Endocarditis causes: Difference between revisions

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(/* Epidemiological Clues in Etiological Diagnosis of Culture-Negative Endocarditis{{Cite journal | last1 = Baddour | first1 = LM. | last2 = Wilson | first2 = WR. | last3 = Bayer | first3 = AS. | last4 = Fowler | first4 = VG. | last5 = Bolger | first5 ...)
 
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__NOTOC__
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{{Endocarditis}}
{{Endocarditis}}
{{CMG}}; {{AE}} {{AZ}}
{{CMG}}; {{AE}} {{AZ}} {{Ochuko}}


==Overview==
==Overview==
The three most common causes of bacterial endocarditis include [[Streptococcus viridans]], [[Staphylococcus aureus|Staphylococci]] and [[Enterococcus]].
The majority of cases of infective endocarditis are due to bacteria.  Common causes of infective endocarditis include ''[[Streptococcus viridans]]'', ''[[Staphylococcus aureus|Staphylococci]]'', and ''[[Enterococcus]]''.
 
==Causes==
 
===Common Causes===
*[[Staphylococcus aureus]]<ref name="Murdoch">{{cite journal|last=Murdoch|first=DR|title=Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study|journal=Archives of Internal Medicine|date=9 March 2009|volume=169|issue=5|pages=463–73|pmid=19273776|doi=10.1001/archinternmed.2008.603|pmc=3625651|display-authors=etal}}</ref>
*[[Streptococcus viridans]]
*[[Coagulase]] negative [[Staphylococci]]
*[[Candida albicans]]
*[[clostridium|Clostridium septicum]]
*[[Enterococcus]]
*[[HACEK organisms]]
*[[Pseudomonas]]
*[[Streptococcus bovis]]
*[[Streptococcus pneumoniae]]
 
