《感染性心内膜炎八年制2016》循环系统课件.ppt

感染性心内膜炎的Duke诊断标准 次要标准 易患因素：包括基础心血管病或静脉毒瘾 发热，≥38℃ 血管征象：主要动脉的栓塞、感染性肺梗死、细菌性动脉瘤、颅内出血、结膜出血、Janeway损害 免疫征象：肾小球肾炎、Osler结节、Roth斑、类风湿因子阳性 致病微生物学证据：血培养阳性但不符合其主要标准，或与IE一致的活动性致病微生物感染的血清学证据 Diagnosis Diagnosis 感染性心内膜炎的Duke诊断标准 病理学条件 微生物 在赘生物、发生栓塞的赘生物或心内脓肿中经培养或组织学检查证实有微生物 病理改变 赘生物或心内脓肿经组织学证实有活动性心内膜炎 临床条件 符合 2 项主要标准 符合 1 项主要标准加3项次要标准 符合 5 项次要标准 鉴别诊断：风湿热、SLE、左房粘液瘤、淋巴瘤腹腔内感染(SBE)、败血症(ABE) Infective endocarditis (IE) is defined as an infection, usually bacterial. The characteristic lesion of IE, the vegetation, is a variably sized amorphous mass of platelets and fibrin with abundant enmeshed microorganisms and moderate inflammatory cells. IE primarily affects the cardiac valves. The heart valve most commonly involved in IE is the mitral valve. Introduction IE are also classified as native valve endocarditis (NVE) and prosthetic valve endocarditis (PVE). From 50 - 75 % of patients with native valve endocarditis (NVE) have predisposing valve conditions, such as rheumatic and congenital valvular disease, while the common causal agents of NVE are streptococci. Prosthetic valve endocarditis (PVE) constitutes 10 to 30 percent of all cases of IE in developed countries. Introduction IE is often called acute or subacute. Acute IE is caused typically by Staphylococcus aureus. It presents with marked toxicity and progresses over days to several weeks to valvular destruction and metastatic infection. Subacute IE, usually caused by viridans streptococci, enterococci, coagulase-negative staphylococci, or gram-negative coccobacilli, evolves over weeks to months with only modest toxicity and rarely causes metastatic infection. Introduction Most of infective endocarditis is due to staphylococci, streptococci, or enterococci. Viridans streptococci are the most common streptococci implicated in native valve infective endocarditis. S. aureus is now the most common pathogen among injection drug users or patients with health care contact. Enterococcal bacteremia is c