What is infective endocarditis?
Infective endocarditis is the inflammation of the pericardium due to bacteria. But all person does not suffer from endocarditis because this is a rare disease because bacteria only attack those who have mitral valve surgery and any problem in the mitral valve.
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Etiology:
Infective endocarditis’s most common cause is caused by staph aureus bacteria. And if a person has undergone Vulvar replacement surgery, then that person has a higher chance of getting this disease.
- The most common cause is staph aureus bacteria.
- Vulvar replacement surgery (prosthetic valve).
If any person facing problems after mitral valve surgery < 60 days generally cause by staphylococcus epidermidis and > 60 days caused by strep viridans.
Symptoms:
- Pain in joints and muscles
- When you breathe chest pain
- Fatigue
- Night sweats
- Shortness of breath
- Swelling in the feet, legs or belly
- A new or changed whooshing sound in the heart (murmur)
- Mitral regurgitation
- Right heart dystrophy
- Fever with chill
Vascular phenomena
When the bacteria break down and enter the systemic circulation from the aorta, the bacteria get stuck in the tiny blood vessels called capillaries, causing lesions.
- Nail:- Bacteria reach the distal end of the hand or black spot seen on the nail called splinter hemorrhage.
- Palm and Sole:- If bacteria reach via the bloodstream in your palm and sole there are show some black and red lesions called Janeway lesions it is painless.
- Artery:- If bacteria reach small tiny vessels stuck there and multiply damage tiny vessels called a mycotic aneurysm.
- Spleen:- Can lead to splenomegaly and also develop a splenic abscess.
Immunological phenomena
In this condition, antibody bind with bacteria means the antigen bind with antibody to make an immune complex. If the immune complex break and mixes in the blood to reach a different part of the body organ can cause some lesions.
- In the retina called the Roth spot
- figure black and read nodule appearance called Osler node it is pain full
- If involve the kidney called glomerulonephritis
- During the investigation give false +ve RA factor
Diagnosis:
Infective endocarditis is diagnosed by duke criteria with these major and minor criteria but during the diagnosis important is to 2 major or 1 major + 3 minor or 5 minor criteria so that we can diagnose infective endocarditis.
Major criteria:
- Blood culture:- we can identify the bacteria (at least 1 hour apart over a period of 24 hours).
- 2 D Echo:- In echo we can see vegetation, in vegetation platelet fibrin or bacterial antigen is present.
Minor criteria:
- Fever
- Presence risk factor
- Any vascular phenomena
- Any immunological phenomena
- Microbiological evidence ( Any one blood culture +ve)
Note:- Blood culture report was done within 96 hours.
Management:
If the patient is suffering from infective endocarditis, then first of all triple antibiotic therapy is given to him. Because we do not know which bacteria caused it.
When the blood culture report comes from the lab and the bacteria are identified in it, then according to that antibiotic is given to it.
- Ampicillin
- Gentamycin
- Vancomycin
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