===Causes by Organ System===
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |[[Acute rheumatic fever]], [[aneurysm of sinus of valsalva]], [[aortic insufficiency]], [[aortic stenosis]], [[aortic valve regurgitation]], [[aortic valve stenosis]], [[asymmetric septal hypertrophy]], [[atrial myxoma]], [[atrioventricular block]], [[Austrian triad ]], [[bacterial endocarditis]], [[endocarditis|Becker fibroblastic endocarditis]], [[bicuspid aortic valves ]], [[calcific aortic stenosis]], [[valvular disease|calcific valvular disease]], [[cardiac catheterization ]], [[cardiac myxoma]], [[cardiac surgery ]], [[cardiomegaly]], [[carditis]], [[central venous catheter]], [[cerebrovascular accident]], [[cholesterol emboli syndrome]], [[coarctation of the aorta ]], [[congenital heart disease ]], [[coronary artery fistula]], [[Ebstein's anomaly]], [[Eisenmenger's syndrome]], [[embolism]], [[first degree AV block]], [[hypertrophic cardiomyopathy]], [[hypoplastic left heart syndrome]], [[infective endocarditis]], [[Libman-Sacks endocarditis]], [[Loeffler endocarditis]], [[marantic endocarditis]], [[mesenteric ischemia]], [[mitral regurgitation]], [[mitral stenosis]], [[mitral valve prolapse]], [[mitral valve replacement]], [[myocardial rupture]], [[nonbacterial thrombotic endocarditis]], [[papillary muscle dysfunction]], [[patent ductus arteriosus]], [[prosthetic heart valves]], [[pulmonary atresia]], [[pulmonic regurgitation]], [[rheumatic heart disease ]], [[right ventricular outflow tract obstruction]], [[second degree AV block]], [[shock]], [[stroke]], [[structural heart disease]], [[subacute endocarditis]], [[tetralogy of Fallot]], [[third degree AV block]], [[tricuspid insufficiency]], [[tricuspid regurgitation]], [[tricuspid stenosis]], [[valvular heart disease]], [[ventricular septal defect]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"|[[Dental extractions]], [[dental implants]], [[dental sepsis]], [[root canal|root canals procedure]], [[rothia dentocariosa]]
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"|[[Behcet disease]], [[scarlet fever]]
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"|[[Aminoglycoside]], [[cocaine]], [[daptomycin]], [[flucloxacillin]], [[fusidic acid]], [[heroin]], [[intravenous drug use]], [[metronidazole]], [[narcotic]], [[pefloxacin]], [[penicillin]], [[streptomycin]], [[vancomycin]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"|[[Adenoidectomy]]
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic & Genito-Uriner'''
|bgcolor="Beige"|[[biliary tract|Biliary tract surgery]], [[endoscopic retrograde cholangiopancreatography ]], [[peritoneovenous shunt|peritoneovenous shunts for ascites]], [[sclerotherapy ]], [[splenic infarction]], [[Whipple disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"|[[Ehlers-Danlos syndrome]], [[mitogen-activated protein kinase 9]], [[parathyroid hormone receptor 1]], [[Turner syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"|[[Antiphospholipid syndrome]], [[chronic eosinophilic leukemia]], [[hypereosinophilic syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"|[[Cystoscopy]],[[infection|iatrogenic infection]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"|[[Abiotrophia]], [[acremonium]], [[acute rheumatic fever]], [[aseptic meningitis]], [[Austrian triad ]], [[bacteremia]], [[bacterial endocarditis]], [[bacteroides]], [[bartonella]], [[brucellosis]], [[campylobacteriosis]], [[candida albicans]], [[capnocytophaga canimorsus]], [[cardiobacterium hominis]], [[cat scratch fever]], [[clostridium sordellii]], [[staphylococci|coagulase-negative staphylococci]], [[corynebacterium]], [[coxiella burnetii]], [[diphtheria ]], [[eikenella corrodens]], [[enterococci ]], [[enterococcus faecalis]], [[erysipelas]], [[erysipelothrix rhusiopathiae|erysipeloid of rosenbach]], [[erysipelothrix rhusiopathiae]], [[fever]], [[peptostreptococcus|finegoldia magna]], [[fungi ]], [[gemella haemolysans]], [[gemella morbillorum]], [[gonorrhea]], [[granuloma]], [[group A streptococcus ]], [[HACEK organisms]], [[haemophilus|haemophilus aphrophilus]], [[haemophilus|haemophilus parainfluenzae]], [[haemophilus|haemophilus paraphrophilus]], [[HIV]], [[infection|iatrogenic infection]], [[infective endocarditis]], [[kingella|kingella kingae]], [[lactobacillus rhamnosus]], [[legionella pneumophila]], [[listeria monocytogenes]], [[loiasis ]], [[melioidosis]], [[meningococcemia]], [[methicillin-resistant staphylococcus aureus]], [[micrococcus]], [[mycobacterium avium-intracellulare]], [[mycobacterium boenickei]], [[mycobacterium brisbanense]], [[mycobacterium fortuitum]], [[mycobacterium houstonense]], [[mycobacterium neworleansense]], [[mycobacterium tuberculosis]], [[gonorrhea|neisseria gonorrhoea]], [[neisseria|neisseria sicca]], [[gram-negative bacteria|non-HACEK gram-negative bacteria]], [[pasteurella multocida]], [[septicemia|postoperative septicemia]], [[propionibacterium acnes]], [[pseudomonas alcaligenes]], [[pseudomonas mendocina]], [[psittacosis]], [[Q fever]], [[rat-bite fever]], [[rheumatic fever]], [[rothia dentocariosa]], [[salmonellosis ]], [[scarlet fever]], [[sepsis]], [[septic arthritis]], [[septicemia ]], [[serratia]], [[staphylococcus aureus]], [[staphylococcus epidermidis]], [[staphylococcus lugdunensis]], [[rat-bite fever|streptobacillary rat-bite fever]], [[streptobacillus]], [[streptococcus bovis]], [[streptococcus milleri]], [[streptococcus mitis]], [[streptococcus mutans]], [[streptococcus pneumoniae]], [[streptococcus sanguinis]], [[streptococcus suis]], [[streptococcus viridans]], [[streptococcus]], [[syphilis]], [[trichinella spiralis]],[[tropheryma whipplei]], [[trypanosoma cruzi]], [[tuberculosis ]], [[typhoid fever]], [[vancomycin-resistant enterococci]], [[Whipple disease]]
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"|[[Ehlers-Danlos syndrome]], [[sclerotherapy]]
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"|[[Antiphospholipid syndrome]], [[aseptic meningitis]], [[Austrian triad]], [[cerebrovascular accident]], [[stroke]], [[cerebral shunt|ventriculoatrial shunts for hydrocephalus]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"|[[Ornithine transcarbamylase]]
|-
|-bgcolor="LightSteelBlue"
| '''Obstetrics & Gynecology'''
|bgcolor="Beige"| [[Antiphospholipid syndrome]], [[Pregnancy]]
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"|[[Atrial myxoma]], [[cancer]], [[cardiac myxoma]], [[chronic eosinophilic leukemia]], [[paraneoplastic syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"| [[respiratory tract|Respiratory tract procedures]]
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"|[[hemodialysis|Chronic hemodialysis]], [[hemodialysis]], [[nephrotic syndrome]], [[urinary casts]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"|[[Acute rheumatic fever]], [[antiphospholipid syndrome]], [[autoimmune disease]], [[Behcet disease]], [[immune complex disease]], [[lupus]], [[paraneoplastic syndrome]], [[polymyalgia rheumatica]], [[rheumatic fever]], [[rheumatoid arthritis]], [[systemic lupus erythematosus]]
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Urologic'''
|bgcolor="Beige"| [[Cystoscopy]], [[prostate cancer surgery|prostatic surgery]]
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"|[[Surgery]]
|-
|}


