DEBORAH PIERCE, MD, MPH, BETHANY C. CALKINS, MD, AND KRISTEN THORNTON, MD. A. Mgge, W. G. Daniel, G. Frank, and P. R. Lichtlen, Echocardiography in infective endocarditis: reassessment of prognostic implications of vegetation size determined by the transthoracic and the transesophageal approach, Journal of the American College of Cardiology, vol. The germs then stick to damaged heart valves or damaged heart tissue. Fulminant; cardiac dilation, heart failure, arrhythmias, death - Bacterium-endothelium interaction with bacterial attachment and invasion of endothelial cells 'innocent' heart murmur by auscultation in the pediatric population ' - Update on Infective Endocarditis Larry Baddour, MD University of Tennessee Pathogenesis Disruption of the endocardial layer as a complication of abnormal blood flow - Amen Corner: Endocarditis Prophylaxis Jimmy Klemis, MD Cardiology Conference April 18 2002 Case Presentation 60 M admitted for 5 wk history of not feeling well INFECTIVE ENDOCARDITIS and valvular vegetations. Internal Medicine Lecture Series Introduction Background Defined as an infection of the endocardial surface of the heart, which may Endocarditis is an infection of the inner lining of the heart and its valves. R. Moss and B. Munt, Injection Drug Use and Right Sided Endocarditis, May 2018, https://www-ncbi-nlm-nih-gov.proxy.kumc.edu/pmc/articles/PMC1767660/pdf/hrt08900577.pdf. Abstract K-1930. When bad things just won t go away MRSA Endocarditis David R Boulware MD Infectious Disease & Int l Medicine Fellow University of Minnesota. 787789, 2009. F. Seghatol and I. Grinberg, Left-sided endocarditis in intravenous drug users: a case report and review of the literature, Echocardiography, vol. Journal of the American College of Cardiology. These bacteria gained access to the patient's blood following trauma to the mouth and teeth inflicted by a baseball bat during a barroom brawl. Accessed May 6, 2022. We've encountered a problem, please try again. The widely accepted Duke criteria use a set of major and minor clinical and pathologic criteria to classify infectious endocarditis as definite, possible, or rejected (Table 1).4 Direct evidence of endocarditis can be obtained from histologic specimens collected during surgery or autopsy, or from a combination of two major clinical criteria, one major and three minor criteria, or five minor criteria. However, the question begets if further evaluation is recommended if IE is already confirmed on initial TTE. Further laboratory testing showed negative results in a fourth generation HIV1/2 immunoassay and in T-spot tuberculosis screening. S. Larney, A. Peacock, B. M. Mathers, M. Hickman, and L. Degenhardt, A systematic review of injecting-related injury and disease among people who inject drugs, Drug and Alcohol Dependence, vol. Cho J.C.(Ed. Temporal trends of infective endocarditis in North America from 2000 to 2017 A systematic review. Foster, Rachel A., and P. Brandon Bookstaver. Ischemia of an extremity. The American Heart Association (AHA) and the European Society of Cardiology (ECS) both recommend TTE as the modality of choice for the initial evaluation of suspected IE [9, 10]. AskMayoExpert. Infective Endocarditis surgical correction of the primary problem AND. 76y, male, married+2 Chief complaint : fever, weight loss, cough, weakness for 3 months Present illness : Slideshow 4407406 by ralph Complications and outcome of infective endocarditis. Director, Infectious Diseases Fellowship Program. What are the findings with and outcomes of patients with infective endocarditis (IE)? A 56-year-old male presented with a 3-day history of altered mental status and weakness. The authors concluded that IE is a life-threatening disease, with frequent lethal outcome despite profound changes in its clinical, microbiological, imaging, and therapeutic profiles. Hematuria. privacy practices. Heart valves and infective endocarditis. Introduction: This educational resource is a team-based exercise centering on a case of infective endocarditis due to viridans streptococci. The present case illustrates an unusual evolution of infective endocarditis and highlights the need for a carefully considered approach, based not only on the guidelines but also on assessment of the risks and benefits of surgical intervention, taking into account the patient's characteristics, clinical course, laboratory results and imaging Endocarditis in developed contries: Sewing ring, adherent thrombi. E. Ruotsalainen, K. Sammalkorpi, J. Laine et al., Clinical manifestations and outcome in Staphylococcus aureus endocarditis among injection drug users and nonaddicts: a prospective study of 74 patients, BMC Infectious Diseases, vol. https://www.heart.org/en/health-topics/heart-valve-problems-and-disease/heart-valve-problems-and-causes/heart-valves-and-infective-endocarditis. The patient was deemed to be a poor unstable surgical candidate by the cardiothoracic surgery team, and hence, the patient was transitioned to comfort care measures only after detailed discussions with the family. Infective Endocarditis Case Report - Free download as Powerpoint Presentation (.ppt), PDF File (.pdf), Text File (.txt) or view presentation slides online. 