Michael at 16:22, 3 July 2014

2014-07-03T16:22:52Z

← Older revision		Revision as of 16:22, 3 July 2014
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	**Larger in acute IE.		**Larger in acute IE.

	Image:		===Image===
			<gallery>
			Image:Haemophilus parainfluenzae Endocarditis PHIL 851 lores.jpg \| Infective endocarditis.
			</gallery>
			www:
	*[http://www.flickr.com/photos/11462589@N05/1126726482/ Infective endocarditis - aortic valve (flickr.com)].		*[http://www.flickr.com/photos/11462589@N05/1126726482/ Infective endocarditis - aortic valve (flickr.com)].

Michael: /* Microscopic */

2014-07-03T16:18:49Z

Microscopic

← Older revision		Revision as of 16:18, 3 July 2014
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	DDx:		DDx:
	*[[Nonbacterial thrombotic endocarditis]] - dirt may mimic micro-organisms.		*[[Nonbacterial thrombotic endocarditis]] - not really inflamed, dirt may mimic micro-organisms.

	==Stains==		==Stains==

Michael: /* Microscopic */

2014-07-03T16:18:25Z

Microscopic

← Older revision		Revision as of 16:18, 3 July 2014
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	==Microscopic==		==Microscopic==
			Features:
	*Inflammatory infiltrate (key feature @ low power):		*Inflammatory infiltrate (key feature @ low power):
	**+/-Plasma cells - subacute.		**+/-Plasma cells - subacute.
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	*Microorganisms - '''key feature''' (diagnostic).		*Microorganisms - '''key feature''' (diagnostic).
	**Hard to see (even at high power).		**Hard to see (even at high power).

			DDx:
			*[[Nonbacterial thrombotic endocarditis]] - dirt may mimic micro-organisms.

	==Stains==		==Stains==

Michael at 16:15, 3 July 2014

2014-07-03T16:15:28Z

← Older revision		Revision as of 16:15, 3 July 2014
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	'''Infective endocarditis''', abbreviated '''IE''', is an uncommon disease of the heart lining/[[heart valves]].		'''Infective endocarditis''', abbreviated '''IE''', is an uncommon disease of the heart lining/[[heart valves]].

	:''Bacterial endocarditis'' and ''subacute bacterial endocarditis'' redirect here.		'''Bacterial endocarditis''' and '''subacute bacterial endocarditis''' (abbreviated '''SBE''') redirect here.

	==General==		==General==

Michael: split out

2014-07-03T16:13:49Z

split out

← Older revision		Revision as of 16:13, 3 July 2014
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	#~~redirect~~ [[~~Heart_valves~~#~~Infective_endocarditis~~]]		'''Infective endocarditis''', abbreviated '''IE''', is an uncommon disease of the heart lining/[[heart valves]].

			:''Bacterial endocarditis'' and ''subacute bacterial endocarditis'' redirect here.

			==General==
			*Infection of the endocardium - often involves the valves (which are covered by endocardium).
			*Before the time of antibiotics -- 100% fatal.

			===Organisms===
			Most common organism overall:
			*''Staphylococcus aureus''.<ref name=pmid12092480>{{Cite journal \| last1 = Petti \| first1 = CA. \| last2 = Fowler \| first2 = VG. \| title = Staphylococcus aureus bacteremia and endocarditis. \| journal = Infect Dis Clin North Am \| volume = 16 \| issue = 2 \| pages = 413-35, x-xi \| month = Jun \| year = 2002 \| doi = \| PMID = 12092480 }}</ref>

			Organisms associated with particular clinical scenarios:
			*IV drug users / normal valves = ''Staphylococcus aureus''.<ref name=Ref_PCPBoD8_298>{{Ref PCPBoD8\|298}}</ref>
			*Previously damaged valve = ''Streptococcus viridans''.
			*Prosthetic valves = ''Staphylococcus epidermidis''.<ref name=pmid19660339>{{Cite journal \| last1 = Alonso-Valle \| first1 = H. \| last2 = Fariñas-Alvarez \| first2 = C. \| last3 = García-Palomo \| first3 = JD. \| last4 = Bernal \| first4 = JM. \| last5 = Martín-Durán \| first5 = R. \| last6 = Gutiérrez Díez \| first6 = JF. \| last7 = Revuelta \| first7 = JM. \| last8 = Fariñas \| first8 = MC. \| title = Clinical course and predictors of death in prosthetic valve endocarditis over a 20-year period. \| journal = J Thorac Cardiovasc Surg \| volume = 139 \| issue = 4 \| pages = 887-93 \| month = Apr \| year = 2010 \| doi = 10.1016/j.jtcvs.2009.05.042 \| PMID = 19660339 }}</ref>

