Fast Five Quiz: Refresh Your Knowledge on Key Aspects of Infective Endocarditis

Michael Stuart Bronze, MD

Disclosures

December 05, 2017

Nosocomial infective endocarditis commonly manifests with elements of a sepsis syndrome (ie, hypotension, metabolic acidosis fever, leukocytosis, and multiple organ failure). The source of bacteremia may develop from an infection in another organ (eg, pneumonia, pyelonephritis) or from a central venous catheter. Most often, these patients are in the intensive care unit. The aging of the population is associated with an increased incidence of staphylococcal healthcare-associated endocarditis, in addition to an increased mortality rate associated with the disease. Approximately 45% of cases of nosocomial/healthcare-associated infective endocarditis occur in patients with prosthetic valves.

Fever and chills are the most common symptoms; anorexia, weight loss, malaise, headache, myalgias, night sweats, shortness of breath, cough, or joint pains are common symptoms as well. Dyspnea, cough, and chest pain are common symptoms in intravenous drug users with infective endocarditis. This is probably related to the predominance of tricuspid valve endocarditis in this group and secondary embolic showering of the pulmonary vasculature.

A key concern is the distinction between subacute and acute infective endocarditis. The diagnosis of subacute infective endocarditis is suggested by a history of an indolent process characterized by fever, fatigue, anorexia, back pain, and weight loss. Less common developments include a cerebrovascular accident or congestive heart failure.

The patient should be questioned about invasive procedures and recreational drug use that may be causing the bacteremia. Most subacute disease caused by Streptococcus viridans infection is related to dental disease. Most cases are caused not by dental procedures, but by transient bacteremias secondary to gingivitis. In 85% of patients, symptoms of endocarditis appear within 2 weeks of dental or other procedures.

For more on the presentation of infective endocarditis, read here.

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