infectious-endocarditis

References:

Global Infectious Diseases and Epidemiology Online Network: Infectious Diseases of the Philippines, 2013 eBook Edition, ISBN 978-1-61755-582-4, by Stephen Berger. Accessed here.


Agent	BACTERIUM OR FUNGUS. viridans streptococci, Staphylococcus aureus, enterococci, Candida albicans, et al.
Reservoir	Human
Vector	None
Vehicle	Endogenous
Incubation Period	Variable
Diagnostic Tests	Blood culture, clinical findings, ultrasonography of heart valves
Typical Adult Therapy	Bactericidal antibiotic appropriate to species
Typical Pediatric Therapy	As for adult
Clinical Hints	Consider in any patient with fever, multisystem disease (i.e., skin lesions, hematuria, neurological symptoms, single or multiple abscesses or bone, brain, lung, etc) and a preexisting cardiac valvular lesion.
Synonyms	Bacterial endocarditis, Endocardite, Endocarditis, Endokarditis, Fungal endocarditis, Infectious endocarditis, S.B.E..

The definitive diagnosis of infective endocarditis requires:

Demonstration of microorganisms; and/or histological lesions in the heart or heart valves; or
Presence of two major criteria; or 1 major and 3 minor criteria; or 5 minor criteria, as follows:
- Major Criteria:
  - Culture:
    - Typical microorganisms (HACEK, Streptococcus viridans, Streptococcus bovis) in 2 separate blood cultures; or community acquired Staphylococcus aureus or enterococcus without obvious focus.
    - Persistently positive blood cultures (drawn more than 12 hours apart; or three positive cultures at least one hour apart).
  - Evidence of endocardial or valvular involvement (echocardiogram, abscess, new valvular regurgitant lesion)
- Minor Criteria:
  - Predisposition (heart condition, drug abuse)
  - Fever
  - Embolic phenomena, mycotic aneurysm, Janeway lesion, or intracranial hemorrhage.
  - Immunological phenomena (Osler nodes, positive rheumatoid factor)
  - Echocardiogram with suggestive, but not specific findings.
  - Positive blood culture, but not meeting Major criteria.

Mneme