Infective Endocarditis

Infective Endocarditis


Infective endocarditis (IE) is an inflammation of the endocardium with microbial etiology accompanied by prolonged bacteremia, fever, heart sound, and vegetations embolism (expansion of the endocardium), which can lead to valve failure, narrowing of the valve orifice, abscesses in the myocardium and mycotic aneurysms.
Differ acute infective endocarditis (with rapidly progressive clinical symptoms, affect tricuspid, less aortic valve) and subacute infective endocarditis (with gradual development, until a few weeks or months, aortic punch, less mitral, and tricuspid valve in drug addicts ).
The incidence of infective endocarditis 2-4 draw secondary cases per 100 000 population and mortality reaches 21-50%, depending on the location and nature of the defeat (left or right-sided IE, natural or artificial valves), the form and stage of disease (acute or subacute IE), concomitant diseases, severity of complications and others.
Factors increasing the risk of developing infective endocarditis, the presence of artificial heart valves, congenital heart defect, rheumatic and other acquired valve lesions, mitral valve prolapse, drug addiction, diagnostic and therapeutic procedures using catheters and endoscopic instruments; dental procedures involving the lining of the airways, gastrointestinal tract and urinary tract.
The etiology of infectious endocarditis depends on the circumstances that provoked it occurs. In 45-65% of cases of IE with natural human heart valves, the disease arises out of streptococci (S.viridans and S.bovis), in 5-18% - of enterococci and 20-35% - of staphylococci. In the development of heart failure increased the role of S.aureus, Enterococcus spp., S.pneumoniae and S.pyogenes.
When addicts disease most commonly affects the aortic valve and leading exciters of infection are bacteria S.aureus, Pseudomonas aeuginosa and enterococci.
The development of infective endocarditis after surgery for placement of prosthetic valve is most commonly due to staphylococci, Enterobacteriaceae, difteroidi, P.aeruginoza, S.epidermidis, S.aureus and fungi such as Candida and Aspergillus.
As a complication of another infectious disease infectious endocarditis can be provoked by brucella, legionella, nokardii, rickettsiae, chlamydiae and mycoplasmas.
Treatment of infective endocarditis
For the treatment of IE apply antibiotic with a broad spectrum of action - a muscle, vein, artery (after inoculation of blood for determination of bacterial activator) and remediation of infectious outbreak.
In the development of heart failure and ineffectiveness of drug therapy is surgery.
In the absence of timely surgical treatment, development of severe heart failure, mortality reaches 60%, and aortic valve injury - up to 80%.

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