ENDOCARDITE:

ETIOLOGIE (in ordinea frecventei): S. aureus, str.Viridans, Enterococ, staf Coagulazo-

negativ, Str bovis, Other strept, bact gram-negative, Fungi.
FACTORI DE RISC: injectii intravenoase, proteze valvulare, proceduri diagnostice
intravasculare, malformatii cardiace, istoric de endocardita, HIV, sarcina, fistule
arteriovenoase pentru hemodializa, Central venous and pulmonary artery catheters,
Peritoneovenous shunts for the control of intractable ascites (sunt peritoneo-venos
ptr.drenarea ascitei), Ventriculoatrial shunts for the management of hydrocephalus (Sunt
ventriculo-atrial ptr. Drenarea hidrocefaliei).
CRITERII DE DIAGNOSTIC: Pathologic criteria [Microorganism (demonstrated by
culture or histology in a vegetation, or in a vegetation that has embolized, or in an
intracardiac abscess) OR Pathologic lesions (vegetation or intracardiac abscess,
confirmed by histology showing active endocarditis)]
Criteriile DUKE (prezenta unui criteriu major si unul minor sau a 3 criterii minore)
Major criteria: 1. Positive blood cultures for IE (A.Typical microorganism for infective
endocarditis from two separate blood cultures : Viridans strept, Str bovis, including
nutritional variant strains, HACEK group (Haemophilus spp,. Actinobacillus actinomycete
comitants, Cardiobacterium hominis, Eikenella spp, and Kingella kingae), Staf aureus
Community - acquired enterococci, in the absence of a primary focus; B. Persistently
positive blood culture; C. Single positive blood culture for Coxiella burnetii)
2. Evidence of endocardial involvement (A.Positive echocardiogram for IE;
B.New valvular regurgitation)
Minor criteria: 1. Predisposition - predisposing heart condition or intravenous drug use;
2.Fever - 38.0°C;
3.Vascular phenomena - major arterial emboli, septic pulmonary infarcts,
mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, Janeway
lesions;
4.Immunologic phenomena - glomerulonephritis, Osler's nodes, Roth
spots, rheumatoid factor;
5.Microbiologic evidence - positive blood culture but not meeting major
criterion as noted previously (excluding single positive cultures for coagulase-negative
straphylococci and organisms that do not cause endocarditis) OR serologic evidence of
active infection with organism consistent with IE ;
EXAMEN CLINIC —new regurgitant murmurs or heart failure; Associated peripheral
cutaneous or mucocutaneous lesions of IE include petechiae, hemoragii unghiale in
aschie, Janeway lesions, Osler's nodes, and Roth spots, focal neurologic deficits, renal
and splenic infarcts, glomerulonephritis, arthritis, septic pulmonary infarcts.
LABORATOR: hemoculturi positive, VSH/PCR crescute, normochromic normocytic
anemia,The white blood cell (leucocite) count may be normal or elevated in patients with
subacute presentations of endocarditis; however, most patients with staphylococcal
endocarditis have leukocytosis (leucocitoza) and some may have thrombocytopenia.
Hyperglobulinemia, cryoglobulins, circulating immune complexes,
hypocomplementemia, elevated rheumatoid factor titers, and false positive serologic
tests for syphilis all occur in some patients.
TRATAMENTUL EB Acute: oxacilina + gentamicina
EB subacute:1. str viridans = penicilina (+ aminoglicozid) sau ampicilina sau
ceftriaxon daca penicilina nu este disponibila; 2. str. Pneumoniae = penicilina sau
ceftriaxon; 3. enterococ = ampicilina sau penicilina, vancomcina + aminoglicozid; 4. s
aureus = oxacilina (+ aminoglicozid); 5. staph epidermitis = vancomicina + gentamicina;
6. HACEK = ceftriaxona.