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{{Endocarditis}}
{{Endocarditis}}
{{CMG}} {{AE}} {{Maliha}}
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==Overview==
==Overview==
Endocarditis may be classified based on the underlying pathophysiology of the process (infective vs. non-infective), the onset of the disease (acute vs. subacute or short incubation vs. long incubation), results of the cultures (culture positive vs. culture negative), the nature of the valve (native vs. prosthetic) and the valve affected ([[aortic]], [[mitral]], or [[tricuspid valve]]).
[[Endocarditis]] may be classified based on the underlying [[pathophysiology]] of the process ([[Infective Endocarditis|infective]] vs. [[Non-infective endocarditis|non-infective]]), the onset of the [[disease]] ([[Acute (medicine)|acute]] vs. [[subacute]] or short [[Incubation period|incubation]] vs. long [[Incubation period|incubation]]), results of the cultures (culture-positive vs. culture-negative), the nature of the [[valve]] (native vs. [[prosthetic]]) and the [[valve]] affected ([[aortic]], [[mitral]], or [[tricuspid valve]]).


==Classification==
==Classification==
===Infective Endocarditis vs. Non-Infective Endocarditis===
* Infectious endocarditis is due to pathogens which are usually bacterial but other organisms may be responsible.<ref name=abc> Infective endocarditis. Wikipedia (2015). https://en.wikipedia.org/wiki/Infective_endocarditis#Pathogenesis Accessed on September 21, 2015</ref> 
* Damage to the [[endothelium]] improves the ability of [[bacteria]] to bind to the surface. 
* Non-infective or marantic endocarditis is rare.
* [[Libman-Sacks endocarditis]] is a form of sterile [[endocarditis]], which occurs more often in patients with [[systemic lupus erythematosus]] and [[antiphospholipid syndrome]].
*Non-infective endocarditis may also occur in patients with [[cancer]], particularly mucinous [[adenocarcinoma]].<ref name=ddd> Endocarditis. Wikipedia (2015). URL=https://en.wikipedia.org/wiki/Endocarditis Accessed on September 21, 2015</ref>


===Short Incubation vs. Long Incubation===
[[Endocarditis]] may be classified into 8 subtypes based on:<ref name="pmid25501052">{{cite journal| author=Ortiz C, López J, García H, Sevilla T, Revilla A, Vilacosta I | display-authors=etal| title=Clinical classification and prognosis of isolated right-sided infective endocarditis. | journal=Medicine (Baltimore) | year= 2014 | volume= 93 | issue= 27 | pages= e137 | pmid=25501052 | doi=10.1097/MD.0000000000000137 | pmc=4602814 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25501052  }}</ref><ref name="pmid19352296">{{cite journal| author=Fernández Guerrero ML, González López JJ, Goyenechea A, Fraile J, de Górgolas M| title=Endocarditis caused by Staphylococcus aureus: A reappraisal of the epidemiologic, clinical, and pathologic manifestations with analysis of factors determining outcome. | journal=Medicine (Baltimore) | year= 2009 | volume= 88 | issue= 1 | pages= 1-22 | pmid=19352296 | doi=10.1097/MD.0b013e318194da65 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19352296  }}</ref><ref name="pmid18402924">{{cite journal| author=Selton-Suty C, Doco-Lecompte T, Freysz L, Chometon F, Duhoux F, Blangy H | display-authors=etal| title=[Non-valvular cardiac devices endocarditis]. | journal=Ann Cardiol Angeiol (Paris) | year= 2008 | volume= 57 | issue= 2 | pages= 81-7 | pmid=18402924 | doi=10.1016/j.ancard.2008.02.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18402924  }}</ref>
Traditionally, infective endocarditis has been clinically divided into [[acute]] and [[subacute]] endocarditis.<ref name=abc> Infective endocarditis. Wikipedia (2015). https://en.wikipedia.org/wiki/Infective_endocarditis#Pathogenesis Accessed on September 21, 2015</ref> This classifies both the rate of progression and severity of disease. Thus subacute bacterial endocarditis (SBE) is often due to [[streptococci]] of low virulence and mild to moderate illness which progresses slowly over weeks and months, while acute bacterial endocarditis (ABE) is a fulminant illness that progresses rapidly over days to weeks and is more likely to be due to ''[[Staphylococcus aureus]]'', which has much greater virulence.<ref name=abc> Infective endocarditis. Wikipedia (2015). URL=https://en.wikipedia.org/wiki/Infective_endocarditis#Pathogenesis Accessed on September 21, 2015</ref> The terms short incubation (<6 weeks) and long incubation (>6 weeks) are preferred.<ref name=abc> Infective endocarditis. Wikipedia (2015). URL=https://en.wikipedia.org/wiki/Infective_endocarditis#Pathogenesis Accessed on September 21, 2015</ref>


