Infective Endocarditis Senior Oral Medicine Chapter 2 August

Infective Endocarditis Senior Oral Medicine Chapter 2 August 27, 2009 Susan Settle, D. D. S.

Infective Endocarditis • A microbial infection of the endothelial surface of the heart or valves • Usually is near congenital or acquired cardiac defects • Designated by the causative organism • Also classified as NVE or PVE

Etiology • Streptococci most common cause (35 -60%) – Mostly viridans group • Staphylococci about 30 -40 and gaining – S. aureus most common cause in IVDU’s – Incidence increasing in hospital-acquired infections

Epidemiology • Population Groups At Greater Risk: – Rheumatic Fever History – Hemodialysis – Previous History Of Endocarditis – Patients With Prosthetic Valves – IV Drug Users (30% Risk Within 2 Years)

Predisposing Conditions • • • Mitral valve prolapse Aortic valve disease Congenital heart disease Prosthetic valve Intravenous drug use No identifiable cause in 25 -47%

Epidemiology • • More Common In Median Age 50 Years Acute Cases Increasing Streptococcal Cases Slightly; Fungal And Gram Negative Cases Increasing

Epidemiology • Incidence Increases With Age, Probably Due To Increased Cardiac Disease And Decreased Immunity • Prosthetic Heart Valve Infections Are Increasing

Epidemiology • Mitral Valve Prolapse: Only 1/4 Of MVP Patients Have Mitral Insufficiency (Regurgitation Or Murmur) - This Results In The Very Slight Increased Risk For Endocarditis

3 Types Of Endocarditis Lesions • Cardiac Lesions • Embolic Lesions: Friable Cardiac Lesions That Break Away • General Lesions

Cardiac Lesions Usually Valvular Most Often Mitral Valve May Cover The Entire Valve Mass Of Platelets, Fibrin And Bacteria • Sterile Vegetations May Occur In 50% Of Lupus Patients • •

General Lesions • • Enlarged Spleen Arthritis Clubbing Of Fingers Cardiac Failure Conduction Abnormalities Stroke Psychiatric Disease Renal Failure

Mortality • Overall Rate About 40% • Death Usually Due To Heart Failure Resulting From Valve Dysfunction • Highest Death Rate Is In Early Prosthetic Valve Endocarditis

Major Diagnostic Criteria • Positive Blood Culture • Echocardiogram Findings Of Endocardial Involvement • New Valvular Regurgitation

Minor Diagnostic Criteria • • Predisposing Heart Conditions IV Drug Use Vascular Emboli Osler Nodes Aneurysm Roth Spots Of The Eye Splinter Hemorrhages

Treatment • Treat It Early! • Culture • Use Bactericidal Agents – PCN G; Cefatriaxone; PCN G + Gentamicin; Nafcillin; Vancomycin

Treatment • Use Adequate Dosage • Parenteral Route • Sufficient Duration: 4 -6 Weeks Or Longer