			Organisms that less commonly cause ''IE'' are known as the ''HACEK group'':<ref name=Ref_PCPBoD8_298>{{Ref PCPBoD8\|298}}</ref>
			*'''''H'''aemophilus'' (''Haemophilus parainfluenzae'', ''Haemophilus aphrophilus'', ''Haemophilus paraphrophilus'').
			*'''''A'''ctinobacillus'' (''Actinobacillus actinomycetemcomitans'', ''Aggregatibacter aphrophilus'').
			*'''''C'''ardiobacterium hominis.
			*'''''E'''ikenella corrodens''. †
			*'''''K'''ingella'' (''Kingella kingae'').

			Notes:
			* † ''Enterococci'' are not included in this list but are lumped with the ''HACEK organisms''.<ref name=Ref_PCPBoD8_298>{{Ref PCPBoD8\|298}}</ref>

			Others:
			*''Stenotrophomonas maltophilia'' (previously ''Pseudomonas maltophilia'') - Gram-negative bacillus,<ref>{{Cite journal \| last1 = Gautam \| first1 = V. \| last2 = Ray \| first2 = P. \| last3 = Vandamme \| first3 = P. \| last4 = Chatterjee \| first4 = SS. \| last5 = Das \| first5 = A. \| last6 = Sharma \| first6 = K. \| last7 = Rana \| first7 = S. \| last8 = Garg \| first8 = RK. \| last9 = Madhup \| first9 = SK. \| title = Identification of lysine positive non-fermenting gram negative bacilli (Stenotrophomonas maltophilia and Burkholderia cepacia complex). \| journal = Indian J Med Microbiol \| volume = 27 \| issue = 2 \| pages = 128-33 \| month = \| year = \| doi = 10.4103/0255-0857.49425 \| PMID = 19384035 }}</ref> rarely causes endocarditis,<ref name=pmid23021356>{{Cite journal \| last1 = Carrillo-Córdova \| first1 = JR. \| last2 = Amezcua-Guerra \| first2 = LM. \| title = Autoimmunity as a possible predisposing factor for Stenotrophomonas maltophilia endocarditis. \| journal = Arch Cardiol Mex \| volume = 82 \| issue = 3 \| pages = 204-7 \| month = \| year = \| doi = 10.1016/j.acmx.2012.03.001 \| PMID = 23021356 }}</ref> high mortality.<ref>{{Cite journal \| last1 = Fontenier \| first1 = G. \| last2 = Freschard \| first2 = R. \| last3 = Mourot \| first3 = M. \| title = Study of the corrosion in vitro and in vivo of magnesium amodes involved in an implantable bioelectric battery. \| journal = Med Biol Eng \| volume = 13 \| issue = 5 \| pages = 683-9 \| month = Sep \| year = 1975 \| doi = \| PMID = 1186330 }}</ref>

			===Clinical===
			*Diagnosed (clinically) using the ''Duke criteria''.<ref>[http://www.medcalc.com/endocarditis.html http://www.medcalc.com/endocarditis.html]</ref><ref>{{cite journal \|author=Durack DT, Lukes AS, Bright DK \|title=New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service \|journal=Am. J. Med. \|volume=96 \|issue=3 \|pages=200-9 \|year=1994 \|month=March \|pmid=8154507 \|doi= \|url=}}</ref>
			**Positive blood cultures.
			**Cardiac involvement - vegetation.
			**+/-Febrile.

			Subdivided into:
			#Acute IE.
			#*Classically due to ''Staphylococcus aureus''.
			#Subacute IE.
			#*Classically due to ''Streptococcus viridans''.

			Treatment:<ref name=pmid23968767>{{Cite journal \| last1 = Gaca \| first1 = JG. \| last2 = Sheng \| first2 = S. \| last3 = Daneshmand \| first3 = M. \| last4 = Rankin \| first4 = JS. \| last5 = Williams \| first5 = ML. \| last6 = O'Brien \| first6 = SM. \| last7 = Gammie \| first7 = JS. \| title = Current Outcomes for Tricuspid Valve Infective Endocarditis Surgery in North America. \| journal = Ann Thorac Surg \| volume = \| issue = \| pages = \| month = Aug \| year = 2013 \| doi = 10.1016/j.athoracsur.2013.05.046 \| PMID = 23968767 }}</ref>
			*Usually medical management.<ref name=pmid16506645>{{Cite journal \| last1 = Chait \| first1 = RD. \| last2 = Midwall \| first2 = J. \| title = Tricuspid valvectomy: long-term survival and surgical options. \| journal = Clin Cardiol \| volume = 29 \| issue = 2 \| pages = 83-4 \| month = Feb \| year = 2006 \| doi = \| PMID = 16506645 \| URL = http://onlinelibrary.wiley.com/doi/10.1002/clc.4960290210/pdf }}</ref>
			*Valve replacement.
			*Valve repair.
			*Valvectomy - for tricuspid valve.