==Epidemiological Clues in Etiological Diagnosis of Culture-Negative Endocarditis<ref>{{Cite journal  | last1 = Baddour | first1 = LM. | last2 = Wilson | first2 = WR. | last3 = Bayer | first3 = AS. | last4 = Fowler | first4 = VG. | last5 = Bolger | first5 = AF. | last6 = Levison | first6 = ME. | last7 = Ferrieri | first7 = P. | last8 = Gerber | first8 = MA. | last9 = Tani | first9 = LY. | title = Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. | journal = Circulation | volume = 111 | issue = 23 | pages = e394-434 | month = Jun | year = 2005 | doi = 10.1161/CIRCULATIONAHA.105.165564 | PMID = 15956145 }}</ref>==
==Epidemiological Clues in Etiological Diagnosis of Culture-Negative Endocarditis<ref>{{Cite journal  | last1 = Baddour | first1 = LM. | last2 = Wilson | first2 = WR. | last3 = Bayer | first3 = AS. | last4 = Fowler | first4 = VG. | last5 = Bolger | first5 = AF. | last6 = Levison | first6 = ME. | last7 = Ferrieri | first7 = P. | last8 = Gerber | first8 = MA. | last9 = Tani | first9 = LY. | title = Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. | journal = Circulation | volume = 111 | issue = 23 | pages = e394-434 | month = Jun | year = 2005 | doi = 10.1161/CIRCULATIONAHA.105.165564 | PMID = 15956145 }}</ref>==
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! Epidemiological features || Common Microorganism(s)
! Epidemiological features || Common Microorganism(s)
|-
|-
| <center>'''Injection drug use'''</center>||
!<center>'''Injection drug use'''</center>
|
*[[Staphylococcus aureus|S. aureus]]
*[[Staphylococcus aureus|S. aureus]]
*oxacillin-resistant strains
*Oxacillin-resistant strains
*Coagulase-negative [[staphylococci]]
*Coagulase-negative [[staphylococci]]
*[[Streptococcus|β-Hemolytic streptococci]]
*[[Streptococcus|β-Hemolytic streptococci]]
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:*[[Pseudomonas aeruginosa]]
:*[[Pseudomonas aeruginosa]]
|-
|-
| <center>'''Indwelling cardiovascular medical devices'''</center> ||
!<center>'''Indwelling cardiovascular medical devices'''</center>
|
*[[Staphylococcus aureus|S. aureus]]
*[[Staphylococcus aureus|S. aureus]]
*Coagulase-negative staphylococci
*Coagulase-negative staphylococci
Line 28: Line 155:
*[[Corynebacterium]] sp
*[[Corynebacterium]] sp
|-
|-
| <center>'''Genitourinary disorders'''</center>
!<center>'''Genitourinary disorders'''</center>


<center>'''Genitourinary infection'''</center>
<center>'''Genitourinary infection'''</center>
Line 34: Line 161:
<center>'''Genitourinary manipulation'''</center>
<center>'''Genitourinary manipulation'''</center>


