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Infective endocarditis

  • Infective endocarditis (IE): Infection of the endocardial surface of the heart, which may involve heart valves, mural endocardium, or septal defect.
  • Commonly caused by bacteria, especially Streptococci, Staphylococci, and Enterococci.
  • Other organisms: Fungi (e.g., Candida), HACEK group.
  • Risk factors: Prosthetic heart valves, structural heart disease, intravenous drug use, dental procedures, and indwelling catheters.
  • Bacteria enter the bloodstream and adhere to damaged endocardium or prosthetic valves.
  • Formation of infective vegetations: Platelets and fibrin entrap the organisms.
  • Damage to heart valves leading to regurgitation and heart failure.
Clinical Features
  • Constitutional symptoms: Fever, malaise, night sweats, weight loss.
  • Cardiac: Murmurs (new or changed), heart failure symptoms.
  • Embolisation signs: Stroke, renal infarcts, splenic infarcts.
  • Classic findings: Osler’s nodes (painful nodules on fingers/toes), Janeway lesions (painless macules on palms/soles), Roth’s spots (retinal haemorrhages), splinter haemorrhages (under the nails).
  • Blood cultures: Multiple sets to identify causative organism.
  • Echocardiography: Transoesophageal (TOE) preferred over transthoracic (TTE) for better visualisation of vegetations and valvular damage.
  • FBC, CRP, ESR: Elevated in inflammation/infection.
  • Antibiotic therapy: Empirical treatment (based on likely organisms) followed by targeted therapy after culture results.
  • Duration: Typically 4-6 weeks, may vary based on organism and location.
  • Surgery: Indicated in heart failure, uncontrolled infection, recurrent emboli, and prosthetic valve endocarditis.
  • Prophylaxis: Antibiotic prophylaxis before dental or surgical procedures in high-risk patients.
  • Early diagnosis and treatment improve outcomes.
  • Complications include heart failure, systemic embolisation, abscess formation, and valvular damage.

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