Infective Endocarditis

Question: What is infective endocarditis? What are the conditions that predispose a person to infective endocarditis. ? How is it prevented?

Answer: endocarditis means infection of the heart valves. bad teeth ----> infection of the valves with viridans strep species and other mouth organisms that seed the blood and get on the valve. IV drug use ---> infection of the valves by poor skin prep -- the patient injects through dirty skin, seeding the blood stream with staph organisms, very rarely pseudomonas aeruginosa. And these land on the heart valves. besides those two groups, anyone who has an artificial heart valve is at greater risk of getting infection. People with leaky valves (manifest on exam by the presence of a heart murmur) are at higher risk. it is prevented by NOT using IV drugs, by getting good DENTAL care. You'll read much about giving an antibiotic before going to the dentist - but the fact is that this practice has NEVER been shown to be effective in preventing heart valve infections -- mostly because the infection doesn't come from the two days a year that you see the dentist, it comes from the 363 OTHER days out of the year when you were shooting drugs and walking around with rotten teeth in your head.

Question: what's the most common bacterium causing acute infective endocarditis? what's the most common bacterium causing acute infective endocarditis?

Answer: Endocarditis is usually a result of a blood infection. Bacteria or other infectious substance can enter the bloodstream during certain medical procedures, including dental procedures, and travel to the heart, where it can settle on damaged heart valves. The bacteria can grow and may form infected clots that break off and travel to the brain, lungs, kidneys, or spleen. Most people who develop infectious endocarditis have underlying heart disease or valve problems. However, an organism commonly found in the mouth, Streptococcus viridans, is responsible for about 50% of all bacterial endocarditis cases. This is why dental procedures increase your chances for developing this condition. Such procedures are especially risk for children with congenital heart conditions. As a result, it is common practice for children with some forms of congenital heart disease and adults with certain heart-valve conditions to take antibiotics before any dental work. Other common culprits include Staphylococcus aureus and enterococcus. Staphylococcus aureus can infect normal heart valves, and is the most common cause of infectious endocarditis in intravenous drug users. Less common causes of infectious endocarditis include pseudomonas, serratia, and candida. (MedlinePlus) Infective endocarditis is infection of the endocardium, usually with bacteria (commonly, streptococci and staphylococci) or fungi. It produces fever, heart murmurs, petechiae, anemia, embolic phenomena, and endocardial vegetations. Vegetations may result in valvular incompetence or obstruction, myocardial abscess, or mycotic aneurysm. Diagnosis requires demonstration of microorganisms in blood and usually echocardiography. Treatment consists of prolonged antimicrobial treatment and sometimes surgery. (Merck)

Question: is there a relation bet Infective Endocarditis&wbc count? a man with 60y has infective endocorditis(streptocoocus viridanse) treated with vancomycin for 2months and symptoms back again the doctor tell me that new TEE show 4 vegetation on mitral valve but wbc count is 6000 so he suggested that its an old infection and itsnt endocorditis.(all symptoms found) Is that tru?if isnt sould i have a surgery?

Answer: Infective endocarditis is infection of the endocardium, usually with bacteria (commonly, streptococci and staphylococci) or fungi. It produces fever, heart murmurs, petechiae, anemia, embolic phenomena, and endocardial vegetations. Vegetations may result in valvular incompetence or obstruction, myocardial abscess, or mycotic aneurysm. Diagnosis requires demonstration of microorganisms in blood and usually echocardiography. Treatment consists of prolonged antimicrobial treatment and sometimes surgery. Consult your doctor.

Question: Why does infective endocarditis causes anemia and how clubbing of finger nails associated with that?

Answer: The anaemia that occurs with infective endocarditis is not haemolytic. Instead, it is the normocytic (normal sized) normochromic (normal coloured) anaemia associated with chronic disease. In this case, it occurs because there is an established infection. Like the anaemia, clubbing of the fingernails is associated with prolonged infective endocarditis. We aren't entirely sure about the mechanism behind it. What we do know is that it relates to increasing blood flow in the clubbed area, and that is likely due to dilation of the blood vessels there. No one can really agree as to why this happens.

Question: can bacteria causing endocarditis lay dormant before it presents as infective endocarditis?

Answer: Not likely....any type of bacteria can be detected through blood work even if it lays dormant.

Question: how can digit clubbing and pethicheae arise as complications of infective endocarditis?

Answer: peticheal haemhorrages are from microemboli causing infarction. No one is sure about clubbing but its suggested to be an immune phenomenon not a result of secondary hypoxia.

Question: Is there much of a link between flossing and/or using mouthwash and infective endocarditis? Flossing can induce a septicemia (albeit tempory), but does it increase the risk for acquiring infective endocarditis by commensual bacteria such as Streptococcus viridans? Would there be any difference in risk for using antiseptic mouthwash?

Answer: Firstly, it doesn't cause a septicaemia. This is where bacteria are actively multiplying within your bloodstream. What you mean is a transient bacteraemia. Yes, brushing and flossing your teeth can potentially lead to infective endocarditis. But by having good dental health, your risk is almost insignificant. If you develop gingivitis or periodontitis, then your risk is higher. You have no choice but to brush and floss. As for antibiotic mouthwashes, products like Listerine (essential oils) are useless. You could use a chlorhexidine mouthwash or gel for superior results. The mouthwash will tend to stain the outside of your teeth (unattractive), so the gel is preferable.