<center>'''pregnancy'''</center>
<center>'''Pregnancy'''</center>


<center>'''Delivery'''</center>
<center>'''Delivery'''</center>
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*[[Neisseria gonorrhoeae]]
*[[Neisseria gonorrhoeae]]
|-
|-
| <center>'''Chronic skin disorders''' </center>||
!<center>'''Chronic skin disorders''' </center>
|
*[[Staphylococcus aureus|S. aureus]]
*[[Staphylococcus aureus|S. aureus]]
*[[Streptococcus|β-Hemolytic streptococci]]
*[[Streptococcus|β-Hemolytic streptococci]]
|-
|-
| <center>'''Poor dental health, dental procedures''' </center>||
!<center>'''Poor dental health, dental procedures''' </center>
|
*Viridans group streptococci
*Viridans group streptococci
*“Nutritionally variant streptococci”
*“Nutritionally variant streptococci”
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*[[HACEK organism]]s
*[[HACEK organism]]s
|-
|-
|  <center>'''Alcoholism, cirrhosis''' </center>||
!<center>'''Alcoholism, cirrhosis''' </center>
|
*[[Streptococcus pneumoniae|S pneumoniae]]
*[[Streptococcus pneumoniae|S pneumoniae]]
*[[Streptococcus|β-Hemolytic streptococci]]
*[[Streptococcus|β-Hemolytic streptococci]]
Line 67: Line 197:
*[[Aeromonas hydrophila|Aeromonas sp]]
*[[Aeromonas hydrophila|Aeromonas sp]]
|-
|-
|  <center>'''Burn patients''' </center>||
!<center>'''Burn patients''' </center>
|
*[[Staphylococcus aureus|S. aureus]]
*[[Staphylococcus aureus|S. aureus]]
*Aerobic Gram-negative bacilli, including
*Aerobic Gram-negative bacilli, including
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*[[Fungi]]
*[[Fungi]]
|-
|-
|  <center>'''Diabetes mellitus''' </center>||
!<center>'''Diabetes mellitus''' </center>
|
*[[Staphylococcus aureus|S. aureus]]
*[[Staphylococcus aureus|S. aureus]]
*[[Streptococcus|β-Hemolytic streptococci]]
*[[Streptococcus|β-Hemolytic streptococci]]
*[[Streptococcus pneumoniae|S pneumoniae]]
*[[Streptococcus pneumoniae|S pneumoniae]]
|-
|-
| <center>'''Early ( < 1 y) prosthetic valve placement''' </center>||
!<center>'''Early ( < 1 y) prosthetic valve placement''' </center>
|
*Coagulase-negative staphylococci
*Coagulase-negative staphylococci
*[[Staphylococcus aureus|S. aureus]]
*[[Staphylococcus aureus|S. aureus]]
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*[[Legionella|Legionella sp]]
*[[Legionella|Legionella sp]]
|-
|-
|  <center>'''Late ( > 1 y) prosthetic valve placement''' </center>||
!<center>'''Late ( > 1 y) prosthetic valve placement''' </center>
|
*Coagulase-negative staphylococci
*Coagulase-negative staphylococci
*[[Staphylococcus aureus|S. aureus]]
*[[Staphylococcus aureus|S. aureus]]
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*[[Corynebacterium]] sp
*[[Corynebacterium]] sp
|-
|-
| <center>'''Dog–cat exposure''' </center>||
!<center>'''Dog–cat exposure''' </center>
|
*[[Bartonellosis|Bartonella sp]]
*[[Bartonellosis|Bartonella sp]]
*[[Pasteurella multocida|Pasteurella sp]]
*[[Pasteurella multocida|Pasteurella sp]]
*[[Capnocytophaga|Capnocytophaga sp]]
*[[Capnocytophaga|Capnocytophaga sp]]
|-
|-
| <center>'''Contact with contaminated milk'''</center>
!<center>'''Contact with contaminated milk'''</center>
<center>'''Contact with infected farm animals'''</center>
<center>'''Contact with infected farm animals'''</center>
||
||
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*[[Erysipelothrix rhusiopathiae|Erysipelothrix sp]]
*[[Erysipelothrix rhusiopathiae|Erysipelothrix sp]]
|-
|-
| <center>'''Homeless, body lice'''</center>||
!<center>'''Homeless, body lice'''</center>
|
*[[Bartonellosis|Bartonella sp]]
*[[Bartonellosis|Bartonella sp]]
|-
|-
| <center>'''AIDS'''</center> ||
!<center>'''AIDS'''</center>
|
*[[Salmonella|Salmonella sp]]
*[[Salmonella|Salmonella sp]]
*[[Streptococcus pneumoniae|S pneumoniae]]
*[[Streptococcus pneumoniae|S pneumoniae]]
*[[Staphylococcus aureus|S. aureus]]
*[[Staphylococcus aureus|S. aureus]]
|-
|-
| <center>'''Pneumonia, meningitis'''</center>||
!<center>'''Pneumonia, meningitis'''</center>
|
*[[Streptococcus pneumoniae|S pneumoniae]]
*[[Streptococcus pneumoniae|S pneumoniae]]
|-
|-
| <center>'''Solid organ transplant'''</center>||
!<center>'''Solid organ transplant'''</center>
|
*[[Staphylococcus aureus|S. aureus]]
*[[Staphylococcus aureus|S. aureus]]
*[[Aspergillus|Aspergillus fumigatus]]
*[[Aspergillus|Aspergillus fumigatus]]
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*[[Candida albicans|Candida sp]]
*[[Candida albicans|Candida sp]]
|-
|-
| <center>'''Gastrointestinal lesions'''</center>||
!<center>'''Gastrointestinal lesions'''</center>
|
*[[Streptococcus bovis|S bovis]]
*[[Streptococcus bovis|S bovis]]
*[[Enterococcus|Enterococcus sp]]
*[[Enterococcus|Enterococcus sp]]
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|-
|-
|}
|}
==Common Causes==
