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ENDOCARDITIS
Mr. ALFRIN ANTONY
Asst. Lecturer
DEPARTMENT OF PATHOLOGY
+919738286092
ENDOCARDITIS
Inflamation of endocardium
A. Non-Infective
Rheumatic Endocarditis
Atypical Verrucous Endocarditis
Non bacterial thrombotic
Endocarditis
B. Infective
Bacterial endocarditis
Other Infective types (tuberculosis,
syphilitic, fungal, viral,
rickettsial)
Infective Endocarditis
Febrile illness
Persistent bacteremia
Characteristic lesion of microbial
infection of the endothelial surface of
the heart the vegetation
Variable in size
Amorphous mass of fibrin & platelets
Abundant organisms
Few inflammatory cells
BACTERIAL ENDOCARITIS
DEFINITION:- Bacterial endocarditis
is serious infection of the valvular
and mural endocardium caused by
different forms of bacteria (other
than tubercle bacilli and bacterial
micro organisms) and characterized
by typical infected and friable
vegetations
CLASSIFICATION
depending on severity
Acute Subacute
Acute bacterial Subacute bacterial
endocarditis:- is endocarditis is
the fulminant and caused by less
obstructive acute virulent bacteria in
infection of the a previously
endocardium by diseased heart and
highly virulent has a gradual down
bacteria in a hill course in a
previously normal period of 6 weeks
heart (fatal2-6 to months-years
weeks)
INCIDENCE
Bacterial endocaditis may occur at
any age
Most cases more than 50yeas
Males > females
ETIOLOGY
1.Infective agents
ABE SABE
2. Staphylococci 2. Streptococci with low
(staphylococcus virulence
aureus) 3. Streptococcus
3. Pneumococci viridans (mouth)
4. Gonococci 4. Streptococci bovis
(stomach)
5. Beeta-streptococci
5. Streptococcus
6. Enterococci pneumoniae
6. Staphylococcus
epidermidis
Predisposing factors
1. Bacteraemia, septicemia and
pyaemia
2. Underlying heart disease
3. Impaired host defence
Pathogenesis
1. The circulating bacteria are lodged
much more frequently on previously
damaged valves from disease, chiefly
RHD nad CHD than healthy valves
2. Conditions producing haemodynamic
stress on the valves are liable to cause
damage to the endocardium, favouring
the formation platelets thrombi which
gets infected from circulating bacteria
3. Non-bacterial thrombotic endocarditis
occurs from prolonged stress
PATHOLOGIC CHANGES
MACROSCOPICALLY MICROSCOPICALLY
Lesions are in The out layer consists
mitral>aortic>both > of eosinophilic
right heart material composed of
SABE > ABE fibrin platelets
Underneath layer is
the basophilic zone
containing colonies of
bacteria
The deeper zone
consists of non-
specific inflammatory
reaction
Symptoms
Acute Subacute
High grade fever Low grade fever
and chills Anorexia
Arthralgias/ Weight loss
myalgias Fatigue
Abdominal pain Arthralgias/
Pleuritic chest pain myalgias
Back pain Abdominal pain
1. Nonspecific
2. Nonblanching
3. Linear reddish-brown lesions found under the nail bed
4. Usually do NOT extend the entire length of the nail
Osler’s Nodes
Osler’s Nodes
American College of Rheumatology
webrheum.bham.ac.uk/.../ default/pages/3b5.htm www.meddean.luc.edu/.../
Hand10/Hand10dx.html
1. More specific
2. Painful and erythematous nodules
3. Located on pulp of fingers and toes
4. More common in subacute IE
Janeway Lesions
Janeway Lesions
1. More specific
2. Erythematous, blanching macules
3. Nonpainful
4. Located on palms and soles
Subconjunctival
Hemorrhages
COMPLICATIONS
CARDIAC EXTRA CARDIAC
Valvular stenosis or Infracts in spleen,
insufficiency kidneys and brain
Perforation, rupture Pulmonory abscesses
and aneurysm of Petechiae (skin
valve and leaflets conjunctiva)
Abscesses in the Osler’s nodes(SABE)
valve ring Janeway’s spots (ABE)
Myocardial abscesses
Suppurative
pericarditis
Cardiac failure
Local Spread of Infection
Acute S. aureus IE with perforation of the Acute S. aureus IE with mitral valve ring
aortic valve and aortic valve vegetations. abscess extending into myocardium.
Septic Pulmonary Emboli
http://www.emedicine.com/emerg/topic164.htm
Septic Retinal Embolus
Roth’s Spots
TUBERCULOUS ENDOCARDITIS
It is characterized by presence of
typical tubeculosis on the
valvular as well as mural
endocardium and form
tuberculosis thrombo emboli
Syphilis endocaditis
Aortic valvular incompitance (severe)
Fungal endocaditis
Oppurtunistic fungal
infections like candidiasis ans
aspergillosis are seen I
patients receiving long term
anti biotic therapy
Viral endocarditis
Only in experiment
Rickettsial endocarditis
Another rare cause of
endocaditis is form infection
in Q fever