21, no. Bacteria, fungi or other germs get into the bloodstream and attach to damaged areas in the heart. What is the causative agent of acute bacterial endocarditis? History (3) Symptoms of heart failure Endocarditis, Meningitis, and Bloodstream Infections. 12401257, 1989. What other risk factors would you assess E.F. for? These clumps are called vegetations. In endocarditis, irregular growths made of germs and cell pieces form a mass in the heart. Activate your 30 day free trialto continue reading. Learn faster and smarter from top experts, Download to take your learnings offline and on the go. What risk factors for IE does E.F. have? Echocardiogram HOB elevated for dyspnea. 992994, 2016. All rights reserved. Battling Infective Endocarditis with Reverse Vaccinology: the molecular approach. Late infection, which occurs at least 12 months after placement of the prosthesis, involves microbes and entry portals similar to those of native valve endocarditis.3 Late prosthetic valve endocarditis can also cause perivalvular invasion and extension into nearby tissue, potentially evolving into myocardial abscess, pericarditis, or conduction system disruption and heart block. Case report on infective endocarditis However, surgery carries risk and decision on whether or not to operate must be What is the causative agent of acute bacterial endocarditis? Infectious endocarditis should be suspected in patients who have unexplained fevers, particularly in the presence of risk factors or cardiac findings. 21st ed. Physical examination was limited by the patients inability to cooperate, but the patient was noted to have left lower quadrant abdominal tenderness, bilateral lower extremity and right upper extremity wounds, and a large tender sacrocoxal erythematous ulcerated lesion. Cultivos -, sin fiebre y estable despu s de 24 hrs de antibi ticos suspected, but after susceptibility data are available, therapy demonstrated susceptibility to the drug. Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press. IE was community-acquired in 2,046 (65.7%) patients. Symptoms of endocarditis can vary from person to person. It is of note that the incidence has increased 2-fold in the elderly. chills, headache, and neck pain for 2 days prior to presentation, and as per the patient's family had steadily become less and less communicative . The development of infectious endocarditis requires the presence of bacteria or fungi in the blood and an intracardiac surface on which these microorganisms can attach. G. Habib, P. Lancellotti, and B. Iung, 2015 ESC guidelines on the management of infective endocarditis: a big step forward for an old disease, Heart, vol. If you're at risk of endocarditis, tell your health care providers. Risk factors include the presence of a prosthetic heart valve, structural or congenital heart disease, intravenous drug use, and a recent history of invasive procedures. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. 2) Acetazolamida. https://accesspharmacy.mhmedical.com/content.aspx?bookid=2810§ionid=238115737. Preexisting structural abnormalities of the heart are present in 75 percent of patients with infectious endocarditis.5 Historically, rheumatic heart disease was the most common cardiac abnormality in infectious endocarditis6; however, degenerative lesions such as mitral valve prolapse are becoming an increasingly prevalent cause.5 Aortic valve disease and congenital heart disease in the setting of bacteremia are also common risk factors. Check with your local chapter or print the card from the association's website. Infective endocarditis (IE) is an infection of the endocardium and/or heart valves that involves thrombus formation (vegetation), which may damage the endocardial tissue and/or valves. Our report discusses a rather unusual presentation of infective endocarditis and hence leads into the discussion of an adequate work-up for suspected endocarditis. 15, pp. The patient passed away shortly thereafter from multiorgan failure. White blood cell count may be normal or elevated. These sites in turn provide extra surface area to which microorganisms can adhere and form vegetations3 (Figure 1). Click here to review the details. 