Cardiovascular

infections
Prof. Dr. Amany Tharwat Abd El Rhman
Dr. Ragda Hussain
Medical Microbiology & Immunology Department, MUST
Rickettsial Diseases

Vasculitis
Distinguishing Features of Rickettsia

• Small, aerobic, Gram negative coccobacilli

• Obligate intracellular parasites of eukaryotic cells, because they are unable to
Produce sufficient energy to replicate extracellularly.
• All are maintained in mammalian reservoirs.
• Transmitted by arthropod vectors e.g ticks, mites, lice or fleas.
• Humans are accidentally infected.
• They are the causative agents of typhus, spotted fevers.
 Diseases caused by Rickettsia

Disease Organism Arthropod vector Mammalian Reservoir

Rocky mountain spotted R. ricketsii Ticks Dogs, rodents (zoonosis)

fever
Epidemic Typhus R. prowazekii Lice Humans

Endemic typhus R. typhi Fleas Rodents (zoonosis)

 Pathogenesis of Rickettsial Infection:

• The typical lesion caused by the rickettsiae is a vasculitis

• Rickettsia infect endothelial cells lining the small blood vessels.
• In the host cell, the bacteria lyse the phagosome membrane with a phospholipase
 get into the cytoplasm where they replicate.
• Pathogenesis is primarily due to destruction of endothelial cells by the endotoxin of
replicating bacteria  leakage of blood  organ and tissue damage due to loss of
blood into the tissue spaces.
• Damage to blood vessels of the skin causes characteristic rash.
Epidemic Typhus
Laboratory Diagnosis

• Laboratory diagnosis of rickettsial diseases is based on serologic tests rather

than isolation of the organism.
e.g ELISA and IFA test are most widely used; fourfold increase in titer is
diagnostic.

• Although rickettsiae can be grown in cell culture or embryonated eggs, this is

a hazardous procedure that is not available in the standard clinical laboratory.
Treatment: doxycycline.

Prevention:
• De-lousing, Rodents control, and Prevention of tick bites.
• doxycycline for exposed persons.

Vaccine: Formalin killed vaccine: for epidemic typhus.

Heart Infection

Endocarditis
Myocarditis
Pericarditis
 Endocarditis
• Definition:
• An inflammation of the endocardium ( inner layer of the heart) .
• It is two types; acute or subacute endocarditis
 Type Infection Common Causal Agents

Acute endocarditis Staphyloccoccus aureus

Subacute - Viridans streptococci (Most common cause, 50%)

endocarditis
- Other bacteria: S. epidermidis and S. aureus, , S. pneumoniae,
Enterococcus, E.coli, Neisseria, Pseudomonas,
Mycobacterium, and Mycoplasma.

- Fungus: candida.
 Acute endocarditis
Causative organisms: Staphyloccoccus aureus
• Most common in hospitalized patients or intravenous drug user.
• usually occurs when the organism travel through bloodstream
to heart.

Clinical picture
• high fever, chills, new or increasing heart murmurs, fatigue, and
emboli manifested by Janeway lesions (painless, macular,
haemorrhagic lesions that occur most commonly on the palms or
soles).
 Subacute endocarditis
Causative organisms:
Viridans streptococci : most common cause ( 50% of cases).

Other organisms are :

• Staphylococcus epidermidis and S. aureus, Candida from the skin,
• Streptococcus pneumoniae from the pharynx,
• Enterococcus and E.oli from the digestive tract.
• Neisseria, Pseudomonas, Mycobacterium, and Mycoplasma.
 Viridans Streptococci Endocarditis

Causative organism:
• Gram-positive cocci arranged in chains, producing α- haemolytic colonies on blood
agar (viridans =green).

• The organisms are normal flora of human oropharynx.

 Pathogenesis:

- During oral surgical procedure e.g. tonsillectomy or teeth extraction the

organism reaches the blood. In healthy individual the organism cleared from
the circulation by the immune system.

• In patients with previously damaged valve e.g. rheumatic heart disease,

congenital heart defect, or artificial prosthetic heart valve the organism may
settle on the surface of heat valve causing subacute bacterial endocarditis
 Virulence factors:

• Virulence of the organism is due to its ability to

synthesize dextrans biofilm from glucose, which allows it to
adhere to damaged heart valves.

