Cardiovascular Infections

CARDIOVASCULAR INFECTIONS

CARDITIS

ENDOCARDITIS

MYOCARDITIS

PERICARDITIS

Infection of the endocardial surfcace

Healthy valve

Damaged / Prosthetic valve

heart valves are affected most commonly (may also affect septal defects or mural endocardium)

RISK FACTORS:

Rheumatic heart disease Congenital heart disease Mitral valve prolapse Degenerative valve disease Prosthetic valve

NBTE

Flora on Mucus membrane/ other heavily colonized surface

BACTEREMIA

TRAUMA

Dental manipulations Pulmonary, Gastrointestinal, Urological procedures and Tonsillectomy

FROM - JANE

Fever

Roth's spots

Osler's nodule

Murmur

Janeaway lesions

Anemia

Nail hemorrhage (splinter H)

Emboli

RISK FACTORS:

Age >60

Male sex

Injection drug use

Poor dentition and dental infection

CO-MORBID CONDITIONS:

Structural heart disease

Valvular disease

Congenital heart disease

Presence of an intravascular device

Chronic hemodialysis

HIV infection

Staphylococcus aureus:

health-care associated

Acute fulminant endocarditis

Viridans Streptococci:

Community-acquired and seen in older patients

Subacute bacterial endocarditis

POST-OPERATIVE (PROSTHETIC VALVE)

Early infection: (<2 months)

Staphylococcus aureus,

CoNS, GNBs and Candida (Nosocomial)

Late infection: (>12months)

Viridans Streptococci,

Staphylococcus aureus, CoNS, Enterococci

Enterococcus species and Streptococcus gallolyticus

associated with colon carcinoma or colonoscopy

IVDA

Most common is Staphylococcus aureus ​​​​​​

Second most common is Pseudomonas aeruginosa

VIRULENCE FACTORS:

Dextran production

Surface adhesin

Adherence to specific components of NBTE

Glycocalyx and slime layer

fibronectin and fibrinogen binds to the specific component of NBTE

septic embolization and deposition of immune complexes:

O, J, R

MODIFIED DUKE'S CRITERIA

MAJOR and MINOR

2 MAJOR

1 MAJOR + 3 MINOR

5 MINOR

DIAGNOSIS:

Electrocardiogram

Echocardiography

Blood culture (3 samples over 24 hours)

Molecular methods (culture-negative IE)

Viridans Streptococci

Gram positive cocci in chains

Alpha-hemolysis greenish discoloration

NOT lysed by bile

NOT sensitive to optochin

Enterococcus species

Enterococcus faecium

Enterococcus faecalis

Gram positive cocci in pairs (spectacle-like)

Carbohydrate antigen - D

No Hemolysis

Grows in 6.5% NaCl

Tolerates 40% bile

Hydrolyze bile esculin

Staphylococcus aureus

Gram-positive cocci in clusters

Beta-hemolysis on blood agar

Catalase positive

Coagulase positive

[Coagulase negative - CoNS]

Methicillin sensitivty / resistance

RHEUMATIC HEART DISEASE

Non-suppurative complications of Strep pharyngitis

Rheumatogenic strains of Streptococcus pyogenes

Cross-reactivity between antibodies produced and body tissue

Type II Hypersensitivity reactions: Molecular mimicry

Pancarditis - mainly heart valve damage

JONES criteria: Major and Minor

JONES CAFE-PAL

Infectious agents:

VIRUS:

Coxsackie B virus

Adeno virus

Echo virus

Parvovirus B19

PROTOZOA:

Trypanosoma cruzi

Acute phase

Subacute phase

Chronic phase

Contact - droplets from nose and throat

RISK GROUPS:

Children

age 20-40

longterm steroid and NSAIDS treatment

Alcoholics

Nutritional deficiencies

DIAGNOSIS:

ECG

Echocardiogram

CMRI

EMB

Elevation of Cardiac enzymes

PCR for viral NA

CHAGA'S DISEASE:

Trypanosoma cruzi

Reduviid bug (kissing bugs; triatomine bugs)

Amastigote (aflagellate) & Trypomastigote (flagellate)

Chagoma - bite site

Romana's sign - periorbital swelling

Viral Pericarditis -

Coxsackie A and B

Echovirus, Herpes, Adeno, HIV, Mumps

Purulent pericarditis -

Muliple etiology - Staph. aureus, Strep. pneumoniae, M. tuberculosis

Echocardiography

ECG: 'saddle-back' concave ST segment elevation and low QRS voltage

ELECTRICAL ALTERNANS

CT & MRI