Alfrin Antony Lecturer Department of pathology +919738286092
ENDOCARDITIS
Inflammation of endocardium A. Non-Infective èRheumatic Endocarditis èAtypical Verrucous Verrucous Endocarditis è Non bacterial thrombotic Endocarditis B. Infective Bacterial endocarditis Other Infective types (tuberculosis, syphilitic, fungal, viral, rickettsial )
INFECTIVE ENDOCARDITIS ENDOCARDITIS It is characterized by colonization or invasion of heart valves by different forms of bacteria leading to formation of thrombotic thrombotic masses laden with organisms so called infective vegetations. 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 bacterial endocarditis is the fulminant and obstructive acute infection of the endocardium by highly virulent bacteria in a previously normal heart ( fatal2-6 fatal2-6 weeks)
Sub acute bacterial endocarditis is caused by less virulent bacteria in a previously diseased heart and has a gradual down hill course in a period of 6 weeks to months-years
Sub acute bacterial endocarditis 1. Strept Streptoco ococci cci with with low low virule virulence nce 2. Strept Streptoco ococcus ccus virida viridans ns (mouth (mouth)) 3. Stre Strept ptoc ococc occii bovis bovis (GI (GIT) T) 4. Stre Strept ptoc ococc occus us pneum pneumoni oniae ae 5. Stap Staphy hylo loco coccu ccuss epid epider ermi midi diss
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PATHOGENISIS
a). The circulating bacteria are lodged much more frequently on previously damaged valves from disease, chiefly RHD nad CHD than healthy valves b). 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 c). Non-bacterial thrombotic endocarditis occurs from prolonged stress PATHOLOGIC CHANGES
MACROSCOPICALLY Lesions are in mitral>aortic>both > right heart SABE > ABE
MICROSCOPICALLY The out layer consists of eosinophilic material composed of fibrin platelets Underneath layer is the basophilic zone containing colonies of bacteria The deeper zone consists of nonspecific inflammatory reaction
SYMPTOMS Acute
High grade fever and chills Arthralgias/ myalgias Abdominal pain Pleuritic chest pain Back pain
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4). splenomegaly, 5). neurologic changes
More specific signs 1). Osler’s Nodes:- Painful and erythematous nodules, Located on pulp of fingers and toes More common in sub acute IE 2). Janeway lesions:- Erythematous, blanching macules Non painful Located on palms and soles 3).Roth Spots:- Seen retina of eye
COMPLICATIONS
CARDIAC Valvular stenosis or insufficiency Perforation, rupture and aneurysm of valve and leaflets Abscesses in the valve ring Myocardial abscesses Suppurative pericarditis Cardiac failure
EXTRA CARDIAC Infracts in spleen, kidneys and brain Pulmonory abscesses Petechiae (skin conjunctiva) Osler’s nodes(SABE) Janeway’s Janeway’s spots (ABE)
Tuberculosis Endocarditis:- It is characterized by presence of typical tuberculosis on the valvular as well as mural endocardium and form tuberculosis thrombo emboli Syphilis Endocarditis:- Aortic valvular incompetence (severe)
cand idiasis ans aspergillosis Fungal Endocarditis:- Opportunistic fungal infections like candidiasis are seen I patients receiving long term anti biotic therapy Viral Endocarditis:- Only in experiment Rickettsial Endocarditis:fever
Another rare cause of endocarditis is form infection in Q
