Endocarditis is the inflammation of the membranous lining of the heart’s cavities. The valves of the heart are the most likely structures to be affected by this disease. Endocarditis is classified as either non-infective or infective. The classification is based on the whether the source of the disease is a microorganism.
The non-infective version of endocarditis is rare. It is also referred to as marantic endocarditis. Sterile endocarditis is called Libman-Sacks endocarditis. This form of endocarditis may occur in patients with lupus eythematosus or anti-phospholipid syndrome. Mucinous andencarcinoma can also cause endocarditis.
Because of the rarity of endocarditis, non-infective, this article with present in detail information about endocarditis, infective.
The symptoms of endocarditis are:
spiking recurrent fevers
growths or vegetations on the valves of the echocardiography
chronic and continuous presence of micro-organisms in blood cultures collected regularly
chronic kidney or renal failure
septic (high bacterium count) embolisms which may cause stroke or gangrene of the fingers and toes
Roth spots- which are hemorrhages of the retina with a white center
new or changed heart murmur
lesions on the skin of the palms and soles, that hemorrhage – known as Janeway lesions
painful, red, raised lesions on the finger pulps – referred to as Osler’s nodes
red pin prick spots on the whites of the eyes called conjunctival petechiae
Diagnosis for infective endocarditis is made using Duke University criteria. The criterion for diagnosis is taken from observation of blood culture, echocardiography and minor criteria.
A blood culture course that tests positive for endocarditis involves two separate blood cultures that test positive for viridans streptococci, Streptococcus bovis, the HACEK group of bacterium or community acquired staphylococcus aureus or enterococci. Two positive cultures should be from blood samples that have been taken over twelve hours apart – or positive cultures in three of four separate cultures in which the samples are drawn over the period of one hour. The first culture and the last culture should only be one hour apart. According to Duke University evidence of endocarditis is also seen on and echocardiography such as a intracardiac mass on the valve or supporting structures, abscess or a partial opening of prosthetic valve.
About ten to fifteen percent of patients in the emergency room who have a fever and are illicit drug users will be diagnoses with endocarditis. Patients with fever who are not illicit drug users have less then a five percent chance of being diagnosed with endocarditis.
A variety of organisms are responsible for infective endocarditis. These organisms can be isolated in a blood culture and examined for growth to assist with diagnosis.
An organism present in the mouth called alpha-haemolytic streptococci is often discovered if symptoms began shortly after dental work. Bacterium that is introduced through the skin – either during surgery, catheterization or IV drug use is often Staphylococcus aureus. Enterococci are a third significant cause of endocarditis. These bacteria enter the blood stream via unusual physical structures of the urinary and gastrointestinal tracts. This bacterium is getting more recognition as a non-social or hospital acquired endocarditis. The two bacterium listed first are the causes of community acquired endocarditis.
Organisms when observed in isolation provide important information as to the cause of the disease:
candida albicans, a yeast is found in IV drug users and those with a compromised immune system, such as AIDS patients
streptococcus bovis is naturally found in the flora of the intestine – patients with this bacterium and endocarditis may have bowel cancer
pseudomonas species are an extremely resilient organism that live well in water, it may contaminate illegal drugs that have been processed with drinking water
IV drug users that contaminate needles with saliva (and have endocarditis) usually have HACEK organisms in their blood cultures. These organisms are found on the gums of the mouth.
The goal of treatment is to remove the micro-organisms completely from the blood stream. The valves of the heart do not have blood vessels, therefore the bacteria are difficult to eradicate. Antibiotics are administered via IV line for a period of two to six weeks. If the heart valve is damaged, it needs to be surgically removed. Replacement heart valves can either be mechanical or bio-prosthetic (donated from an animal). Infective endocarditis has a mortality rate of twenty-five percent.
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