Many types of organism can cause infective endocarditis. These are generally isolated by [[blood culture]], where the patient's blood is sampled under sterile conditions, and any growth is noted and identified. It is therefore important to draw blood cultures before initiating antibiotic therapy.  70% of cases of endocarditis are due to the following three pathogens:
#Alpha-haemolytic [[Streptococcus|streptococci]], that are present in the mouth will often be the organism isolated if a dental procedure caused the bacteraemia.
#If the bacteraemia was introduced through the skin, such as contamination in surgery, during catheterization, or in an IV drug user, ''[[Staphylococcus aureus]]'' is common.
#A third important cause of endocarditis is ''[[Enterococcus|Enterococci]]''. These bacteria enter the bloodstream as a consequence of abnormalities in the gastrointestinal or urinary tracts. ''[[Enterococcus|Enterococci]]'' are increasingly recognized as causes of nosocomial or hospital-acquired endocarditis. This contrasts with alpha-haemolytic [[streptococci]] and ''[[Staphylococcus aureus]]'' which are causes of community-acquired endocarditis.
==Less Common Causes==
Some organisms, when isolated, give valuable clues to the cause, as they tend to be specific.
*''[[Candida albicans]]'', a [[yeast]], is associated with IV drug users and the [[immunocompromised]]. Fungal endocarditis accounts for 5% of cases of native endocarditis and 10% of cases of prosthetic valve endocarditis. A diagnosis of fungal endocarditis is difficult, because many patients are afebrile with a normal white blood cell count (WBC). The fungus is often difficult to culture, and blood cultures are typically negative. Fungal infections often result in large vegetations, systemic embolization, myocardial invasion, and are extremely resistant to medical therapy. Early surgical intervention is warranted because medical mortality approaches 100% Anti-fungal therapy for life is required.
*''[[Pseudomonas]]'' species, which are very resilient organisms that thrive in water, may contaminate street drugs that have been contaminated with drinking water.  [[Pseudomonas aeruginosa|P. aeruginosa]] can infect a child through foot punctures, and can cause both endocarditis and [[septic arthritis]].<ref>http://wordnet.com.au/Products/topics_in_infectious_diseases_Aug01.htm Topics in Infectious Diseases Newsletter, August 2001, Pseudomonas aeruginosa.</ref>
*''[[Streptococcus bovis]]'' and ''Clostridium septicum'', which are part of the natural flora of the bowel, are associated with [[colon cancer|colonic malignancies]]. When they present as the causative agent in endocarditis, it usually indicates that a [[colonoscopy]] should be performed due to worries regarding hematogenous spread of bacteria from the colon due to the neoplasm breaking down the barrier between the gut lumen and the blood vessels which drain the bowel.<ref>{{cite web|url=http://www.blackwell-synergy.com/doi/abs/10.1046/j.1445-1433.2001.02231.x?cookieSet=1&journalCode=ans|title=Clostridium septicum and malignancy |author=Simon S. B. Chew, David Z. Lubowski|date=2001|source=ANZ Journal of Surgery 71 (11), 647–649}}</ref>
*''[[HACEK organisms]]'' are a group of bacteria that live on the dental gums, and can be seen with IV drug abusers who contaminate their needles with saliva. Patients may also have a history of poor dental hygiene, or pre-existing valvular disease.<ref>{{cite web|url=http://www.emedicine.com/med/topic935.htm|title=HACEK Group Infections|author=Mirabelle Kelly, MD|date= June 7, 2005}}</ref>
==Causes by Organ System==
{|style="width:80%; height:100px" border="1"
|style="height:100px"; style="width:25%" border="1" bgcolor="LightSteelBlue" | '''Cardiovascular'''
|style="height:100px"; style="width:75%" border="1" bgcolor="Beige" |[[Asymmetric septal hypertrophy]], [[aortic stenosis | Calcific aortic stenosis]], [[Cardiac catheterization]], [[Cardiac surgery]], [[Congenital Heart Disease]], [[Mitral valve prolapse]], [[Prosthetic heart valve]], [[atrial septal defect|Septal defects]], [[valvular heart disease|Valve disease]], [[bacterial endocarditis|Previous bacterial endocarditis]], [[Rheumatic Heart Disease]], [[Sclerotherapy]], [[Myxoma|Cardiac myxoma]], [[Tetralogy of Fallot]], [[Structural heart disease]], [[Patent ductus arteriosus]], [[Coarctation of the aorta]], Calcific [[valvular disease]], [[Bicuspid aortic valves]]
|-
|-bgcolor="LightSteelBlue"
| '''Chemical / poisoning'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Dental'''
|bgcolor="Beige"|[[Dental extractions]], [[Dental implants]], [[Root canals]]
|-
|-bgcolor="LightSteelBlue"
| '''Dermatologic'''
|bgcolor="Beige"|[[Skin infection]]
|-
|-bgcolor="LightSteelBlue"
| '''Drug Side Effect'''
|bgcolor="Beige"|[[IV drug|IV drug use]]
|-
|-bgcolor="LightSteelBlue"