			==Gross==
			*Location - left-sided involvement (mitral, aortic) more common than right-sided involvement (pulmonic, tricuspid).
			**This is reversed in IV drug users.<ref name=Ref_PCPBoD8_298>{{Ref PCPBoD8\|298}}</ref><ref name=pmid16401952>{{Cite journal \| last1 = Mathura \| first1 = KC. \| last2 = Thapa \| first2 = N. \| last3 = Rauniyar \| first3 = A. \| last4 = Magar \| first4 = A. \| last5 = Gurubacharya \| first5 = DL. \| last6 = Karki \| first6 = DB. \| title = Injection drug use and tricuspid valve endocarditis. \| journal = Kathmandu Univ Med J (KUMJ) \| volume = 3 \| issue = 1 \| pages = 84-6 \| month = \| year = \| doi = \| PMID = 16401952 }}</ref>
			*+/-Valvular destruction.
			**More common in acute IE.
			*+/-Distant emboli, e.g. [[splenic infarct]].
			**More common in acute IE.
			*+/-Valvular vegetations.
			**Irregular ball of loosely adherent tissue - dull, irregular surface.
			**On the ventricular aspect in aortic valve IE.
			**Larger in acute IE.

			Image:
			*[http://www.flickr.com/photos/11462589@N05/1126726482/ Infective endocarditis - aortic valve (flickr.com)].

			==Microscopic==
			*Inflammatory infiltrate (key feature @ low power):
			**+/-Plasma cells - subacute.
			**+/-Neutrophils - typically abundant, may be rare in subacute.<ref>URL: [http://emedicine.medscape.com/article/216650-overview#a0104 http://emedicine.medscape.com/article/216650-overview#a0104]. Accessed on: 26 November 2013.</ref>
			*Microorganisms - '''key feature''' (diagnostic).
			**Hard to see (even at high power).

			==Stains==
			*[[GMS stain]] (Gomori Methenamine-silver stain).
			**Look for [[fungi]].
			*[[Gram stain]].
			**Look for bacteria.

			==Sign out==
			<pre>
			TRICUSPID VALVE, VALVECTOMY:
			- FRAGMENTS OF VALVE WITH INFECTIVE ENDOCARDITIS -- ABUNDANT COCCI
			ORGANISMS IDENTIFIED.
			- THIN RIM OF CARDIAC MUSCLE WITHOUT APPARENT PATHOLOGY.
			</pre>

			<pre>
			MITRAL VALVE, VALVE REPLACEMENT:
			- FRAGMENTS OF VALVE WITH INFECTIVE ENDOCARDITIS -- ABUNDANT COCCI
			ORGANISMS IDENTIFIED.
			</pre>

			===No microorganisms===
			<pre>
			AORTIC VALVE (BICUSPID), VALVE REPLACEMENT:
			- BICUSPID VALVE WITH CALCIFIC AORTIC STENOSIS AND MILD ENDOCARDITIS.
			- NO MICROORGANISMS APPARENT.
			</pre>

			===Micro===
			The sections show valve tissue with an attached vegetation with abundant cocci organisms
			and neutrophils. No calcification is apparent.

			====No microorganisms====
			The sections show valve tissue with marked calcification, scattered neutrophils and plasma cells. No microorganisms are identified with routine stains.

			==See also==
			*[[Heart valves]].

			==References==
			{{Reflist\|2}}

	[[Category:Diagnosis]]		[[Category:Diagnosis]]
			[[Category:Cardiovascular pathology]]

Michael: redirect w/ cat.

2011-10-23T01:54:42Z

redirect w/ cat.

New page

#redirect [[Heart_valves#Infective_endocarditis]]

[[Category:Diagnosis]]

Infective endocarditis - Revision history

Michael at 16:22, 3 July 2014

Michael: /* Microscopic */

Michael: /* Microscopic */

Michael at 16:15, 3 July 2014

Michael: split out

Michael: redirect w/ cat.