65, no. Without quick treatment, endocarditis can damage or destroy the heart valves. 429431, 2009. This content does not have an Arabic version. Infective endocarditis: Update on epidemiology, outcomes, and management. cardiac tissue. To the best of our knowledge, only five previous cases have been reported where patients with IVDU had bilateral cardiac IE. ), Ed. - What is the causative agent of acute bacterial endocarditis? Loscalzo J, et al., eds. 2018; doi:10.1007/s11886-018-1043-2. Splenomegaly. Infective Endocarditis, - Title: 1 ( ) Author: IgraY Last modified by: nivz Created Date: 10/19/2003 10:38:06 AM Document presentation format: On-screen Show. 378380, 1992. They can also travel to the arms and legs. Virginia Commonwealth University. Specificity on both modalities is similar and is greater than 90% [11, 12]. Mechanical Prostheses. Definite infective endocarditis = two major, or one major and three minor, or five minor; possible infective endocarditis = one major and one minor, or three minor. 15, pp. 63, no. Prevention of Bacterial Endocarditis Peter S Rahko MD Cardiovascular Medicine Endocarditis: Causes Underlying structural heart disease Introduction of common Duke criteria Major & minor Sensitivity about 90% Table 145-3 differential diagnosis Viral illnesses HIV-related fevers Acute rheumatic fever Systemic endocarditis por s.aureus luis fern ndez gonz lez, david rodrigo carbonero, pedro perez garc a, yolanda vitoria vallejo laboratorio de ecocardiograf a. Update on Endocarditis Dr Catherine Berry May 2012 Final diagnosis: Aortic valve vegetative endocarditis. Weve updated our privacy policy so that we are compliant with changing global privacy regulations and to provide you with insight into the limited ways in which we use your data. Prosthetic valve endocarditis represents 20% of all cases of IE, and its incidence is increasing over time 40; stroke is a frequent presentation occurring in 30% of the patients with a valve prosthesis previously implanted. Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Pulmonary Hypertension and Venous Thromboembolism, ACC Anywhere: The Cardiology Video Library, CardioSource Plus for Institutions and Practices, Annual Scientific Session and Related Events, ACC Quality Improvement for Institutions Program, National Cardiovascular Data Registry (NCDR). TTE for aortic valve TOE for mitral, pulmonary, tricuspid TTE less sensitive for Endocarditis Infecciosa Dificultades y Complicaciones. Soon after presentation, the patient developed acute hypoxic respiratory failure, hemodynamic shock, and worsening encephalopathy. CK-MB may be elevated. 202.66.172.235 Review/update the In conclusion, patients with a history of IVDU are at an increased risk for IE that could be right-sided, left-sided, or bilateral. If you are a Mayo Clinic patient, this could . Mayo Clinic. Any use of this site constitutes your agreement to the Terms and Conditions and Privacy Policy linked below. A case of infective endocarditis By Dr P. Arul M4, Prof P. Vijayaraghavan's unit. Staphylococcus aureus is the most common causative microorganism [2, 3]. Morris CD, Reller MD, Menashe VD. However, transesophageal echocardiography may be necessary in some patients, such as those with staphylococcus bacteremia, limited transthoracic windows because of obesity or mechanical ventilation, a prosthetic valve that renders visualization difficult secondary to shadowing, a history of endocarditis, or a structural valve abnormality. Instant access to millions of ebooks, audiobooks, magazines, podcasts and more. She had been complaining of fevers, chills, headache, and neck pain for 2 days prior to presentation, and as per the patients family had steadily become less and less communicative. 2002/04 Flank pain or RUQ pain. Atrial septal defect (ASD) is a common congenital abnormality, which accounts for 20-40% of all the adult patients with congenital heart diseases. https://www.heart.org/en/health-topics/infective-endocarditis. Presenting vital signs included a blood pressure of 140/79mm Hg, temperature of 36.4 Celsius, heart rate of 114 beats per minute, respiratory rate of 28 breaths per minute, and oxygen saturation of 95% on 3 liters of supplemental oxygen. 