| '''Ear Nose Throat'''
|bgcolor="Beige"|[[Adenoidectomy]]
|-
|-bgcolor="LightSteelBlue"
| '''Endocrine'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Environmental'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Gastroenterologic & Genito-Uriner'''
|bgcolor="Beige"|[[Biliary tract|Biliary tract surgery]], [[Cystoscopy]], [[Endoscopic retrograde cholangiopancreatography]], Urethral dilation, [[Prostatic|Prostatic surgery]], [[Whipple disease]], Ulcerative lesions of the [[colon]] due to [[carcinoma]], Ulcerative lesions of the [[colon]] due to [[inflammatory bowel disease]], Peritoneovenous [[shunts]] for [[ascites]]
|-
|-bgcolor="LightSteelBlue"
| '''Genetic'''
|bgcolor="Beige"|[[Marfan's syndrome|Marfan's Syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Hematologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Iatrogenic'''
|bgcolor="Beige"|[[Urethral]] dilation, [[Prostate]] surgery, [[Cystoscopy]]
|-
|-bgcolor="LightSteelBlue"
| '''Infectious Disease'''
|bgcolor="Beige"|[[Diphtheria]], [[Staphylococcus epidermidis]], [[Staphylococcus aureus]], [[Streptococcus bovis]], [[Viridans streptococci]], [[Group A streptococcus]], [[Gram negative|Gram negative rods]], [[Enterococuss]], [[Candida]], [[Tuberculosis]], [[Salmonellosis]], [[HIV]], [[Bacteroides]], HACEK Group of organism
|-
|-bgcolor="LightSteelBlue"
| '''Musculoskeletal / Ortho'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Neurologic'''
|bgcolor="Beige"|Ventriculoatrial [[shunts]] for [[hydrocephalus]]
|-
|-bgcolor="LightSteelBlue"
| '''Nutritional / Metabolic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Obstetrics & Gynecology'''
|bgcolor="Beige"|[[Childbirth]]
|-
|-bgcolor="LightSteelBlue"
| '''Oncologic'''
|bgcolor="Beige"|[[Paraneoplastic syndrome]]
|-
|-bgcolor="LightSteelBlue"
| '''Opthalmologic'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Overdose / Toxicity'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Psychiatric'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Pulmonary'''
|bgcolor="Beige"|[[Respiratory infection]], Respiratory tract procedures
|-
|-bgcolor="LightSteelBlue"
| '''Renal / Electrolyte'''
|bgcolor="Beige"|Chronic [[hemodialysis]]
|-
|-bgcolor="LightSteelBlue"
| '''Rheum / Immune / Allergy'''
|bgcolor="Beige"|[[Acute rheumatic fever]], [[Systemic lupus erythematosus]], [[Marantic endocarditis]], Immune impairment
|-
|-bgcolor="LightSteelBlue"
| '''Trauma'''
|bgcolor="Beige"| No underlying causes
|-
|-bgcolor="LightSteelBlue"
| '''Miscellaneous'''
|bgcolor="Beige"|Surgical systemic-pulmonary shunts and conduits
|-
|}
===Causes in Alphabetical Order===
{{Multicol}}
*[[ Asymmetric septal hypertrophy]]
*[[Acute rheumatic fever]]
*[[Adenoidectomy ]]
*[[Aortic valve regurgitation]]
*[[Aortic valve stenosis]]
*[[Bacteroides]]
*[[Bicuspid aortic valves ]]
*[[Biliary tract]] surgery
*[[Calcific aortic stenosis]]
*Calcific [[valvular disease]]
*[[Candida albicans]]
*[[Cardiac catheterization ]]
*[[Cardiac myxoma]]
*[[Cardiac surgery ]]
*Chronic [[hemodialysis ]]
*Coagulase-negative [[staphylococci]]
*[[Coarctation of the aorta ]]
*[[Congenital Heart Disease ]]
*[[Cystoscopy ]]
*[[Dental extractions ]]
*[[Dental implants ]]
*[[Dental sepsis]]
*[[Diphtheria ]]
*[[Endoscopic retrograde cholangiopancreatography ]]
*[[Enterococci ]]
*[[Fungi ]]
*[[Gram negative]] rods
*[[Group A streptococcus ]]
*HACEK Group of organism
*History of [[endocarditis ]]
*[[HIV ]]
*[[Immune]] impairment
*Intravascular procedure in settings of [[bacteremia]]
*Intravenous [[catheter]]-related[[ infection ]]
*[[Intravenous drug use ]]
*[[Marantic endocarditis]]
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*[[Mitral valve prolapse]] with regurgitation
*[[Mycobacterium avium-intracellulare]]
*Non-HACEK [[gram-negative bacteria ]]
*Other [[streptococci ]]
*[[Paraneoplastic syndrome]]
*[[Patent ductus arteriosus]]
*Peritoneovenous [[shunts]] for [[ascites ]]
*[[Pregnancy ]]
*Previous [[bacterial]] [[endocarditis ]]
*Prostatic surgery 
*[[Prosthetic heart valve ]]
*[[Prosthetic heart valves]]
*[[Q fever]]
*[[Respiratory tract]] procedures 
*[[Rheumatic Heart Disease ]]
*Root canals procedure
*[[S. aureus ]]
*[[Salmonellosis ]]
*[[Sclerotherapy ]]
*Septal defects
*[[Skin infection ]]
*[[Staphylococcus epidermidis  ]]
*[[Streptococcus bovis ]]
*[[Streptococcus]] milleri
*[[Streptococcus viridans]]
*[[structural heart disease]]
*Surgical systemic-pulmonary [[shunts]] and conduits
*[[Systemic lupus erythematosus ]]
*[[Tetralogy of Fallot]]
*[[Tuberculosis ]]
*Ulcerative lesions of the [[colon]] due to  [[inflammatory bowel disease ]]
*Ulcerative lesions of the [[colon]] due to [[carcinoma ]]
*[[Urethral]] dilation
*[[Ventricular septal defect]]
*Ventriculoatrial [[shunts]] for [[hydrocephalus ]]
*[[Whipple disease]]
{{EndMultiCol}}