Clinical picture
• Low-grade fever, with weight loss, night sweats, increasing heart
sounds, fatigue, emboli to others sites manifested as splinter
hemorrhages (under the finger nail).
 Staphylococcus epidermidis endocarditis
• Causative organism:
• - Gram positive cocci arranged in clusters, coagulase negative, nonhemolytic, and

novobiocin sensitive.
• - It is a commensal on the skin.

• Pathogenesis:
• Virulence factors::
• The organism produce a glycocalyx that adhere to biomedical devices e.g intravascular catheter and
prosthetic devices;
• causing septicemia prosthetic heart valves endocarditis.
 Laboratory Diagnosis :
Subacute bacterial endocarditis
• Specimen blood: blood culture
• According causative agent:
On blood agar form α-hemolytic colonies of S. viridans
and must be distinguished from S. pneumoniae
(pneumococci), which is also α-hemolytic. Viridans group
streptococci are bile insoluble and optochin resistant.
Non hemolytic colonies of S. epidermidis: catalase +ve,
coagulase –ve, novobiocin sensitive.
Viridans streptococci

Catalase -ve,

A B
tube A : bile insoluble
 Novobiocin-sensitive
Staphylococcus epidermidis

No hemolytic colonies of
S.epidermidis
Novobiocin-resistant
Staphylococcus saprophyticus
• Treatment:
Penicillin or vancomycin + aminoglycosides (gentamycin) for endocarditis

• Prevention:
Prophylactic antibiotics amoxicillin prior to dental work for individuals with
damaged heart valve.
Good daily dental hygiene.
 Myocarditis
Definition:
• Myocarditis is inflammation of the heart muscle
(myocardium)

Causative organisms
• Viral causes : Coxsackie viruses are the most common cause .
• Bacterial causes: Staph. aureus, Enterococcus faecalis (as a complication of endocarditis),
C.diphtheriae (toxin), Borrelia burgderferi.
• Fungi: candida, aspergillus, histoplasam capsulatum (in immunocompromised patients).
Clinical picture:
• Patients present with signs and symptoms of heart failure.
 Pericarditis
• Definition:
• Inflammation of the sac around the heart (the
pericardium).
•
• Causative organisms
• Staphylococcus aureus and Streptococcus pneumoniae
are most common.
• Mycobacterium tuberculosis
• Fungi: e.g Histoplasma capsulatum
Mode of transmission:
Pathogens reach the pericardium by either :
Hematogenous or
Direct spread from adjacent intrathoracic structures or,
Rarely directly from infected myocardium.

Clinical picture:
• Chest pain is the most common manifestation of pericarditis.
• Pain often worsens with inspiration or coughing.
 Rheumatic fever

Post-streptococcal immune-mediated (non-suppurative)

disease
• Causative organism: streptococcus pyogenes

• Pathogenesis:
• Occurs 2-4 weeks after respiratory tract infection usually pharyngitis by S.
Pyogenes rheumatogenic strains; bearing certain M proteins.
•
• It is autoimmune disease- Type II hypersensitivity reaction-: It is due to
immunologic reaction between cross-reacting antibodies to certain
streptococcal M proteins and antigens of joint, heart, and brain tissue.
•
• C/P: Fever, malaise, migratory polyarthritis, endocarditis, myocarditis, and
rheumatic chorea. Recurrence is common, causing heart damage.
Lab.Diagnosis:
•
• Non specific tests : elevated Erythrocyte sedimentation rate (ESR) and C-
reactive protein.
•
• Specific test: Anti-streptolysin O (ASO) test : ASO titers (>200 Todd
units/ml).
Anti Streptolysin O test Titer 1/400 +ve test
Treatment:
No Benefit from penicillin treatment after the onset of rheumatic fever.

Prevention of rheumatic fever: possible prophylactic antibiotics for at least 5

years post-acute rheumatic fever with benzathine penicillin; once each month.
 Vector-borne diseases of the cardiovascular system

Arthropod
Disease Organism Mammalian Reservoir
vector
Plague Yersinia pestis Fleas; Rodents
Lyme disease Borrelia burgdorferi ticks Field mice

Rocky mountain spotted fever R. ricketsii Ticks Dogs, rodents

Epidemic Typhus R. prowazekii Lice Humans

endemic typhus R. typhi Fleas Rodents

Epidemic Relapsing Fever lice Humans

Borrelia recurrentis

Endemic Relapsing Fever ticks Rodents

Borrelia hermsii