Infective Endocarditis

INFECTIVE ENDOCARDITIS

Alfrin Antony Lecturer Department of pathology +919738286092

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 is the fulminant and obstructive acute infection of the endocardium by highly virulent bacteria in a previously normal heart (fatal2-6 weeks)

Sub acute bacterial endocarditis 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 1. Staphylococci (staphylococcus aureus) 2. Pneumococci 3. Gonococci 4. Beeta-streptococci 5. Enterococci

Sub acute bacterial endocarditis 1. Streptococci with low virulence 2. Streptococcus viridans (mouth) 3. Streptococci bovis (GIT) 4. Streptococcus pneumoniae 5. Staphylococcus epidermidis

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  Lesions are in mitral>aortic>both > right heart  SABE > ABE

MICROSCOPICALLY  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 nonspecific inflammatory reaction

SYMPTOMS Acute     

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

Subacute      

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 reddishbrown 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

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CARDIAC Valvular stenosis or insufficiency Perforation, rupture and aneurysm of valve and leaflets Abscesses in the valve ring Myocardial abscesses Suppurative pericarditis Cardiac failure

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EXTRA CARDIAC 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