===Culture Positive vs. Culture Negative===
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center
Infective endocarditis may also be classified as culture-positive or culture-negative.<ref name=abc> Infective endocarditis. Wikipedia (2015). https://en.wikipedia.org/wiki/Infective_endocarditis#Pathogenesis Accessed on September 21, 2015</ref> Culture-negative endocarditis is due to micro-organisms that require a longer period of time to be identified in the laboratory.<ref name=abc> Infective endocarditis. Wikipedia (2015). https://en.wikipedia.org/wiki/Infective_endocarditis#Pathogenesis Accessed on September 21, 2015</ref> Such organisms are said to be [[Growth medium|fastidious]] because they have demanding growth requirements. Some pathogens responsible for culture-negative endocarditis include ''[[Aspergillus]]'' species, ''[[Brucella]]'' species, ''[[Coxiella burnetii]]'', ''[[Chlamydia]]'' species, and [[HACEK organism|HACEK bacteria]].<ref name=abc> Infective endocarditis. Wikipedia (2015). Uhttps://en.wikipedia.org/wiki/Infective_endocarditis#Pathogenesis Accessed on September 21, 2015</ref>
|valign=top|
 
===Native Valve Endocarditis vs. Prosthetic Valve Endocarditis===
Finally, the distinction between native-valve endocarditis and prosthetic-valve endocarditis is clinically important. Prosthetic-valve endocarditis constitutes 10-20% of cases of endocarditis. The greatest risk is during the first 6 months after valve surgery. [[Staphylococcus epidermidis]] is the most common cause.


|+
! style="background: #4479BA; width: 200px;" | Classification criterion
! style="background: #4479BA; width: 400px;" | Subgroups
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
:Underlying pathophysiology
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Infective Endocarditis|Infective endocarditis]] vs. non-infective [[endocarditis]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Onset of the disease
| style="padding: 5px 5px; background: #F5F5F5;" |
* Short [[Incubation period|incubation]] vs. long [[Incubation period|incubation]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Culture result
| style="padding: 5px 5px; background: #F5F5F5;" |
* Culture positive vs. culture negative
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
:Nature of the valve
| style="padding: 5px 5px; background: #F5F5F5;" |
*Native [[valve]] [[endocarditis]] vs. [[Prosthesis|prosthetic]] valve [[endocarditis]]
|-
|}<br />
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Infectious disease]]
 
[[Category:Intensive care medicine]]
[[Category:Intensive care medicine]]
[[Category: Up-To-Date]]
[[Category: Up-To-Date]]
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Latest revision as of 21:00, 3 March 2020

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

Overview

Endocarditis may be classified based on the underlying pathophysiology of the process (infective vs. non-infective), the onset of the disease (acute vs. subacute or short incubation vs. long incubation), results of the cultures (culture-positive vs. culture-negative), the nature of the valve (native vs. prosthetic) and the valve affected (aortic, mitral, or tricuspid valve).

Classification

Endocarditis may be classified into 8 subtypes based on:[1][2][3]

Classification criterion Subgroups
Underlying pathophysiology
Onset of the disease
Culture result
  • Culture positive vs. culture negative
Nature of the valve


References

  1. Ortiz C, López J, García H, Sevilla T, Revilla A, Vilacosta I; et al. (2014). "Clinical classification and prognosis of isolated right-sided infective endocarditis". Medicine (Baltimore). 93 (27): e137. doi:10.1097/MD.0000000000000137. PMC 4602814. PMID 25501052.
  2. Fernández Guerrero ML, González López JJ, Goyenechea A, Fraile J, de Górgolas M (2009). "Endocarditis caused by Staphylococcus aureus: A reappraisal of the epidemiologic, clinical, and pathologic manifestations with analysis of factors determining outcome". Medicine (Baltimore). 88 (1): 1–22. doi:10.1097/MD.0b013e318194da65. PMID 19352296.
  3. Selton-Suty C, Doco-Lecompte T, Freysz L, Chometon F, Duhoux F, Blangy H; et al. (2008). "[Non-valvular cardiac devices endocarditis]". Ann Cardiol Angeiol (Paris). 57 (2): 81–7. doi:10.1016/j.ancard.2008.02.005. PMID 18402924.

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