA BOLIVARIANA DE VENEZUELA

MINISTERIO DE EDUCACION SUPERIOR

INSTUTITO VENEZOLANO DE LOS SEGUROS SOCIALES
POSTGRADO DE PEDIATRIA Y PUERICULTURA
CATEDRA: INGLES
PROFESOR: VICTOR SANCHEZ

Endocarditis bacteriana
Bacterial Endocarditis

Integrante:
Jennifer Garcia
CI: 19.075.977

Valera, Junio de 2016

DEFINITION:
It is defined as a bacterial infection, in the form of vegetation, from the surface
endocardial, which requires rapid identification and effective treatment. The
vegetation is made by a collection of platelets, fibrin, inflammatory cells and
microorganisms. It generally affects the heart valves, but it can also be designed in
septal defects or chordae.
CLINICAL MANIFESTATIONS
The clinical presentation of infective endocarditis usually it includes demonstrations
or extracardiac findings associated with intracardiac spread of infection. He interval
between bacteremia and the onset of symptoms is short. Is calculated 80% of
patients develop symptoms in 2 weeks.
Fever is the most common symptom and sign; however, it may be absent in
patients with heart failure, heart failure, Patients with previous use of antibiotics, or
the presence of infectious endocarditis less virulent germs.
80-85% of patients with endocarditis native valve infective show heart murmur;
however, when the endocarditis involving the tricuspid valve Murmurs can not
auscultated. Similarly, in S. aureus infection in only 30-45% of cases may be heard
murmurs in the initial clinical evaluation.
Previously it stated that about 50% of patients had classic peripheral
manifestations. Of these, the petechiae are the most common. Another feature is
the subungual splinter hemorrhages and Osler nodules; Janeway lesions are not
painful erythematous or hemorrhagic macular small spots, which appear on the
palms of hands and soles of the feet and result from septic emboli. Roth spots are
oval shaped retinal hemorrhages

DIAGNOSTIC
Endocarditis should be suspected in patients with peripheral manifestations:
bacteremia, fungaemia, evidence of active valvulitis, peripheral embolism and
immunological phenomena.
Modern diagnostic criteria of Duke University combine important parameters in the
old Beth Israel criteria with echocardiographic findings and their diagnostic
sensitivity reaches 74%.
LABORATORY FINDINGS
70-90% of patients have anemia in the blood picture with a normocytic
normochromic index. In subacute endocarditis does not usually have leukocytosis,
but usually acute themselves with important neutrophilia. Thrombocytopenia is rare
to find. ESR is increased to 55 mm / h in almost all patients. Other evidence
demonstrating the immune compromise are: circulating immune complexes,
rheumatoid factor, cryoglobulins and C-reactive protein.
Taking blood cultures: Blood cultures are a major criterion for the definitive
diagnosis of endocarditis. There must be a minimum of 2 doses (2 separate
venipuncture, each sample divided into 2 bottles) for each ordered blood culture.
An amount of 8-10 ml of blood in each bottle maximizes the possibility of positive
results.
ECHOCARDIOGRAM
The sensitivity of transthoracic echocardiography to detect vegetations in the valve
varies between 38-90% using surgery as the gold standard.
Transesophageal echocardiography has higher sensitivity, especially in posterior
structures as the mitral valve, for which 82-100% is reported in different series. The
overall specificity between 91-98%.

TREATMENT
The basis of medical treatment is the use of parenteral antibiotics against specific
organism. The resolution of fever with effective therapy appropriate seed varies
from 3 to 7 days, and the persistence of fever suggests the formation of an
intracardiac or remote abscess. Between 10-20% of patients with endocarditis
demostradaspor surgery or autopsy have negative blood cultures; the causes are
manifold: the main one is the initiation of empiric therapy before taking blood
cultures. Less common are the presence of organisms HACEK, fungal
endocarditis, by intracellular germs such as Bartonella sp, Chlamydia sp, Coxiella
burnetii.
Empirical antibiotic therapy: if the patient is not in acute stage or heart failure, it
is preferred to expect the initial results of blood cultures. If all three blood cultures
are negative after 24-48 hours should get 2 or 3 additional blood cultures before
initiating empiric therapy. Initiating oxacillin combined with gentamicin is not
sufficient to adequately cover enterococci, but by adding Penicillin G while crops
expected. If what it is required is empirical antibiotic use for prosthetic valve
endocarditis in, initiate vancomycin, rifampin and gentamicin.
SURGICAL TREATMENT
Surgical treatment should preferably be performed after the infection control and
hemodynamic stabilization. Never delay surgery in cases of heart failure or
cardiogenic shock in a patient with repair options. early surgery in cases of aortic
or annular abscess is also recommended when the infection is resistant to
antimicrobial therapy.