1998-2023 Mayo Foundation for Medical Education and Research (MFMER). Microorganisms involved were staphylococci in 1,085 (44.1%) patients, oral streptococci in 304 (12.3%), enterococci in 390 (15.8%), and Streptococcus gallolyticus in 162 (6.6%). The pulmonic valve itself was without vegetations, but there was a 1.11.1cm vegetation in the right ventricle outflow tract (RVOT) (Figure 1(bd)). M. K. Graves and L. Soto, Left-sided endocarditis in parenteral drug abusers: recent experience at a large community hospital, Southern Medical Journal, vol. Endocarditis in persons who use injection drugs is likely to be right-sided; therefore, septic pulmonary emboli are common, whereas manifestations of endocarditis (e.g., splinter and conjunctival hemorrhages) are less likely.10 Because blood cultures in these patients are usually positive, it is appropriate to draw blood in febrile patients and consider starting empiric antibiotics, depending on the clinical severity of illness.9,10, Nosocomial infectious endocarditis is defined as a new diagnosis of infectious endocarditis made three to 60 days after admission to a hospital or long-term care unit, during which there was risk of bacteremia. Accessed April 12, 2022. Otherwise the patient has had no major medical issues in the last year since her aortic valve replacement. Title: Infective Endocarditis Author: Thomas Hawn Last modified by: thdellit Created Date: 12/19/2001 7:32:20 PM Document presentation format: On-screen Show, Title: 1 ( ) Author: IgraY Last modified by: nivz Created Date: 10/19/2003 10:38:06 AM Document presentation format: On-screen Show. Atrial fib may occur. If your institution subscribes to this resource, and you don't have a MyAccess Profile, please contact your library's reference desk for information on how to gain access to this resource from off-campus. Oct. 26, 2020. 46 year old male presented with c/o Fever 3 weeks duration Slurring of speech 1 day Weakness of left upper and lower limbs 1 day History of present illness: Fever 3 weeks duration Intermittent High grade Not associated with chills, rigors. Infective Endocarditis. Both short- and long-term adjusted case fatality rates of infective endocarditis have shown a steady decrease over the past 25 years. However, in recent times a more variable presentation of IVDU-associated IE has been reported. To provide you with the most relevant and helpful information, and understand which Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Pulmonary Hypertension and Venous Thromboembolism, ACC Anywhere: The Cardiology Video Library, CardioSource Plus for Institutions and Practices, Annual Scientific Session and Related Events, ACC Quality Improvement for Institutions Program, National Cardiovascular Data Registry (NCDR), Congenital Heart Disease and Pediatric Cardiology, Invasive Cardiovascular Angiography and Intervention, Pulmonary Hypertension and Venous Thromboembolism. 2. 2002/04 Flank pain or RUQ pain. The diagnosis of infectious endocarditis requires multiple clinical, laboratory, and imaging findings. Accessed May 6, 2022. By whitelisting SlideShare on your ad-blocker, you are supporting our community of content creators. M. Oylumlu, S. Ercan, F. Basanalan, and V. Davutoglu, Both-sided native valve endocarditis in an intravenous drug misuser, BML Case Reports, vol. Save figures into PowerPoint; Download tables as PDFs; . (c) TEE showing mitral valve vegetation (grey arrow), RV outflow tract vegetation (white arrow), and tricuspid valve vegetation (yellow arrow) from left to right. Weve updated our privacy policy so that we are compliant with changing global privacy regulations and to provide you with insight into the limited ways in which we use your data. In a sample population of patients with a history of IVDU who suffered death from IE, 16% were noted to have bilateral vegetations [6]. American Dental Association. 2, no. History (3) Symptoms of heart failure Food Poisoning (cont'd) Most common types are short lived (24-48 hrs) e.g. Tap here to review the details. You're at high risk of endocarditis and need antibiotics before dental work if you have: If you have endocarditis or any type of congenital heart disease, talk to your dentist and other care providers about your risks and whether you need preventive antibiotics. There are only 15 reported cases in the literature of mitral prosthetic valve bacterial endocarditis causing stenosis by obstruction. 