Infective endocarditis


Infective endocarditis

Description of infective endocarditis

At the outset it must be said that this is a relatively rare disease, but untreated ending nearly 100% fatal, ie death.

Nowadays, this disease affects about 6/100 ths. people a year and twice as likely as men are affected.

When the disease occurs that the inner lining of the heart (endocardium) which also forms the valve, is attacked bybacteria (rarely other microorganisms – fungi, chlamydia), herein settle and start to reproduce. There may be a so-called.Inflammatory thrombus or vegetation.

Mostly a disability flap that has changed surface or flap, which is the body’s own (valve replacement). Thrombus growing bacteria and provides plenty of space and the perfect environment to create defense mechanisms, which are already our body (immune system) is not able to cope. At precisely this moment occurs problém.Od now development of the disease depends on the type of bacteria, which are settled.

In the first case, the aggressive bacterium capable of their products flap destroyed in a very short time (typicallyStaphylococcus aureus, Streptococcus pyogenes). Furthermore, for this specific form, that of vegetation may release particles or chunks containing bacteria, and because they are aggressive, invade further sites which settles and damage them (the so-called rise. Metastatic foci). They gradually inundate the entire bodywith fatal consequences.

Furthermore, there is a risk that the fragments which are entered by the blood stream to another place in the body may vessel in which they get stuck clog (there embolization – carried off). Then there is insufficient blood supply (ischemia) in the region behind and necrosis of tissue.

This kind of infectious endocarditis is called acute endocarditis (fast and serious progress) and is compared to the other as much rarer, but without early treatment up to six weeks with death.

In the latter case a less aggressive bacteria that rather than destruovali flap there multiply and can grow to sizes that prevent the free flow of blood in the heart (the most common causes areStreptococcus viridans, Streptococcus epidermidis). This is called subacute endocarditis (with slower progression).

Even from this vegetation can release particles (embolization may occur) and there is the risk ischemization different tissues. Metastatic foci but it does not constitute, therefore, does not damage their tissue products. When nezaléčení leads to death within one year.

For both forms is true that the heart can cause a situation that will undermine its pumping function, which has very serious consequences for the circulatory system and can lead to heart failure.

 

Risk factors and causes of infectious endocarditis

A prerequisite for the establishment of bacteria and creation of vegetation is primarily the presence of bacteria in blood (bacteremia). This occurs when wounds, but can also occur when the performance associated with disruption of the skin, the deeper layers of tissue or mucous membranes and bleeding. It occurs therefore, under normal circumstances, eg. Skin injury, tooth brushing. The problem arises only when these organisms are resistant to our immunity, or choose somewhere to settle down and begin to multiply.

Thus, another prerequisite is any damage to the flap, especially their surface (only in exceptional cases, to attack the valve completely healthy). These include birth defects valvular, congenital defects of the heart and great vessels of the heart of resigning, valves damaged before the passed inflammation (rheumatic fever), a type defects – mitral / aortic stenosis, mitral / aortic insufficiency, tricuspid valve defects, mitral valve prolapse, defects, ventricular septum, obstructive cardiomyopathy, Falotova tetralogy and more. Not all have the same degree of risk, anyway, all have a smaller or bigger risk in conjunction with other factors.

It is important to mention here an artificial replacement valves (valvular prosthesis) that pose a high risk.

As a significant risk factor is drug abuse, respectively. the intravenous route. In these individuals, the risk of IE to 1000 times higher than the general population.

Another risk factor is any condition associated with a significant weakening of the immune system, whether on its own insufficiency (leukemia, AIDS, cancer, congenital immune disorders), or conditions where immunity is lowered artificially, either by drugs (immunosuppressants, eg. Corticosteroids , cytostatics – in transplant patients, in patients with autoimmune diseases), or operations, which is both used by the body itself stressful situation and plays a role that is artificially disrupted outer barrier and the inner body environment is exposed to microorganisms.

It is not an intrusion of bacteria into the body during surgery, because surgical field before the performance devoid of any living organism, however, in the period after surgery, these sites are again colonized by bacteria and they may, in exceptional cases, the wound penetrate and spread from there. This is particularly the case of the oral cavity, as well as genitourinary and gastrointestinal tract.

At this point, it is appropriate to say that today, when the surgery and post-operative treatment performed under highly sterile conditions and is to cover the period around performance with antibiotics, this risk was minimized. Anyway infective endocarditis among the complications of the surgery.

From here the general risk factors include poor body condition and diet, neglect oral hygiene, switching inflammatory diseases, inadequate treatment of injury, a condition which is either lowered immunity or unnecessarily admitted a larger number of bacteria in the blood.

Combining the above factors increases the risk of infective endocarditis.

 

Prevention of infective endocarditis

In the case of this disease unfortunately not significant prevention by the layperson is not possible.But it can be recommended to people who know that they suffer from some aforementioned defect hearts to this whenever it is waiting for a surgical procedure or performance, in which disrupts the body surface or mucous membrane and this performance is associated with bleeding , alerted the attending physician.

This is especially important for doctors tooth with which it is to this could forget, because so insignificant surgery such as tooth extraction, has a high risk of penetration of bacteria into the organism and for these people should be tearing covered antibiotics, which reduces the danger of bacteria settlement on the valve to a minimum.

Among other interventions, which could fail to penetrate the bacteria in the body are tearing storey (tonsillectomy) or nasal (adenektomie) almonds, bronchoscopy, drainage of infected wounds, performances in the gastrointestinal and genitourinary tract or cardiac surgery.

