Infective Endocarditis Lecture Notes

Introduction

• Speaker: Rishi Desai, Chief Medical Officer at Osmosis
• Topic: Infective Endocarditis

Signs and Symptoms

• Acronym: FROM JANE

  Letter	Meaning	Description
  F	Fevers	High body temperature
  R	Roth Spots	Specific lesions seen in the eye
  O	Osler Nodes	Painful, tender nodules
  M	Murmur	Heart murmur present
  J	Janeway Lesions	Non-painful, erythematous lesions
  A	Anemia	Low red blood cell count
  N	Nail Bed Hemorrhages	Also known as splinter hemorrhages
  E	Emboli	Embolic phenomena seen on imaging

Diagnosis

• Duke's Criteria

  • Divided into major and minor criteria
  • Major Criteria:
    • Two positive blood cultures
    • Echocardiogram (Echo)
      • Look for vegetations or changes in valve movement
      • New regurgitation or stiffer valve movement
      • Prosthetic valve dehiscence

• Common Organisms:

  • Staphylococcus aureus
  • Staphylococcus epidermidis
  • Enterococci
  • Rare organisms like HACEK group

Treatment

• Primarily bacterial treatment with antibiotics

  • Combinations include Unasyn and Gentamicin, or Vancomycin with either Gentamicin or Ciprofloxacin
  • Adjust based on culture and susceptibilities

• Duration and Challenges:

  • Long-term antibiotic treatment is often necessary
  • Prosthetic valves may require surgical replacement if antibiotics fail
  • Antibiotics are less effective on prosthetic materials due to poor penetration

Clinical Pearl

• Endocarditis as a biofilm infection
  • Bacteria are embedded in mucus-like biofilms
  • Requires prolonged antibiotic treatment due to poor penetration
  • Goal is to sustain high antibiotic concentration over time to eradicate bacteria

Conclusion

• Understanding of infective endocarditis includes recognizing symptoms, correctly diagnosing using criteria, and managing treatment challenges, particularly with prosthetic valves and biofilm infections.