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Bacterial endocarditis

Infective endocarditis

Overview

Bacterial endocarditis is an infection of the lining of the heart (endocardium) and usually also of the heart valves. Bacterial endocarditis occurs when bacteria enter the bloodstream and attack the lining of the heart or the heart valves. Bacterial endocarditis causes growths or holes on the valves or scarring of the valve tissue, most often resulting in a leaky heart valve. Without treatment, bacterial endocarditis can be a fatal disease.

Symptoms - Bacterial endocarditis

  • Fever
  • Fatigue
  • Loss of appetite
  • Night sweats
  • Chills
  • Joint discomfort
  • Headache
  • Weakness
  • Aches
  • Back pain
  • Heart murmur
  • Weight loss
  • Shortness of breath on exertion
  • Swollen feet
  • Swollen legs
  • Swollen abdomen
  • Blood in urine
  • Dark lines under nails caused by hemorrhage
  • Unusual urine color
  • Painful red nodes on finger pads
  • Painful red nodes on toe pads
  • Heart murmur
  • Petechiae

Causes - Bacterial endocarditis

Bacteria that are introduced into the bloodstream can sometimes lodge on heart valves and infect the endocardium. Bacteria can enter the bloodstream through:

  • Everyday oral activities. Activities such as brushing teeth or chewing food can allow bacteria to enter the bloodstream — especially if teeth and gums aren't healthy.
  • An infection or other medical condition. Bacteria may spread from an infected area, such as a skin sore. Gum disease, a sexually transmitted infection or an intestinal disorder — such as inflammatory bowel disease — also may give bacteria the opportunity to enter the bloodstream.
  • Catheters or needles. Bacteria can enter the body through a catheter. The bacteria that can cause endocarditis can also enter the bloodstream through the needles used for tattooing or body piercing. Contaminated needles and syringes are a special concern for people who use intravenous (IV) drugs.
  • Certain dental procedures. Some dental procedures that can cut the gums may allow bacteria to enter the bloodstream.
In people with normal heart valves, usually no harm is done, and the body's white blood cells and immune responses rapidly destroy these bacteria. However, damaged heart valves may trap the bacteria, which can then lodge on the endocardium and start to multiply.

Prevention - Bacterial endocarditis

To help prevent endocarditis, make sure to practice good hygiene:

  • Pay special attention to dental health — brush and floss teeth and gums often, and have regular dental checkups.
  • Avoid procedures that may lead to skin infections, such as body piercings or tattoos.
  • Seek prompt medical attention if you develop any type of skin infection or open cuts or sores that don't heal properly.
As a preventive measure, people at high risk of infective endocarditis are given antibiotics before certain surgical, dental, and medical procedures. People at high risk include those with:
  • Replacement valves
  • Some birth defects of the heart
  • A transplanted heart that has an abnormal valve
  • A previous episode of infective endocarditis

Diagnosis - Bacterial endocarditis

The diagnosis of bacterial endocarditis is based on the presence of symptoms, the results of a physical examination and the results of diagnostic tests:

  • Symptoms of infection
  • Blood cultures show bacteria or microorganisms commonly found with endocarditis. Blood cultures allow the laboratory to isolate the specific bacteria that is causing infection.
  • Echocardiogram (ultrasound of the heart) may show growths, abscesses (holes), new regurgitation (leaking) or stenosis (narrowing), or an artificial heart valve that has begun to pull away from the heart tissue.

Prognosis - Bacterial endocarditis

If untreated, infective endocarditis is always fatal. When treatment is given, the risk of death depends on factors such as the person's age, duration of the infection, the presence of a replacement heart valve, the type of infecting organism, and the amount of damage done to the heart valves. Nonetheless, with aggressive antibiotic treatment, most people survive.

Treatment - Bacterial endocarditis

Treatment usually consists of at least 2 weeks and often up to 8 weeks of antibiotics given intravenously in high doses. Heart surgery may be needed to repair or replace damaged valves, remove vegetations, or drain abscesses if antibiotics do not work, a valve leaks significantly, or a birth defect connects one chamber to another.

Resources - Bacterial endocarditis

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