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==Overview==
==Overview==
The three most common causes of bacterial endocarditis include [[Streptococcus viridans]], [[Staphylococcus aureus|Staphylococci]] and [[Enterococcus]].
Many types of organism can cause infective endocarditis.  These are generally isolated by [[blood culture]], where the patient's blood is sampled under sterile conditions, and any growth is noted and identified.  It is therefore important to draw blood cultures before initiating antibiotic therapy.  70% of cases of endocarditis are due to the following three pathogens; [[Streptococcus viridans]], [[Staphylococcus aureus|Staphylococci]] and [[Enterococcus]].


==Causes==
==Causes==
===Life Threatening Causes===
===Life Threatening Causes===
===Common Causes===
===Common Causes===
 
*[[Candida albicans]]
Many types of organism can cause infective endocarditis. These are generally isolated by [[blood culture]], where the patient's blood is sampled under sterile conditions, and any growth is noted and identified. It is therefore important to draw blood cultures before initiating antibiotic therapy.  70% of cases of endocarditis are due to the following three pathogens:
*[[Enterococcus]]
 
*[[HACEK organisms]]
#Alpha-haemolytic [[Streptococcus|streptococci]], that are present in the mouth will often be the organism isolated if a dental procedure caused the bacteraemia.
*[[Staphylococcus aureus]]
#If the bacteraemia was introduced through the skin, such as contamination in surgery, during catheterization, or in an IV drug user, ''[[Staphylococcus aureus]]'' is common.
*[[Streptococcus viridans]]
#A third important cause of endocarditis is ''[[Enterococcus|Enterococci]]''. These bacteria enter the bloodstream as a consequence of abnormalities in the gastrointestinal or urinary tracts. ''[[Enterococcus|Enterococci]]'' are increasingly recognized as causes of nosocomial or hospital-acquired endocarditis. This contrasts with alpha-haemolytic [[streptococci]] and ''[[Staphylococcus aureus]]'' which are causes of community-acquired endocarditis.
*[[Pseudomonas]]<ref>http://wordnet.com.au/Products/topics_in_infectious_diseases_Aug01.htm Topics in Infectious Diseases Newsletter, August 2001, Pseudomonas aeruginosa.</ref>
 
*[[Streptococcus bovis]]
==Less Common Causes==
*[[clostridium|Clostridium septicum]]<ref>{{cite web|url=http://www.blackwell-synergy.com/doi/abs/10.1046/j.1445-1433.2001.02231.x?cookieSet=1&journalCode=ans|title=Clostridium septicum and malignancy |author=Simon S. B. Chew, David Z. Lubowski|date=2001|source=ANZ Journal of Surgery 71 (11), 647–649}}</ref>
Some organisms, when isolated, give valuable clues to the cause, as they tend to be specific.
*''[[Candida albicans]]'', a [[yeast]], is associated with IV drug users and the [[immunocompromised]]. Fungal endocarditis accounts for 5% of cases of native endocarditis and 10% of cases of prosthetic valve endocarditis. A diagnosis of fungal endocarditis is difficult, because many patients are afebrile with a normal white blood cell count (WBC). The fungus is often difficult to culture, and blood cultures are typically negative. Fungal infections often result in large vegetations, systemic embolization, myocardial invasion, and are extremely resistant to medical therapy. Early surgical intervention is warranted because medical mortality approaches 100% Anti-fungal therapy for life is required.
*''[[Pseudomonas]]'' species, which are very resilient organisms that thrive in water, may contaminate street drugs that have been contaminated with drinking water.  [[Pseudomonas aeruginosa|P. aeruginosa]] can infect a child through foot punctures, and can cause both endocarditis and [[septic arthritis]].<ref>http://wordnet.com.au/Products/topics_in_infectious_diseases_Aug01.htm Topics in Infectious Diseases Newsletter, August 2001, Pseudomonas aeruginosa.</ref>
*''[[Streptococcus bovis]]'' and ''Clostridium septicum'', which are part of the natural flora of the bowel, are associated with [[colon cancer|colonic malignancies]]. When they present as the causative agent in endocarditis, it usually indicates that a [[colonoscopy]] should be performed due to worries regarding hematogenous spread of bacteria from the colon due to the neoplasm breaking down the barrier between the gut lumen and the blood vessels which drain the bowel.<ref>{{cite web|url=http://www.blackwell-synergy.com/doi/abs/10.1046/j.1445-1433.2001.02231.x?cookieSet=1&journalCode=ans|title=Clostridium septicum and malignancy |author=Simon S. B. Chew, David Z. Lubowski|date=2001|source=ANZ Journal of Surgery 71 (11), 647–649}}</ref>
*''[[HACEK organisms]]'' are a group of bacteria that live on the dental gums, and can be seen with IV drug abusers who contaminate their needles with saliva. Patients may also have a history of poor dental hygiene, or pre-existing valvular disease.<ref>{{cite web|url=http://www.emedicine.com/med/topic935.htm|title=HACEK Group Infections|author=Mirabelle Kelly, MD|date= June 7, 2005}}</ref>


