endokarditis infective ngaji pramita.pptx

endocartis infective

1. Pembimbing : dr Erwin azmar , sppd , kkv INFECTIVE ENDOCARDITIS

2. MEMBRAN PERIKARDIUM

3. INFECTIVE ENDOCARDITIS

4. INFECTIVE ENDOCARDITIS Infective endocarditis (IE) is a major public health challenge, In 2019, the estimated incidence of IE was 13.8 cases per 100 000 subjects per year, and IE accounted for 66 300 deaths worldwide. Population at risk of infective endocarditis: Patients with previous IE Patients with surgically implanted prosthetic valves, with transcatheter implanted prosthetic valves, and with any material used for cardiac valve repair Patients with congenital heart disease (CHD) (not including isolated congenital valve abnormalities) are at increased risk of IE Patients with ventricular assist devices

5. Diagnosis INFECTIVE ENDOCARDITIS The diagnosis IE is based on clinical suspicion supported by consistent microbiological data and documentation of IE related cardiac lesions by imaging techniques Clinical features infective endocarditis: sepsis or fever of unknown origin in the presence of risk factors present with a complication mimicking a wide range of medical conditions that may prompt evaluation of other diseases, such as rheumatological, neurological, and autoimmune disorders, or even malignancy In the European Infective Endocarditis Registry (EURO-ENDO), fever (77.7%), cardiac murmur (64.5%), and congestive HF (27.2%) were the most frequent clinical presentations. Embolic complications were detected in 25.3% of patients and cardiac conduction abnormalities were found in 11.5%. Some classical signs, such as peripheral stigmata, are less frequently observed, but may still be observed in severe infections caused by S. aureus and in cases of subacute endocarditis (mainly caused by Streptococcis spp.).

6. Diagnosis INFECTIVE ENDOCARDITIS Laboratory findings: Laboratory investigations and biomarkers typically yield non-specific result. The degree of anaemia, leucocytosis/ leucopaenia , the number of immature white cell forms, concentrations of C-reactive protein and procalcitonin, erythrocyte sedimentation rate, and markers of end-organ dysfunction (serum lactate, serum creatinine, bilirubin, thrombocytopaenia, cardiac troponin, and natriuretic brain peptides) can be used to estimate the severity of sepsis, but none is diagnostic of IE C-reactive protein and procalcitonin are the most widely evaluated biomarkers. In 2009, the ICE-PCS showed that the most frequent microorganisms causing IE were S. aureus (31%), followed by oral streptococci (17%), and CoNS (11%)

7. Definitions of the 2023 ESC modified diagnostic criteria of infective endocarditis FDG-PET/CT, 18F-fluorodeoxyglucose positron emission tomography; CT(A), computed tomography (angiography); HACEK, Haemophilus, Aggregatibacter , Cardiobacterium , Eikenella , and Kingella ; IE, infective endocarditis; Ig, immunoglobulin; PWID, people who inject drugs; TOE, transoesophageal echocardiography; TTE, transthoracic echocardiography; WBC SPECT/CT, white blood cell single photon emission tomography/computed tomography. a For detailed explanation of predisposing conditions, please see Section 3.

8. Diagnostics Risk Factor

9. Laboratory Findings The degree of anaemia, leucocytosis/ leucopaenia , the number of immature white cell forms, concentrations of C-reactive protein and procalcitonin, erythrocyte sedimentation rate, and markers of end-organ dysfunction (serum lac- tate , serum creatinine, bilirubin, thrombocytopaenia, cardiac troponin, and natriuretic brain peptides) can be used to estimate the severity of sepsis , but none is diagnostic of IE C-reactive protein and procalcitonin are the most widely evaluated biomarkers in RCTs of antibiotic stewardship

10. Blood Culture Blood culture-positive infective endocarditis At least three sets of blood cultures should be obtained at 30-minute in- tervals prior to antibiotic therapy, each containing 10 mL of blood, and should be incubated in both aerobic and anaerobic atmo - spheres Sampling should be obtained from a peripheral vein ra - ther than from a central venous catheter (because of the risk of contamination and misleading interpretation), using a meticulous sterile technique Blood culture-negative infective endocarditis Blood culture-negative IE most commonly arises as a conse - quence of previous antibiotic administration, underlying the importance of performing blood cultures prior to antibiotic therapy, particularly in patients with known risk factors for IE. Blood culture-negative IE can also be caused by fungi or fastidious bacteria, notably obligatory intra- cellular bacteria. Isolation of these microorganisms requires culturing on specialized media, and their growth is relatively slow.

11. ECG

12. echocardiography TOE (Transesophageal echocardiography)  Vegetation characteristics and size, perivalvular complications (abscess, pseudoaneurysm, new partial dehiscence of prosthetic valve), intracardiac fistula, and leaflet perforation are the main echocardiographic findings for the diagnosis and evaluation of local complications of IE

13. Chest X- Ray Radiology in Infective Endocarditis. C Prados , C Carpio, A. Santiago, I Silva, R Alvarez-Sala.2012

14. CT Scan thorax • Peripheral triangle opacities, corresponding to regions of pulmonary infarcts produced by septic embolism. • Peripheral, poorly marginated bilateral lung nodules. • Cavitary nodules with thick irregular walls. These nodules typically measure 5-35 mm, have a peripheral and basilar predominance, and demonstrate air-bronchograms. The nodule may increase in number and change from day to day (figure 3). • “Feeding vessel sign” that consists of a distinct vessel leading directly into the center of a nodule. • Radiologic findings suggestive of empyema like pleural effusion, thickening and enhacement of the visceral and parietal pleurae and inflammation of the extrapleural fat. Also, empyema had been described as a pleural collection that is immnobile on decubitus views. Pleural fluid, pericardic fluid and pneumothorax. • Unilateral or bilateral interstitial lung infiltrate. Radiology in Infective Endocarditis. C Prados , C Carpio, A. Santiago, I Silva, R Alvarez-Sala.2012

15. Treatment

16. Empirical treatment

17. Complications Uncontrolled Infection ( Peristent infection, Locally Uncontrolled infection, Infection with resistant of virulent organism) Neurological complication Infective aneurysm Splenic complication Myocarditis and pericarditis Heat rhythm and conduction distrubacnces Acu te renal failure

18. Prevention

19. Thank You