INFECTIVE ENDOCARDITIS.ppt
- 2. Infective Endocarditis (IE) o An acute or subacute inflammation of the endocardium caused by bacteria, virus or fungi o Common etiologic are: Streptococcus Viridans Staphylococcus Aureus Group D Streptococcus
- 3. Infective … •Pathophysiology o Most often a complication of congenital or Rheumatic heart disease o But can occur with out any residual cardiac defects o Rheumatic heart disease, primarily mitral and aortic valves, common in our setup
- 4. Infective … o Preceding dental, urinary or intestinal procedures identified in one third of patients as a source of infection o Other risks are central venous catheterization, prosthetic valves etc… o Vegetation found at the site of endocardial erosion that result from high velocity blood flow
- 5. Infective … o Thus children with VSD, PDA and left sided valvular lesions are at high risk of ID •Clinical manifestations o Onset can be acute and severe with: High grade fever and prostration, or o Insidious With prolonged fever o Commonly it varies within a range between the two
- 6. Infective … •Common symptoms are: o Low grade fever, chills, fatigue, arthralgia, myalgia, malaise, night sweats, weight loss, stroke or seizure •Physical findings: o Tachycardia, arrhythmia o New or changing murmur o Splenomegaly
- 7. Infective … o Arthritis o Heart failure o Neurologic deficits o Skin manifestations such as: Petechia, splinter hemorrhage (nail bed bleeding) Janeway lesions (painless small hemorrhagic lesions on palms and soles) Osler nodes (tender pea sized intradermal nodules in the pads of fingers) o Clubbing
- 8. Infective … •Lab Findings o Blood culture 3-5 separate samples, positive in 90% of cases without prior antibiotic intake o Additional information can be obtained from: Echocardiography (vegetations), raised ESR, leucocytosis, anemia, hematuria, renal failure…. •Diagnosis o Gold standard is blood culture
- 9. Infective… •Treatment o Hospitalization o Specific Initial empiric antibiotics to cover Gram positive and negative organisms. Combination of cloxaxillin, ampicillin and gentamycin for 4-6 weeks (except gentamycin for 2 weeks) o Supportive For heart failure and nutrition
- 10. infective… •Prevention o General dental care and oral hygiene o Treatment of infection in high risk children o Antibiotic prophylaxis before surgical procedures of genito-urinary and gastro- intestinal systems