===Causes by Organ System===
===Causes by Organ System===
Line 161: Line 157:
*[[Gram negative]] rods  
*[[Gram negative]] rods  
*[[Group A streptococcus ]]
*[[Group A streptococcus ]]
*HACEK Group of organism
*[[HACEK organisms]]<ref>{{cite web|url=http://www.emedicine.com/med/topic935.htm|title=HACEK Group Infections|author=Mirabelle Kelly, MD|date= June 7, 2005}}</ref>
*History of [[endocarditis ]]
*History of [[endocarditis ]]
*[[HIV ]]
*[[HIV ]]

Revision as of 18:25, 1 June 2015

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Zaghw, M.D. [2]

Overview

Many types of organism can cause infective endocarditis. These are generally isolated by blood culture, where the patient's blood is sampled under sterile conditions, and any growth is noted and identified. It is therefore important to draw blood cultures before initiating antibiotic therapy. 70% of cases of endocarditis are due to the following three pathogens; Streptococcus viridans, Staphylococci and Enterococcus.

Causes

Life Threatening Causes

Common Causes

Causes by Organ System

Cardiovascular Asymmetric septal hypertrophy, Calcific aortic stenosis, Cardiac catheterization, Cardiac surgery, Congenital Heart Disease, Mitral valve prolapse, Prosthetic heart valve, Septal defects, Valve disease, Previous bacterial endocarditis, Rheumatic Heart Disease, Sclerotherapy, Cardiac myxoma, Tetralogy of Fallot, Structural heart disease, Patent ductus arteriosus, Coarctation of the aorta, Calcific valvular disease, Bicuspid aortic valves
Chemical / poisoning No underlying causes
Dental Dental extractions, Dental implants, Root canals
Dermatologic Skin infection
Drug Side Effect IV drug use
Ear Nose Throat Adenoidectomy
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic & Genito-Uriner Biliary tract surgery, Cystoscopy, Endoscopic retrograde cholangiopancreatography, Urethral dilation, Prostatic surgery, Whipple disease, Ulcerative lesions of the colon due to carcinoma, Ulcerative lesions of the colon due to inflammatory bowel disease, Peritoneovenous shunts for ascites
Genetic Marfan's Syndrome
Hematologic No underlying causes
Iatrogenic Urethral dilation, Prostate surgery, Cystoscopy
Infectious Disease Diphtheria, Staphylococcus epidermidis, Staphylococcus aureus, Streptococcus bovis, Viridans streptococci, Group A streptococcus, Gram negative rods, Enterococuss, Candida, Tuberculosis, Salmonellosis, HIV, Bacteroides, HACEK Group of organism
Musculoskeletal / Ortho No underlying causes
Neurologic Ventriculoatrial shunts for hydrocephalus
Nutritional / Metabolic No underlying causes
Obstetrics & Gynecology Childbirth
Oncologic Paraneoplastic syndrome
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Respiratory infection, Respiratory tract procedures
Renal / Electrolyte Chronic hemodialysis
Rheum / Immune / Allergy Acute rheumatic fever, Systemic lupus erythematosus, Marantic endocarditis, Immune impairment
Trauma No underlying causes
Miscellaneous Surgical systemic-pulmonary shunts and conduits

Causes in Alphabetical Order


Epidemiological Clues in Etiological Diagnosis of Culture-Negative Endocarditis[4]

Epidemiological features Common Microorganism(s)
Injection drug use
Indwelling cardiovascular medical devices
Genitourinary disorders
Genitourinary infection
Genitourinary manipulation
pregnancy
Delivery
Abortion
Chronic skin disorders
Poor dental health, dental procedures
  • Viridans group streptococci
  • “Nutritionally variant streptococci”
  • Abiotrophia defectiva
  • Granulicatella sp
  • Gemella sp
  • HACEK organisms
Alcoholism, cirrhosis
Burn patients
  • S. aureus
  • Aerobic Gram-negative bacilli, including
Diabetes mellitus
Early ( < 1 y) prosthetic valve placement
Late ( > 1 y) prosthetic valve placement
Dog–cat exposure
Contact with contaminated milk
Contact with infected farm animals
Homeless, body lice
AIDS
Pneumonia, meningitis
Solid organ transplant
Gastrointestinal lesions


References

  1. ↑ http://wordnet.com.au/Products/topics_in_infectious_diseases_Aug01.htm Topics in Infectious Diseases Newsletter, August 2001, Pseudomonas aeruginosa.
  2. ↑ Simon S. B. Chew, David Z. Lubowski (2001). "Clostridium septicum and malignancy". Unknown parameter |source= ignored (help)
  3. ↑ Mirabelle Kelly, MD (June 7, 2005). "HACEK Group Infections".
  4. ↑ Baddour, LM.; Wilson, WR.; Bayer, AS.; Fowler, VG.; Bolger, AF.; Levison, ME.; Ferrieri, P.; Gerber, MA.; Tani, LY. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145. Unknown parameter |month= ignored (help)

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