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Cardiac Infections

Endocarditis, Rheumatic Fever, Myocarditis, and Kawasaki Disease

Infective Endocarditis: Etiologic Agents

Streptococci

Viridans accounts for more than 50% of streptococci causing infective endocarditis, including nutritionally variant S defectivus and S adjacens

Enterococci ~ 5%S pneumoniae, beta streptococci - rare

Staphylococci: especially post-op or in normal hearts

 HACEK group: 5-10%

Others -5%

Aerobic gram negatives: neonates; line-associated infective

Coxiella burnetii

Infective Endocarditis - Pathogenesis cardiac infections, endocarditis, valve infection

Factors Associated with

Areas of turbulent flow (jet effect, eddies)

Endothelial disruption

Sterile fibrin-platelet thrombus development on the abnormal surface

Entrapment of bacteria from "stray bacteremia" leads to focus of infection

Infective Endocarditis - Clinical Features

Acute Presentation

High fever, toxicity

Infective Endocarditis - EvaluationIcon

Three or more blood cultures (separate venipunctures) before therapy

Trans-thoracic echocardiography (-60% sensitive)

Role of trans-esophageal echocardiography is evolving

IconInfective Endocarditis - Diagnostic CriteriaIcon

Duke Criteria