Presentations
1. Sub Acute Endocarditis
Fever - symptoms of cardiac failure or embolization
Night sweats - combination of renal failure and heart murmurs
Weight loss
Weakness
2. Acute Endocarditis
In intra venous drug abusers (IVDA)
3. Prosthetic Valve Endocarditis : Two varieties
i) develops soon after surgery, due to infec tion of prosthesis at surgery
ii) occurs late, following a bacteremia.
Valve
Organisms causing endocarditis according to age/population characteristics:
Neonates - Staphylo coccus aureus
- Coagulase negative staphy lococci
- Group B streptococci
Occasionally - Gram negative bacilli
- Candida species
Older children - Streptococci predominant (40%)
- Staphylococcus aureus
Adults - Streptococci - 53%
- Staphylococcus aureous - 10%
- Coagulase negative staphy lococci - 9%
- Enterococci - 9%
- Hemophilus species - 6%
Mitral valve prolapse with mitral regurgitation accounts for 7-30% of native valve endocarditis.
Rheumatic heart disease -> 20-25% cases.
Mitral valve > Aortic Valve
Congenital Heart disease
-10-20% of younger adults
- 8% older adults
Among adults common predisposing lesions are
- patent ductus arteriosis
- ventricular septal defect
- bicuspid aortic valve (particularly > 60 yrs)
IVDA (Intravenous Drug Abuse)
- Staphylococcus aureus - 57%
- Streptococci - 9%
- Enterococci - 10%
- Gram negative bacilli - 7%
- Fungi - 5%
- Polymicrobial - 6%
- Culture negative - 3%
- Miscellaneous - 3%
Uncommon organisms
- Coagulase negative staphylococcus (CNS)
- Coxiella burnetii
- Brucella
- Candida and Aspergillus
- Legionella
- Pseudomonas
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