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) or acute suppurative illness such as pneumonia or meningitis
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 ring affected in both.
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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