INFECTIVE ENDOCARDITIS

ENDOCARDITIS

Inflammation of endocardium A. Non-Infective èRheumatic Endocarditis èAtypical Verrucous Endocarditis èNon bacterial thrombotic Endocarditis B. Infective èBacterial endocarditis èOther Infective types (tuberculosis, syphilitic, fungal, viral, rickettsial)

INFECTIVE ENDOCARDITIS

It is characterized by colonization or invasion of heart valves by different forms of bacteria leading to formation of thrombotic masses laden with organisms so called infective vegetations.

BACTERIAL ENDOCARITIS

DEFINITION:- Bacterial endocarditis is serious infection of the valvular and mural endocardium caused by different forms of bacteria (other than tubercle bacilli and bacterial micro organisms) and characterized by typical infected and friable vegetations

CLASSIFICATION (depending on severity)

Acute bacterial endocarditis Sub acute bacterial endocarditisis the fulminant and obstructive acute infection of the endocardium by highly virulent bacteria in a previously normal heart (fatal2-6 weeks)

is caused by less virulent bacteria in a previously diseased heart and has a gradual down hill course in a period of 6 weeks to months-years

ETIOLOGY

Acute bacterial endocarditis Sub acute bacterial endocarditis1. Staphylococci (staphylococcus

aureus)2. Pneumococci3. Gonococci4. Beeta-streptococci5. Enterococci

1. Streptococci with low virulence2. Streptococcus viridans (mouth)3. Streptococci bovis (GIT)4. Streptococcus pneumoniae5. Staphylococcus epidermidis

Alfrin AntonyLecturer Department of pathology+919738286092

PATHOGENISIS

a). The circulating bacteria are lodged much more frequently on previously damaged valves from disease, chiefly RHD nad CHD than healthy valves

b). Conditions producing haemodynamic stress on the valves are liable to cause damage to the endocardium, favouring the formation platelets thrombi which gets infected from circulating bacteria

c). Non-bacterial thrombotic endocarditis occurs from prolonged stress

PATHOLOGIC CHANGES

MACROSCOPICALLY MICROSCOPICALLY Lesions are in mitral>aortic>both >

right heart SABE > ABE

The out layer consists of eosinophilic material composed of fibrin platelets

Underneath layer is the basophilic zone containing colonies of bacteria

The deeper zone consists of non-specific inflammatory reaction

SYMPTOMSAcute Subacute

High grade fever and chills Arthralgias/ myalgias Abdominal pain Pleuritic chest pain Back pain

Low grade fever Anorexia Weight loss Fatigue Arthralgias/ myalgias Abdominal pain

SIGNS Fever Heart murmur Nonspecific signs –

1). Petechiae :- Often located on extremities or mucous membranes 2). subungal or “splinter” hemorrhages:- Nonblanching, Linear reddish- brown lesions found under the nail bed, Usually do NOT extend the entire length of the nail

3). clubbing, 4). splenomegaly, 5). neurologic changes

More specific signs - 1). Osler’s Nodes:- Painful and erythematous nodules, Located on pulp of fingers and toes More common in sub acute IE

2). Janeway lesions:- Erythematous, blanching macules Non painful

Located on palms and soles 3).Roth Spots:-Seen retina of eye

COMPLICATIONS

CARDIAC EXTRA CARDIAC Valvular stenosis or insufficiency Perforation, rupture and aneurysm

of valve and leaflets Abscesses in the valve ring Myocardial abscesses Suppurative pericarditis Cardiac failure

Infracts in spleen, kidneys and brain Pulmonory abscesses Petechiae (skin conjunctiva) Osler’s nodes(SABE) Janeway’s spots (ABE)

Tuberculosis Endocarditis:- It is characterized by presence of typical tuberculosis on the valvular as well as mural endocardium and form tuberculosis thrombo emboli

Syphilis Endocarditis:- Aortic valvular incompetence (severe)

Fungal Endocarditis:- Opportunistic fungal infections like candidiasis ans aspergillosis are seen I patients receiving long term anti biotic therapy

Viral Endocarditis:- Only in experiment

Rickettsial Endocarditis:- Another rare cause of endocarditis is form infection in Q fever