Infective endocarditis resident survival guide: Difference between revisions

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{{familytree/start |summary=Definition of Infective Endocarditis According to the Modified Duke Criteria}}
{{familytree | | | | | | | | A01 | | | | |A01= '''Definite Infective Endocarditis According to Modified Duke Criteria'''}}
{{familytree | | | | | | | | |!| | | | | |}}
{{familytree | | | | | | | | A01 | | | | |A01= <div style="float: left; text-align: left; width: 40em; padding:1em;">'''Pathological Criteria'''
:❑ Microorganisms demonstrated by culture or histological examination of a vegetation <br>
:❑ Pathological lesions; vegetation or intracardiac abscess confirmed by histological examination showing active endocarditis <br>
'''Clinical Criteria'''
:❑ 2 major criteria; or
:❑ 1 major criterion and 3 minor criteria; or
:❑ 5 minor criteria <br>
'''Possible IE'''
:❑ 1 major criterion and 1 minor criterion; or
:❑ 3 minor criteria<BR>
'''Rejected'''
:❑ Firm alternative diagnosis explaining evidence of IE; or
:❑ Resolution of IE syndrome with antibiotic therapy for 4 days; or
:❑ No pathological evidence of IE at surgery or autopsy, with antibiotic therapy for 4 days; or
:❑ Does not meet criteria for possible IE as above</div>}}
{{familytree/end}}


==Causes==
==Causes==

Revision as of 15:26, 28 February 2014


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Farman Khan, MD, MRCP [2]

Definition

Infection of the endothelium of the heart including but not limited to the valves. It can be either acute or subacute. Acute bacterial endocarditis is defined as Infection of normal heart valves with a virulent organism like S. aureus, Group A or other beta-hemolytic streptococci, Streptococcus pneumoniae. Subacute bacterial endocarditis is an indolent infection of abnormal valves with less virulent organism like Streptococcus viridans.

Criteria Definite Infective Endocarditis According to Modified Duke Criteria
Pathological Criteria
Microorganisms demonstrated by culture or histological examination of a vegetation
Pathological lesions; vegetation or intracardiac abscess confirmed by histological examination showing active endocarditis
Clinical Criteria
2 major criteria; or
1 major criterion and 3 minor criteria; or
5 minor criteria
Possible IE
1 major criterion and 1 minor criterion; or
3 minor criteria
Rejected
Firm alternative diagnosis explaining evidence of IE; or
Resolution of IE syndrome with antibiotic therapy for 4 days; or
No pathological evidence of IE at surgery or autopsy, with antibiotic therapy for 4 days; or
Does not meet criteria for possible IE as above

Causes

Life Threatening Causes

Life-threatening causes include conditions which may result in death or permanent disability within 24 hours if left untreated. Endocarditis can be a life-threatening condition if it is left untreated, and it must be treated as such irrespective of the causes.

Common Causes

Management

Diagnostic Criteria

Shown below is an algorithm depicting the diagnostic criteria of infective endocarditis based on the 2005 American Heart Association (AHA) technical review and medical position statement regarding guidelines on infective endocarditis.[1]

 
 
 
 
Duke Criteria
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
The Duke Clinical Criteria for Infective Endocarditis requires either:

❑ Two major criteria, or

❑ One major and three minor criteria, or

❑ Five minor criteria
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Major Criteria
 
 
 
Minor criteria
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Positive Blood Culture for Infective Endocarditis
  • Typical microorganism consistent with infective endocarditis from 2 separate blood cultures, as noted below:
Viridans streptococci, streptococcus bovis
HACEK group
❑ Community-acquired staphylococcus aureus
Enterococci, in the absence of a primary focus, or
  • Microorganisms consistent with infective endocarditis from persistently positive blood cultures defined as:
❑ 2 positive cultures of blood samples drawn >12 hours apart, or
❑ All of 3 or a majority of 4 separate cultures of blood (with first and last sample drawn 1 hour apart)

Echocardiographic evidence of endocardial involvement

❑ Oscillating intracardiac mass on valve or supporting structures, in the path of regurgitant jets, or
❑ On implanted material in the absence of an alternative anatomic explanation, or
❑ Abscess, or
❑ New partial dehiscence of prosthetic valve, or
❑ New valvular regurgitation (worsening or changing of preexisting murmur not sufficient)
 
 
 
  • Predisposition:
❑ Predisposing heart condition or intravenous drug use
  • Fever:
❑ Temperature > 38.0° C (100.4° F)
  • Vascular phenomena:
Major arterial emboli
❑ Septic pulmonary infarcts
Mycotic aneurysm
Intracranial hemorrhage
Conjunctival hemorrhage
Janeway lesions
  • Immunologic phenomena:
Glomerulonephritis
Osler's nodes
Roth spots
Rheumatoid factor
  • Microbiological evidence:
❑ Positive blood culture but does not meet a major criterion as noted above
❑ Serological evidence of active infection with organism consistent with infectious endocarditis
  • Echocardiographic findings:
❑ Consistent with infectious endocarditis but do not meet a major criterion as noted above
 
 
 
 
 
 

Diagnostic approach

Shown below is an algorithm summarizing the approach to infective endocarditis.

 
 
 
 
 
 
 
A1 Box 1 in Row 1
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
B1 Box 1 in Row 2
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
C1 Box 1 in Row 3
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Box 4 in row 4
 
 
 
Box 5 in row 4
 
 
 
 
 
 
 
 
 
Box 6 in row 4
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
Box 7 in row 5
 
 
 
 
 
 
 
 
 
Box 8 in row 5
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
box 9 in row 6
 
 
 
box 10 in row 6
 
Box 11 in row 6
 
 
Box 12 in row 6
 
 
 
 
 
 
 
Box 13 in row 6
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
{{{ G01 }}}
 
 
 
 
 
 
{{{ G03 }}}
 
{{{ G04 }}}{{{ G05 }}}
 
 
 
 
 
 
 
{{{ G06 }}}

Do's

Dont's

References


Template:WikiDoc Sources

  1. Baddour Larry M., Wilson Walter R., Bayer Arnold S., Fowler Vance G. Jr, Bolger Ann F., Levison Matthew E., Ferrieri Patricia, Gerber Michael A., Tani Lloyd Y., Gewitz Michael H., Tong David C., Steckelberg James M., Baltimore Robert S., Shulman Stanford T., Burns Jane C., Falace Donald A., Newburger Jane W., Pallasch Thomas J., Takahashi Masato, Taubert Kathryn A. (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-Executive Summary: Endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): 3167–84. PMID 15956145.