天津医科大学内科学课件 Infective Endocarditis.pptVIP

Minor criteria 1. Predisposition: predisposing heart condition or intravenous drug abuse 2. Fever ?38°C 3. Vascular phenomena: major arterial embolic, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, janeway’s lesion Minor criteria 4. Immunologic phenomena Glomerulonephritis Osler’s nodes Roth’s spots rheumatoid factor 5. Echocardiogram findings consistent with endocarditis but not meeting major criteria 6. Microbiologic evidence: positive blood cultures not meeting major criteria or serologic evidence of active infection consistent with endocarditis Clinical diagnosis criteria Two major criteria One major and three minor criteria Five minor criteria Definite IE Treatment Pre-antibiotic era - a death sentence Antibiotic era microbiologic cure in majority of patients Treatment The regular antibiotic therapy include following: 1. Early use as soon as clinical diagnosis has been set up 2. High serum concentration 3. Treatment is continued for prolonged period at least 4~6 weeks 4. Bactericidal antibiotics should be chosen 5. Monitoring serum bactericidal titer 6. Combination bactericidal and bacteriostatic Surgical treatment Indications Moderate to severe congestive heart failure due to valve dysfunction Unstable prosthesis Uncontrolled infection despite optimal antimicrobial therapy, fungi ect. Staphylococcus aureus Prosthetic valve endocarditis (PVE) with an intracardiac complication Relapse of PVE at optimal therapy Many Thanks! A HACEK organism is one of a set of slow-growing Gram negative bacteria that form a normal part of the human flora. They are a frequent cause of endocarditis in children. * Infective Endocarditis Xin Du Cardiovascular Centre Case 23-year-old female patient Congenital heart disease Fever for the last 3 weeks Poor appetite, weight loss, fatigue Thrill and a harsh systolic murmur along the left sternal border Echo Findings Infective Endocarditis(IE) I