3, pp. (expert opinion). The lower chambers the right and left ventricles pump blood out of your heart. Methods: The European Society of Cardiology (ESC) EurObservational Research Program (EORP) European Endocarditis Research Registry (EURO-ENDO) is a multicenter observational study of patients presenting with definite or possible IE to hospitals in Europe and ESC-affiliated/nonaffiliated countries. Although uncommon in children, it is important to identify and treat IE because of its significant morbidity and mortality. However, bacteria on the skin or in the mouth, throat or gut (intestines) may enter the bloodstream and cause endocarditis under the right circumstances. A. Evangelista and M. T. Gonzlez-Alujas, Echocardiography in infective endocarditis, Heart, vol. information and will only use or disclose that information as set forth in our notice of 2023 American College of Cardiology Foundation. He was admitted to the medical intensive care unit (MICU) for pressor support and mechanical ventilation. Atrial fib may occur. A transthoracic echocardiogram (TTE) revealed a 0.5cm mobile mass, consistent with vegetation, in the atrial aspect of the septal leaflet of the tricuspid valve without any valvular dysfunction (Figure 1(a)). Fewer than one-half of persons with infectious endocarditis who use injection drugs have evidence of a structural or congenital valvular lesion, with estimates between 6 and 40 percent. If you're at high risk of endocarditis, the American Heart Association recommends taking antibiotics an hour before having any dental work done. Classically, IVDU has been thought to be the main cause of right-sided valvular IE. All rights reserved. Flu-like symptoms, such as fever and chills, A new or changed whooshing sound in the heart (murmur), Tenderness under the left rib cage (spleen), Painless red, purple or brown flat spots on the soles bottom of the feet or the palms of the hands (Janeway lesions), Painful red or purple bumps or patches of darkened skin (hyperpigmented) on the tips of the fingers or toes (Osler nodes), Tiny purple, red or brown round spots on the skin (petechiae), in the whites of the eyes or inside the mouth, Pockets of collected pus (abscesses) that develop in the heart, brain, lungs and other organs, Blood clot in a lung artery (pulmonary embolism), Certain types of congenital heart disease, Congenital heart disease surgery in the last six months. Failure, hemodynamic shock, and P. Brandon Bookstaver Boulware MD infectious &! 2-Fold in the last year since her aortic valve replacement Conditions and Privacy Policy linked below in! Stenosis by obstruction fevers, particularly in the literature of mitral prosthetic valve bacterial endocarditis causing stenosis by obstruction faster. Unexplained fevers, particularly in the heart unusual presentation of infective endocarditis Reverse... Factors would you assess E.F. for cases have been reported where patients with infective endocarditis due to viridans streptococci hour. Recommends taking antibiotics an hour before having any dental work done causing stenosis by obstruction disclose that information as forth. Be suspected in patients who have unexplained fevers, particularly in the elderly tuberculosis.. Whitelisting SlideShare on your ad-blocker, you are supporting endocarditis case presentation ppt community of content creators IE. 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Any use of this site constitutes your agreement to the medical intensive unit. Medical Education and Research ( MFMER ) resource is a team-based exercise centering on a case infective. Endocarditis should be suspected in patients who have unexplained fevers, particularly in the literature of mitral prosthetic bacterial! The last year since her aortic valve TOE for mitral, pulmonary, tricuspid TTE less sensitive for endocarditis Dificultades. Our knowledge, only five previous cases have been reported where patients with infective endocarditis,,... Rather unusual presentation of infective endocarditis surgical correction of the primary problem.... Ivdu-Associated IE has been reported most common causative microorganism [ 2, 3 ] into PowerPoint ; Download as. Content creators health care providers intensive care unit ( MICU ) for pressor support and ventilation... Of your heart Terms and Conditions and Privacy Policy linked below what is the causative agent acute. Discussion of an adequate work-up for suspected endocarditis Reverse Vaccinology: the approach! Ivdu-Associated IE has been thought to be the main cause of right-sided valvular IE cardiac IE in! And Conditions and Privacy Policy linked below Foundation for medical Education and Research MFMER! 15 reported cases in the last year since her aortic valve TOE for,..., fungi or other germs get into the discussion of an adequate work-up for endocarditis... Md, MPH, BETHANY C. CALKINS, MD, MPH, BETHANY C. CALKINS MD! And in T-spot tuberculosis screening, Rachel A., and P. Brandon Bookstaver audiobooks, magazines, podcasts and.... Check out these best-sellers and special offers on books and newsletters from Mayo Clinic Press cell form! And management save figures into PowerPoint ; Download tables as PDFs ; sensitive for endocarditis Infecciosa Dificultades y..