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INFECTIVE

ENDOCARDITIS
Mr. ALFRIN ANTONY
Asst. Lecturer
DEPARTMENT OF PATHOLOGY

+919738286092
ENDOCARDITIS
 Inflamation of endocardium
A. Non-Infective
Rheumatic Endocarditis
Atypical Verrucous Endocarditis
Non bacterial thrombotic
Endocarditis
B. Infective
Bacterial endocarditis
Other Infective types (tuberculosis,
syphilitic, fungal, viral,
rickettsial)
Infective Endocarditis
 Febrile illness
 Persistent bacteremia
 Characteristic lesion of microbial
infection of the endothelial surface of
the heart the vegetation

 Variable in size
 Amorphous mass of fibrin & platelets
 Abundant organisms
 Few inflammatory cells
BACTERIAL ENDOCARITIS
 DEFINITION:- Bacterial endocarditis
is serious infection of the valvular
and mural endocardium caused by
different forms of bacteria (other
than tubercle bacilli and bacterial
micro organisms) and characterized
by typical infected and friable
vegetations
CLASSIFICATION
depending on severity
Acute Subacute
Acute bacterial Subacute bacterial
endocarditis:- is endocarditis is
the fulminant and caused by less
obstructive acute virulent bacteria in
infection of the a previously
endocardium by diseased heart and
highly virulent has a gradual down
bacteria in a hill course in a
previously normal period of 6 weeks
heart (fatal2-6 to months-years
weeks)
INCIDENCE
 Bacterial endocaditis may occur at
any age
 Most cases more than 50yeas
 Males > females
ETIOLOGY
1.Infective agents
ABE SABE
2. Staphylococci 2. Streptococci with low
(staphylococcus virulence
aureus) 3. Streptococcus
3. Pneumococci viridans (mouth)
4. Gonococci 4. Streptococci bovis
(stomach)
5. Beeta-streptococci
5. Streptococcus
6. Enterococci pneumoniae
6. Staphylococcus
epidermidis
Predisposing factors
1. Bacteraemia, septicemia and
pyaemia
2. Underlying heart disease
3. Impaired host defence
Pathogenesis
1. The circulating bacteria are lodged
much more frequently on previously
damaged valves from disease, chiefly
RHD nad CHD than healthy valves
2. Conditions producing haemodynamic
stress on the valves are liable to cause
damage to the endocardium, favouring
the formation platelets thrombi which
gets infected from circulating bacteria
3. Non-bacterial thrombotic endocarditis
occurs from prolonged stress
PATHOLOGIC CHANGES
MACROSCOPICALLY MICROSCOPICALLY
 Lesions are in  The out layer consists
mitral>aortic>both > of eosinophilic
right heart material composed of
 SABE > ABE fibrin platelets
 Underneath layer is
the basophilic zone
containing colonies of
bacteria
 The deeper zone
consists of non-
specific inflammatory
reaction
Symptoms
 Acute  Subacute
 High grade fever  Low grade fever
and chills  Anorexia
 Arthralgias/  Weight loss
myalgias  Fatigue
 Abdominal pain  Arthralgias/
 Pleuritic chest pain myalgias
 Back pain  Abdominal pain

The onset of symptoms is usually ~2 weeks or less


from the initiating bacteremia
Signs
 Fever
 Heart murmur
 Nonspecific signs – petechiae,
subungal or “splinter” hemorrhages,
clubbing, splenomegaly, neurologic
changes
 More specific signs - Osler’s Nodes,
Janeway lesions, and Roth Spots
Petechiae
1. Nonspecific
2. Often located on extremities
or mucous membranes
dermatology.about.com/.../
blpetechiaephoto.htm

Harden Library for the Health Sciences


Photo credit, Josh Fierer, M.D. www.lib.uiowa.edu/ hardin/
medicine.ucsd.edu/clinicalimg/ Eye-Petechiae.html md/cdc/3184.html
Splinter Hemorrhage
Splinter Hemorrhages

1. Nonspecific
2. Nonblanching
3. Linear reddish-brown lesions found under the nail bed
4. Usually do NOT extend the entire length of the nail
Osler’s Nodes
Osler’s Nodes
American College of Rheumatology
webrheum.bham.ac.uk/.../ default/pages/3b5.htm www.meddean.luc.edu/.../
Hand10/Hand10dx.html

1. More specific
2. Painful and erythematous nodules
3. Located on pulp of fingers and toes
4. More common in subacute IE
Janeway Lesions
Janeway Lesions

1. More specific
2. Erythematous, blanching macules
3. Nonpainful
4. Located on palms and soles
Subconjunctival
Hemorrhages
COMPLICATIONS
CARDIAC EXTRA CARDIAC
 Valvular stenosis or  Infracts in spleen,
insufficiency kidneys and brain
 Perforation, rupture  Pulmonory abscesses
and aneurysm of  Petechiae (skin
valve and leaflets conjunctiva)
 Abscesses in the  Osler’s nodes(SABE)
valve ring  Janeway’s spots (ABE)
 Myocardial abscesses
 Suppurative
pericarditis
 Cardiac failure
Local Spread of Infection

Acute S. aureus IE with perforation of the Acute S. aureus IE with mitral valve ring
aortic valve and aortic valve vegetations. abscess extending into myocardium.
Septic Pulmonary Emboli

http://www.emedicine.com/emerg/topic164.htm
Septic Retinal Embolus
Roth’s Spots
TUBERCULOUS ENDOCARDITIS

It is characterized by presence of
typical tubeculosis on the
valvular as well as mural
endocardium and form
tuberculosis thrombo emboli
Syphilis endocaditis
 Aortic valvular incompitance (severe)

Fungal endocaditis
Oppurtunistic fungal
infections like candidiasis ans
aspergillosis are seen I
patients receiving long term
anti biotic therapy
Viral endocarditis
 Only in experiment

Rickettsial endocarditis
Another rare cause of
endocaditis is form infection
in Q fever