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lecture 21 greenberg

most common structure involved in infectious endocarditis the heart valves; thus those with congenital or acquired valvular dz are more at risk for developing IE
pathogenesis of infective endocarditis there is initial damage to endocardium, high blood flow causes accumulation of plts and fibrin. thrombus can trap bacteria, which invade and make more fibrin deposition forming a vegetation, usually at the low-pressure side of an obstruction/valve
most common procedures performed by doctors that cause bacteremia dental extractions, periodontal surg, urethral dilatation, TURP, tonsillectomy
how bacteria are able to attach to surfaces/sterile vegetations viridans Strep, S. bovis and Candida - make dextrans to attach to endocardium // S. aureus binds to fibronectin and fibrinogen
most common pathogens of native-valve IE Staphylococci and Streptococci
most common pathogen of IE after GI/GU procedures Enterococci
most common pathogen of IE in IVD user or pt with prosthetic-valve IE Staphylococci especially MRSA // fungal organisms increasingly associated with IVDA IE
cause of most culture-negative IE cases HACEK organisms (GN & grow slowly) and very rarely Coxiella burnetii
_____ lives in gut an if pt develops endocarditis from this pathogen, colon ca is much more highly associated (may be imminent) Streptococcus bovis
IE cases with ______ are associated with alcoholics and homeless persons, almost always when they have prior valvular dz Bartonella quintana & henselae
clinical manifestations of IE although non-specific, sx are: fever, dyspnea, weakness & chills // PEx findings: fever, murmur that is new or changing in character (especially aortic insufficiency)
specific microembolic manifestations of IE painful Osler nodes, nonpainful Janeway lesions, retinal hemorrhages aka Roth spots, splinter hemorrhages, conj petechiae, CVA
cornerstone of IE dx (+) blood cultures, usually constant level of bacteremia over time
which type of Echo is the best at evaluating prosthetic valves? transesophageal echocardiography
tx of IE avoid anticoagulation, bactericidal abx for 2-8 wks, surg if necessary, manage complications like stroke, arrhythmias, heart blocks, CHF, etc.
most common procedures which may merit prophylaxis for IE bronchoscopy and dental surg
cause of most nosocomial bacteremias and thus IE cases hyperalimentation/TPN & IV cath related infections: IJ = femoral > subclavian, C/L > peripheral lines, AV fistulas for dialysis
typical causative agents of myocarditis most predominantly viral like Echovirus or Coxsackie virus, also Lyme and Chagas dz
common causative pathogen for pericarditis Mycobacterium tuberculosis
Created by: sirprakes



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