Infective Endocarditis (IE)

Exam Cram

Outline

Background 

By association:

• Dental infections Streph mitis, viridans, sanguinis 

• Colorectal cancer Streptococcus bovis (gallolyticus)

• Valve implantation (<2m) Staph epidermis

• Valve implant delayed c. 6m Staph aur, streph viridans

By Organism

Staph Aureus

• Tricuspid regurgitation and pulmonary abscesses

• Worst prognosis, mortality 40%

• Associated with IVDU, indwelling lines (dialysis)

• 6m post prosthetic valve implant

• Management

  1. Consider surgical debridlement

  2. Flucloxacillin

  3. Vancomycin & Rifampicin (MRSA or pen allergy) +- gentamicin

Coxiella endocarditis

• Domestic and farm animals, 

• Transmitted via ticks and unpasteurised milk

• Often culture negative

• Also cause pneumonia and hepatitis

Streph viridans

• Commonest cause of infective endocarditis in developing world

• Associated with dental infections

• Management: amoxicillin & gentamicin

Diagnosis

Dukes Criteria: 

• 2 major

• 1 major and 3 minor

• 5 minor

Major

• Blood cultures

• Vegetation on ECHO

Minor

• Predisposition/ RF: IVDU, valvular operation

• Fever

• Vascular phenomena

• Immune phenomena

• Atypical bacteraemia

History:

Examination:

• Janeway lesions (Jane is nice)- not painful, embolic

• Osler nodes (Osler = ow)- painful 

• Splinter hemorrhages- purple nodules, immune mediated

• Finger clubbing

Ix

Differentials

Management

Prophylaxis

No longer required for GI, urinary or dental interventions routinely

In very high risk, amoxicillin 3g stat would be a reasonable prophylactic regime

Med Reg Notes

Antibiotics per organism detected (see local guidelines)

• Enterococcus: amoxicillin & gentamicin 4-6 weeks

References