Intravascular infections Flashcards

1
Q

transient bacteremia

A

clearance exceeds entry

source is local infection somewhere

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2
Q

continuous bacteremia

A

seeding exceeds clearance capacity

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3
Q

septicemia

A

clearance mechanisms subverted

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4
Q

in infective endocarditits is there a continuous concentration in the blood or does is go up and down?

A

continuous concentration of bacteria in the blood

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5
Q

what are the four endovascular infections

A

infective endocarditis
infected thrombus
mycotic aneurysm
infections of intravascular devices

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6
Q

predispositions of IE

A
congenital heart disease
Rheumatic heart disease
conditions leading to bacteremia
IV drug abuse
Hopitalization
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7
Q

prior to antibiotic era what was the fatality rate of IE?

A

100%

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8
Q

Pathogenesis of IE

A
  • turbulent blood flow
  • Endothelial cell activation
  • Fibrin and platelet deposition
  • Silent of clinical bacteremia seed sterile vegetations
  • bacteria grow within fibrin vegetations
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9
Q

what is unique about the endocardium including valves, chordae, papillary muscle and atria that make them prime for immune evasion of bacteria?

A

they receive their nourishment from the blood stream and DO NOT have capillaries. Neutrophils require capillaries to get to infection site.
**Thus innate and acquired immune mechanisms are subverted.

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10
Q

observations of IE in vivo

A

bacteria imbedded within vegetations are impossible to entirely eradicate
*IE is characterized by unrestricted microbial replication within vegetations leading to in vivo bacterial colonies

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11
Q

Diagnosis: Duke Criteria

major findings

A
  • continuous bacteremia

- target lesion on valve, supports or endocardium by (ECHO or new murmur)

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12
Q

Diagnosis: Duke Criteria

minor findings

A
fever
predisposing heart condition
IV drug user
embolic phenomena
immunological phenomena
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13
Q

signs of IE

A

tender Osler nodes
non tender Janeway lesions
Roth spot in eye
Conjunctival petechiae

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14
Q

Microbiology of IE

A
  • staphylococci-S. aureus, coagulase neg staph spp.
  • streptococci-viridans spp. and gamma strep
  • Enterococci
  • Gram negative bacilli
  • Fungi
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15
Q

are more virulent and less virulent species going to cause IE?

A

less virulent

mostly Strep. mutans, where as S. pyogenes doesn’t causes much IE

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16
Q

clinical correlation

A
congestive heart failure
stroke
infarcts
glomerulonephritis
mycotic aneurysms
abscesses(local or distant)
17
Q

what dental procedures give the highest bacteremia values?

A

periodontal surgery 88%
extraction 60%
Brushing or irrigation device 40%

18
Q

high risk adverse outcome from IE

A
  • prosthetic heart valve or prosthetic material inserted for repair
  • previous infective endocarditis
  • congenital heart disease
  • cardiac treatment patients who develop valvulopathy
19
Q

how do you prevent IE

A
prophylactic antibiotics prior to procedures for those with:
-prosthetic heart valves
-previous IE
-congenital heart diseases
-heart Tx with valvulopathies 
IV or PO regimens at time of procedures
20
Q

treatment of IE

A
IV therapy
-bactericidal regimen
length of treatment-2,4,6,8 wks
test for antibiotic sensitivity 
Surgery