==References==
==References==
{{reflist|2}}
{{Reflist|2}}


[[Category:Emergency medicine]]
[[Category:Emergency medicine]]
[[Category:Cardiology]]
[[Category:Cardiology]]
[[Category:Infectious disease]]
 
[[Category:Intensive care medicine]]
[[Category:Intensive care medicine]]
[[Category:Up-To-Date]]
[[Category:Up-To-Date]]
[[Category:Crowdiagnosis]]


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Latest revision as of 02:13, 6 March 2020

Endocarditis Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ahmed Zaghw, M.D. [2] Ogheneochuko Ajari, MB.BS, MS [3]

Overview

The majority of cases of infective endocarditis are due to bacteria. Common causes of infective endocarditis include Streptococcus viridans, Staphylococci, and Enterococcus.

Causes

Common Causes

Causes by Organ System

Cardiovascular Acute rheumatic fever, aneurysm of sinus of valsalva, aortic insufficiency, aortic stenosis, aortic valve regurgitation, aortic valve stenosis, asymmetric septal hypertrophy, atrial myxoma, atrioventricular block, Austrian triad , bacterial endocarditis, Becker fibroblastic endocarditis, bicuspid aortic valves , calcific aortic stenosis, calcific valvular disease, cardiac catheterization , cardiac myxoma, cardiac surgery , cardiomegaly, carditis, central venous catheter, cerebrovascular accident, cholesterol emboli syndrome, coarctation of the aorta , congenital heart disease , coronary artery fistula, Ebstein's anomaly, Eisenmenger's syndrome, embolism, first degree AV block, hypertrophic cardiomyopathy, hypoplastic left heart syndrome, infective endocarditis, Libman-Sacks endocarditis, Loeffler endocarditis, marantic endocarditis, mesenteric ischemia, mitral regurgitation, mitral stenosis, mitral valve prolapse, mitral valve replacement, myocardial rupture, nonbacterial thrombotic endocarditis, papillary muscle dysfunction, patent ductus arteriosus, prosthetic heart valves, pulmonary atresia, pulmonic regurgitation, rheumatic heart disease , right ventricular outflow tract obstruction, second degree AV block, shock, stroke, structural heart disease, subacute endocarditis, tetralogy of Fallot, third degree AV block, tricuspid insufficiency, tricuspid regurgitation, tricuspid stenosis, valvular heart disease, ventricular septal defect
Chemical / poisoning No underlying causes
Dental Dental extractions, dental implants, dental sepsis, root canals procedure, rothia dentocariosa
Dermatologic Behcet disease, scarlet fever
Drug Side Effect Aminoglycoside, cocaine, daptomycin, flucloxacillin, fusidic acid, heroin, intravenous drug use, metronidazole, narcotic, pefloxacin, penicillin, streptomycin, vancomycin
Ear Nose Throat Adenoidectomy
Endocrine No underlying causes
Environmental No underlying causes
Gastroenterologic & Genito-Uriner Biliary tract surgery, endoscopic retrograde cholangiopancreatography , peritoneovenous shunts for ascites, sclerotherapy , splenic infarction, Whipple disease
Genetic Ehlers-Danlos syndrome, mitogen-activated protein kinase 9, parathyroid hormone receptor 1, Turner syndrome
Hematologic Antiphospholipid syndrome, chronic eosinophilic leukemia, hypereosinophilic syndrome
Iatrogenic Cystoscopy,iatrogenic infection
Infectious Disease Abiotrophia, acremonium, acute rheumatic fever, aseptic meningitis, Austrian triad , bacteremia, bacterial endocarditis, bacteroides, bartonella, brucellosis, campylobacteriosis, candida albicans, capnocytophaga canimorsus, cardiobacterium hominis, cat scratch fever, clostridium sordellii, coagulase-negative staphylococci, corynebacterium, coxiella burnetii, diphtheria , eikenella corrodens, enterococci , enterococcus faecalis, erysipelas, erysipeloid of rosenbach, erysipelothrix rhusiopathiae, fever, finegoldia magna, fungi , gemella haemolysans, gemella morbillorum, gonorrhea, granuloma, group A streptococcus , HACEK