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INFECTIVE ENDOCARDITIS – A DISEASE NOT TO BE MISSED
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What is Infective Endocarditis?
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A microbial infection of the endocardium ( the hearts
inner lining) which also affects the heart valves
Common causative organism are mainly bacteria (Staph. aureus, Staph. epidermis, Strep viridians ,
Enterococci) but can include fungi (candida albicans )
Microorganisms adhere and multiply on the heart
valves leading to vegetation growth
This vegetation can break off and cause emboli to
occlude blood vessels within the body.
Infective endocarditis is life threatening if not
recognised and treated early.
Presentation
Initially symptoms may be vague and non specific such as
• Low grade fever/chills
• Night sweats
• Fatigue
• Arthralgia
• Weight loss
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At Risk Groups
Include people with
• Prosthetic heart valves
• Congenital heart defects
• Degenerative heart disease
• Implanted cardiac devices, pacemaker/ICD
• Long term indwelling vascular catheters
• Previous history of endocarditis
• Body piercings
• Poor dental hygiene
• Immunocompromised states
• Intravenous drug use
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Infective Endocarditis can manifest with varied & diverse
clinical presentation often the result of major vessel
emboli from rupture of vegetation & abscess formation
on valves.
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Stroke - confusion, hemiplegia, sensory dysfunction
Pulmonary Embolism- breathlessness, tachycardia
Splenic infarction- pain on splenic palpation
Renal infarction- loin pain , haematuria,
glomerulonephritis
Retinal haemorrhages - Roth spots -seen on
fundoscopy
Dermatological signs- result of small emboli travelling to
peripheral vessels include
• Nail fold infarct (No.1)
• Splinter haemorrhage- thin linear haemorrhages under nail
beds (No.2)
. • Oslers nodes- small, tender red / purple nodules found on
distal digits on fingers and toes (No.3)
• Petechial rash, on body, inside eyelids & oral mucosa
(No. 4& 6)
• Janeway leisons- Small painless, macular lesions on palms
and soles of feet (No.5)
Management
• Early recognition and investigation is crucial
• Blood cultures (ideally pre antibiotic therapy)
• Early Echo (Transoesophageal )
Complications and Clinical Signs of
Embolization
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As the disease progresses damage to the heart valves
occurs and cardiac signs may be seen such as
• New heart murmur or change in existing murmur
• ↓ Cardiac out put
• Heart failure
• Conduction disorders (mainly) AV Blocks
• Myocardial infarction
• Treatment is with lengthy iv antibiotic therapy +/valve surgery
• Team approach involve Cardiologist, ID, Microbiology
Key Message
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Infective Endocarditis is diverse and can masquerade
as other illnesses. Vigilance and suspicion are key to
its recognition. Consider infective endocarditis in at risk
patients who present with fever of unknown origin.