Description, Causes and Risk Factors:
Endocarditis caused by the direct invasion of bacteria and leading to deformity and destruction of the valve leaflets. Two types are acute bacterial endocarditis and subacute bacterial endocarditis.
Bacterial endocarditis is an infection of the inner surface of the heart or the heart valves caused by bacteria usually found in the mouth, intestinal tract or urinary tract. This infection results in a serious illness which requires prolonged treatment and on occasion produces injury to the heart or even death. Endocarditis is a major concern in almost all un-repaired congenital heart defects as well as in most repaired defects with a few exceptions.
Bacterial endocarditis can occur with many heart defects but is most common in aortic valve lesions, a patent ductus arteriosus (un-repaired), tetralogy of Fallot, ventricular septal defects, coarctation of the aorta, and mitral valve prolapse with mitral regurgitation.
However, an organism commonly found in the mouth, Streptococcus viridans, is responsible for about 50% of all bacterial endocarditis cases. This is why dental procedures increase your chances for developing this condition. Such procedures are especially risky for children with congenital heart conditions. As a result, it is common practice for children with some forms of congenital heart disease and adults with certain heart-valve conditions to take antibiotics before any dental work.
Bacteria or other infectious substance can enter the bloodstream during certain medical procedures, including dental procedures, and travel to the heart, where it can settle on damaged heart valves. The bacteria can grow and may form infected clots that break off and travel to the brain, lungs, kidneys, or spleen.
The presenting signs and symptoms of bacterial endocarditis are highly variable, and the severity of illness ranges from mild-to-severe. Fever is almost always a symptom. Other symptoms are loss of appetite, unexplained weight loss, new rashes (both painful and painless), headache, backache, joint pain, confusion, shortness of breath, or sudden weakness in the face or limbs suggestive of a stroke.
Bacterial endocarditis can usually be diagnosed if the physician suspects its presence in a child with a congenital heart defect and a prolonged fever. Blood tests show signs of inflammation such as an elevated sedimentation rate (ESR),while anemia and blood cells in the urine are often present. The most important diagnostic test for endocarditis involves a positive blood culture.
The following tests may be performed:
Erythrocyte sedimentation rate (ESR).
Blood culture and sensitivity (to detect bacteria).
CT scan of the chest.
Echocardiography (ultrasound of the heart).
Complete blood count (may show mild anemia).
You will be admitted to the hospital so you can receive antibiotics through a vein. Long-term, high-dose antibiotic treatment is needed to get rid of the bacteria. Treatment is usually given for 4 - 6 weeks, depending on the specific type of bacteria. Blood tests will help your doctor choose the best antibiotic.
The most common organism responsible for bacterial endocarditis is Staphylococcus aureus, which is resistant to penicillin in most cases. High rates of resistant to oxacillin are also seen, in which cases treatment with vancomycin is required. Viridans group streptococci and Streptococcus bovis are usually highly susceptible to penicillin and can be treated with penicillin or ceftriaxone (RocephinSM).
Surgery may be needed to replace damaged heart valves. Early treatment of bacterial endocarditis generally has a good outcome.
NOTE: The above information is educational purpose. The information provided herein should not be used during any medical emergency or for the diagnosis or treatment of any medical condition.
DISCLAIMER: This information should not substitute for seeking responsible, professional medical care.
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