Infective Endocarditis in children (2).ppt

IE

1. INFECTIVE ENDOCARDITIS
DR. CHIKONDE

2. Definition
•Infective endocarditis is microbial infection of the
endocardial surface of the heart, including the heart
valves
•Characterised by formation of vegetation that are
composed of:
–Inflammatory cells
–Fibrin
–Platelets
•May be classified as
–Acute or subacute

3. AETIOLOGY
BACTERIA
ViridansStreptococcus groups: S. sanguis, S. mitis, S. mutan, S.
anginosus, S. salivarius, S. bovis
Staphylococcus aureus
Enterococcus
Coagulase-negative staphylococci
Streptococci: groups A, B (in neonates and elderly), Streptococcus
pneumoniae
Gram-negative enteric bacilli
HACEK organisms (i.e., Haemophilus aphrophilus, Aggregatibacter
species, Cardiobacterium hominis, Eikenella corrodens, and
Kingella kingae)

4. Chlamydophila
Coxiella burnetii (Q fever)
FUNGI
Candida species
CULTURE NEGATIVE
Fastidious organisms (Abiotrophia or Granulicatella species)
Bartonella species Tropheryma whipplei, Coxiella burnetii
(Q fever)

5. Risk factors
•Rheumatic valve disease
•Intravenous drug use
•Bicuspid valves
•Aortic stenosis
•Aortic insufficiency
•Mitral valve prolapse
•Marfan syndrome
•Previous endocarditis
•Pulmonary artery cartherization

6. Pathophysiology
•normal endothelium is resistant to infection by
most bacteria and to thrombus formation
•Infective endocarditis occurs at sites of pre-
existing endocardial damage
•Organism may directly infect the Intact
endothelium or exposed subendothelial tissue,
•These areas attract fibrin and platelet
aggregation.
•Platelet plugs further attract colonization by
micobial organisms

7. Pathophysiology cont.d
•Vegetations may grow
•Large vegetations
–may break away as emboli
–May destroy adjacent tissues
–May cause aneurysm

8. Frequency of cardiac valve
involvement
•mitral>aortic>tricuspid>pulmonary
•30% of patients have concomitant aortic and
mitral valve involvement
•5% of patients have simultaneous involvement
of left and right sided heart valves

9. Clinical features
•Highly variable
•Can be acute or subacute
•Can be classed as
–Native valve endocarditis
–Prosthetic valve endocarditis
–Endocarditis in intravenous drug users

10. Features continued
•Fever
–Generally present but may be absent in elderly or
immunosuppressed
–In subacute endocarditis, fever is typically low-
grade and rarely exceeds 39.4C
•Cardiac Manifestations
–Heart murmur
–CCF in 30 to 40%

11. •Musculoskeletal
–Painless erythematous papule and macules in
the palms and soles
–Painful erythematoue subcutaneous nodules
in the pulp space of the fingers and toes
–Petechiae haemorrhages
–Splinter haemaorrhages
•Splenomegaly
•Flame shaped retinal haemorrhages with
pale centre-ROTH SPOTS

13. DIAGNOSIS

14. investigations
•Blood cultures
–Are positive in 85 to 90% of pt
–Collect up to 6 specimens
•Echocardiogram
–Useful to demonstrate vegetations
–And evaluate valvular damage and ventricular
function

15. •Other tests
–FBC
–Serum creatinine
–CXR
–ECG
–C-reactive proteins
–ESR

16. Major complications of
endocarditis
•Congestive heart failure
•Embolism
–CNS-leads to CVAs, Seizure disorders, brain
abscess
–KIDNEYS-may manifest with haematuria
–SPLEEN-splenic infarcts

17. Management
•Two aspects
–Medical and
–Surgical management.
•Medical management
–Antibiotic therapy should be commenced
–Aim the initial antibiotic therapy at the most likely
cause.

19. SURGICAL TREATMENT
–Indications for cardiac surgery in patient with
endocarditis include
•Moderate to severe heart failure with valve dysfucntion
•Fungal endocarditis

21. PROPHYLAXIS
•Cardiac conditions for which prophylaxis is
indicated include
–High risk
–And low risk factors

22. HIGH RISK
•Prosthetic heart valves
•Prior bacterial endocarditis
•Complex cyanotic congenital
heart disease;
•lesions after correction
•Patent ductus arteriosus
•Coarctation of the aorta
•Surgically constructed
systemicpulmonary shunts
MODERATE
•Congenital cardiac malformations
•ventricular septal defect,
•bicuspid aortic valve
•Acquired aortic and mitral valve
dysfunction
•Hypertrophic cardiomyopathy
•Mitral valve prolapse with
valvular regurgitation