For peace of mind add that prevention exercise for us doctors to the above-mentioned heart disease specifically asked prior to surgery and antibiotics are administered, so the risk is very small.

 

Signs and symptoms of infectious endocarditis

It depends on whether it is a form of acute or subacute.

In case of acute endocarditis is a sudden onset of the tumultuous course, when there is a rapidrise in temperature to values above 39C adds to the fever, chills, leads to enlargement of the liver and spleen, there is anemia (anemia), ie. question is pale and may lead to disorders of consciousness. This is the so-called sepsis (sepsis = blood poisoning), the body is literally flooded with bacteria, their products and particles and leads to rapid deterioration of general condition.

In subacute endocarditis may be the beginning of a completely unobtrusive. Usually begins with nonspecific ( “flu”) symptoms lasting several weeks. It succeeds fatigue, weakness, may be joint and muscle pain, loss of appetite. It might also weight loss and temperature, headache,night sweats, blood in the urine. Also often leads to enlargement of the spleen or liver, usually after prolonged infection.

Furthermore, there are signs of organ. The skin and mucous membranes can appear tiny red dots caused by damage to blood vessels, and by pouring the blood into their surroundings (petechiae), hereinafter sometimes painful swelling can be observed on the balls of the fingersor on the soles, respectively. palm, they are more common in the acute form.

Skin may acquire shade of white coffee, especially on the face. Under the fingernails may appear dark point looking like matchsticks. The eyes can sometimes be observed bruising and purpura, similar to that of skin.

Sometimes the disease can manifest directly their complications, stroke or loss of vision in one eye. This occurs due to embolization of vegetation in the brain, or eye arteries and their blockages.

 

Treatment of infectious endocarditis

Primarily used drug therapy, deploying the kind of antibiotics that can effectively destroy the microorganism. They are relatively high doses as is required to drugs penetrated the vegetation.Supply of drugs is accurately dosed, because the drugs into the body through the incorporation of so called intravenously. Cannula, which is a tube inserted into a vein, which can be left for several days and to which is connected the infusion of medications. The treatment lasts for a few (2 -6) weeks, depending on the bacterial species and the place of its establishment.

It can also cause operational solutions, mostly in complicated cases where circulation fails or leads to the release part of the vegetation on the market, does not take up during drug therapy for diseases caused by fungi, in large plants. In this power is replaced with artificial valves affected flap.

We must deliver the sad fact that even today the death rate from this disease, especially acute form very high. Moves, according to the form (acute / subacute), bacteria (aggressive / non-aggressive), the state of the flap (artificial / private) and the overall condition of the patient, presence / absence of complications from 5% in the mildest form of 70% at the most difficult.

 

Complications of infective endocarditis

IE complications can be divided into cardiac and extracardiac.

In the case of cardiac complications threatens especially the acute form the risk of perforation of the flap, which creates its incompetence, which, according to the scale, very serious consequences for the circulatory system and can lead to heart failure.

Furthermore, the infection can pass from endocardium to the next layer of the heart, where there is purulent inflammation and violates heart function. Can lead to the fact that the inflammation penetrate the heart, then the heart, the pericardium (pericardium – bag, which houses the heart), there is a purulent exudate, which limits the performance of the heart and also becomes the source of further spread of the infection to the surroundings.

In the case of subacute endocarditis happens that vegetation grows and progressively clogs the opening between sections of heart, until it can happen that it completely clogged, or so that the amount of blood flowing around is inadequate to supply the body.

For extra heart complications, one was already mentioned above, and it embolism or theformation of metastatic lesions by type of bacteria. These are primarily organs such as the brain, eye, kidney, spleen. Here there is either insufficient blood supply to a tissue necrosis, or to the development of purulent inflammation. In the case of the brain are relatively tragic consequences then, as there is a stroke (stroke) with irreversible damage, or septic inflammation of the brain (pyogenic encephalitis) or its packaging (purulent meningitis) with high risk of permanent damage.

Other complications include the formation of immune complexes. Immune complexes are formed by combining the services of our antibodies and any part or product of the microorganism. Their problem is that they can be deposited in the tissues and induce an immune response of the body, thus to defend against begin.

The body is in the case of defense to be able, in an effort to most effectively destroy the enemy, very aggressive. This aggression but in this case appears to be inappropriate and non-adjacent locally. It is a fact that the complex is stored somewhere, doing nothing there and the body begins to fight against him and invades the tissue or the area in which the complex is stored. Most often stored in the vessel wall and gives rise to the inflammation (vasculitis) may also affect the joints(arthritis), the kidneys (glomerulonephritis), skin.

 

Examination of infective endocarditis

The first level blood test, a patient is probably waiting several donations, of which doctors try for the shortest possible time to find out what the organism is to be further administered antibiotic therapy as effective as possible.

The second most important is the ultrasound examination (ie. Echocardiography), which is a performance in which the chest accompanied probe, which captures the look of the heart and surrounding areas, its interior and bodies stored there, so it is able to detect the presence of vegetation on the flap. It is the examination absolutely does not burden, when the probe after painting gel attached to the outdoor side of the chest, and the image is sensed through the chest wall.

Sometimes it is however necessary to view the heart from a different angle, in which case the physician elects to access from the esophagus, where the esophagus introduce similar ultrasonic probe (transesophageal echocardiography). This examination, patients may cope worse, anyway, they are before the procedure given tranquillizers, which remain conscious, but their performance does not matter much.

Among other applicable tests, ECG and X-ray of the heart and lungs.

Other names: bacterial endocarditis, endocarditis, inflammation of the endocardium, endocarditis, IE

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