Organisms responsible for

Acute Bacterial Endocarditis

staph aureus

Strep pneumoniae

Strep pyogenes

N. meningitidis

H. Influenzae

4 events required for initiation

of

SUBACUTE  (chronic) Bacterial Endocarditis

1. Bacteremia (transient and frequent in normal folks)
2. Previously damaged cardiac valve or endothelial damage from venturi flow (McCallum's patch
3. Sterile platlet-fibrin thrombus over damaged endocardium
4. High titer of agglutinating antibody:  creates critical innoculum

Organisms responsible for

SUBACUTE

Bacterial Endocarditis

HACEK Group

• Haemophilus
• Actinobacillus
• Cardiobacterium
• Eikenella
• Kingella

Mechanisms responsible for clinical features of

INFECTIVE ENDOCARDITIS

1. VALVE DESTRUCTION
2. EMBOLIZATION (especially MCA)
3. METASTATIC INFECTION (mycotic aneurisms, septal abcesses, brain abceses, bact. meningitis)
4. IMMUNE PHENOMENA, esp. glomerulonephritis arthritis, pos rheumatoid factor

Changing heart murmurs

Osler's nodes (tender, on fingers, toes)

Janeway Liesions (soles of feet or palms)

Splinter hemorrhages

Splenomegaly

Roth spots

Finger clubbing

How do you obtain a

POSITIVE DIAGNOSIS

of

Infective endocarditis

Blood test/culture

daily X3

(bacteremia is continuous, not intermittant)

(Also do daily EKG to look for elongted P-R interval--> Septal abcess)

Are most immunodeficiency disorders

PRIMARY OR SECONDARY?

Discuss critical levels of neutrophil count and causes of

NEUTROPENIA

• < 1000/mm3 will result in increased bacterial infections, some severe (esp. at <500/mm3)

• Chemo and radiation therapy for cancer often the cause

Level of CD4+

when we say AIDS is present

Diseases seen in with HIV

at CD4 < 500/mm3

Strep pneumoniae pneumonia

Pulmonary tuberculosis

Kaposi's sarcoma (HHV 8)

Shingles

Oral hairy leukoplakia (EBV)

Muccocutaneous Candida (vaginitis, thrush)

Diseases sen at CD4 counts <200/mm3

with

HIV

Fungal infections:

Pneumocyctitis jerovecii

Candida esophagitis

disseminated Cryptococcus neoformans

Coccoidies imitis (SW USA)

T. Gondii

Chronic crypto parvum and microsporidia

VIRAL

HSV, PML

miliary TB

• Metabolic Dz:  uremia, diabetes mellitus
• Splenectomy - predisposes to sepsis fom encapsulated bacteria, particularly Strep pneumoniae
• Any chronic debilitating illness, presence of foreign bodies, invasive proc, malnutrition
• Loss of gag reflex: predisposes to aspiration--> pneumonia