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INFECTIVE ENDOCARDITIS

Posted by SAMUEL ISABIRYE on February 5, 2013 at 4:50 PM

An infection of the heart valves and lining of the

heart chambers by microorganisms which is difficult

to diagnose and treat. It is classified into 3 types:

 

.

Sub-acute endocarditis: caused by low virulence

organisms such as Streptococcus viridans

.

Acute endocarditis: caused by common pyogenic

organisms such as Staphylococcus aureus

 

.

Post-operative endocarditis: following cardiac

surgery and prosthetic heart valve placement.

The commonest organism involved is

 

Staphylococcus albus

 

UCG 2010

195

 

 

 

9. Cardiovascular diseases

Clinical features

 

z

Acute or chronic illness

 

z

Fatigue

 

z

Weight loss

 

z

Low grade fever and chills

 

z

Embolic phenomena affecting various body organs

 

z

Congenitally abnormal or previously damaged

heart valve predisposes to this condition

 

z

Heart failure may occur

 

z

The disease may be of short duration if due to

acute endocarditis and the patient may be

critically ill

 

z

Prominent and changing heart murmurs may occur

 

z

Splenomegaly, hepatomegaly

 

z

Anaemia

 

z

Finger clubbing

 

Note:

 

.

Any unexplained fever in a patient with a heart

valve problem should be regarded as endocarditis

 

Differential diagnosis

 

z

Cardiac failure with heart murmurs

z

Febrile conditions associated with anaemia

 

Investigations

 

¾

Blood cultures: these are usually positive and all

efforts should be made to identify the responsible

pathogen and obtain sensitivity data before

starting treatment

 

¾

At least 3 sets of blood cultures 8 mls each

should be obtained (each from a separate

venepucture) at least one hour apart.

 

¾

Blood: haemogram, ESR

 

¾

Urinalysis for microscopic haematuria, protenuria

 

¾

Echocardiography

 

¾

ECG

 

UCG 2010

196

 

 

 

9. Cardiovascular diseases

Initial empirical therapy HC4

f

benzylpenicillin 4 MU IV every 4 hours

 

plus gentamycin 1mg/kg IV every 8 hours

child: Benzyl Penicillin 50,000 IU/kg per dose

every 6 hours and Gentamycin 2.5mg/kg per

dose every 8 hours

´

gentamycin is contraindicated in pregnancy

 

Once a pathogen has been identified:

 

f

Amend treatment accordingly

 

Prevention

 

z

Prophylactic Amoxicillin 2g (50mg/kg for

children) plus gentamycin 1 hour before plus

500 mgs 8 hourly for 48 hrs after dental

extraction and tonsillectomy in individuals with

cardiac valve defects.

 

z

Prompt treatment of skin infections

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