organisms, haemophilus aphrophilus, haemophilus parainfluenzae, haemophilus paraphrophilus, HIV, iatrogenic infection, infective endocarditis, kingella kingae, lactobacillus rhamnosus, legionella pneumophila, listeria monocytogenes, loiasis , melioidosis, meningococcemia, methicillin-resistant staphylococcus aureus, micrococcus, mycobacterium avium-intracellulare, mycobacterium boenickei, mycobacterium brisbanense, mycobacterium fortuitum, mycobacterium houstonense, mycobacterium neworleansense, mycobacterium tuberculosis, neisseria gonorrhoea, neisseria sicca, non-HACEK gram-negative bacteria, pasteurella multocida, postoperative septicemia, propionibacterium acnes, pseudomonas alcaligenes, pseudomonas mendocina, psittacosis, Q fever, rat-bite fever, rheumatic fever, rothia dentocariosa, salmonellosis , scarlet fever, sepsis, septic arthritis, septicemia , serratia, staphylococcus aureus, staphylococcus epidermidis, staphylococcus lugdunensis, streptobacillary rat-bite fever, streptobacillus, streptococcus bovis, streptococcus milleri, streptococcus mitis, streptococcus mutans, streptococcus pneumoniae, streptococcus sanguinis, streptococcus suis, streptococcus viridans, streptococcus, syphilis, trichinella spiralis,tropheryma whipplei, trypanosoma cruzi, tuberculosis , typhoid fever, vancomycin-resistant enterococci, Whipple disease
Musculoskeletal / Ortho Ehlers-Danlos syndrome, sclerotherapy
Neurologic Antiphospholipid syndrome, aseptic meningitis, Austrian triad, cerebrovascular accident, stroke, ventriculoatrial shunts for hydrocephalus
Nutritional / Metabolic Ornithine transcarbamylase
Obstetrics & Gynecology Antiphospholipid syndrome, Pregnancy
Oncologic Atrial myxoma, cancer, cardiac myxoma, chronic eosinophilic leukemia, paraneoplastic syndrome
Opthalmologic No underlying causes
Overdose / Toxicity No underlying causes
Psychiatric No underlying causes
Pulmonary Respiratory tract procedures
Renal / Electrolyte Chronic hemodialysis, hemodialysis, nephrotic syndrome, urinary casts
Rheum / Immune / Allergy Acute rheumatic fever, antiphospholipid syndrome, autoimmune disease, Behcet disease, immune complex disease, lupus, paraneoplastic syndrome, polymyalgia rheumatica, rheumatic fever, rheumatoid arthritis, systemic lupus erythematosus
Trauma No underlying causes
Urologic Cystoscopy, prostatic surgery
Miscellaneous Surgery

Epidemiological Clues in Etiological Diagnosis of Culture-Negative Endocarditis[2]

Epidemiological features Common Microorganism(s)
Injection drug use
Indwelling cardiovascular medical devices
Genitourinary disorders
Genitourinary infection
Genitourinary manipulation
Pregnancy
Delivery
Abortion
Chronic skin disorders
Poor dental health, dental procedures
  • Viridans group streptococci
  • “Nutritionally variant streptococci”
  • Abiotrophia defectiva
  • Granulicatella sp
  • Gemella sp
  • HACEK organisms
Alcoholism, cirrhosis
Burn patients
  • S. aureus
  • Aerobic Gram-negative bacilli, including
Diabetes mellitus
Early ( < 1 y) prosthetic valve placement
Late ( > 1 y) prosthetic valve placement
Dog–cat exposure
Contact with contaminated milk
Contact with infected farm animals
Homeless, body lice
AIDS
Pneumonia, meningitis
Solid organ transplant
Gastrointestinal lesions

References

  1. ↑ Murdoch, DR; et al. (9 March 2009). "Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study". Archives of Internal Medicine. 169 (5): 463–73. doi:10.1001/archinternmed.2008.603. PMC 3625651. PMID 19273776.
  2. ↑ Baddour, LM.; Wilson, WR.; Bayer, AS.; Fowler, VG.; Bolger, AF.; Levison, ME.; Ferrieri, P.; Gerber, MA.; Tani, LY. (2005). "Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America". Circulation. 111 (23): e394–434. doi:10.1161/CIRCULATIONAHA.105.165564. PMID 15956145. Unknown parameter |month= ignored (help)

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