infective endocarditis

risk of IE
1. in kids of any age w/ congenital heart disease
  1. except those w/ secundum ASD
2. risk highest where there is turbulent jet of blood
  1. VSD
  2. coarctation of aorta
  3. persistent ductus arteriosus
  4. surgical insertion of prosthetic stuff
be highly suspicious!
1. any child/adult w/
  1. sustained fever
  2. malaise
  3. raised ESR
  4. unexplained anaemia
  5. haematuria
2. don't rely on presence of classical physical stigmata for diag
clinical signs
1. fever
2. anaemia & pallor
3. splinter haemorrhages in nailbed
4. clubbing (late)
5. necrotic skin lesions
6. changing cardiac signs
7. splenomegaly
8. neuro signs from cerebral infarction
9. retinal infarcts
10. arthritis/arthralgia
11. haematuria (microscopic)
diagnosis
1. multiple blood cultures should be taken
  1. before Abx started
2. detailed cross sec echo
  1. confirm diag by IDing vegetations
    1. but can never exclude IE
    2. vegetations made of fibrin & platelets
      1. contain pathogen
3. raised acute phase reactants
  1. useful to monitor response to Rx
alpha haemolytic strep (strep viridans)
1. commonest causative organism
Rx
1. penicillin+ aminoglycoside
  1. 6 weeks therapy
  2. check serum Abx level will kill pathogen
2. if infected prosthetic material present
  1. surgical removal may be needed
prophylaxis
1. good dental hygiene
  1. most imp factor
  2. must strongly encourage in kids w/ congenital heart disease
2. Abx prophylaxis
  1. no longer recommended in UK
  2. may be needed in other countries for
    1. any dental Rx
    2. surgery, which is likely to be assoc w/ bacteraemia

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infective endocarditis

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	Created by v.djabatey over 10 years ago