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Alternative namesEndocarditis - infectious
Infectious endocarditis is an infection of the lining of the heart chambers and heart valves caused by bacteria, viruses, fungi, or other infectious agents.
Causes, incidence, and risk factors
Infectious endocarditis is an inflammation of the heart valves. It can affect the heart muscle (myocarditis) or the lining of the heart (pericarditis). Most people who develop infectious endocarditis have underlying heart disease .
The infection may be bacteremia (bacteria in the blood), which is common during dental, upper respiratory, urologic, and lower gastrointestinal diagnostic and surgical procedures. The infection can cause growths on the heart valves, the lining of the heart, or the lining of the blood vessels. These growths may form clots that break off and travel to the brain, lungs, kidneys, or spleen.
Since Streptococcus viridans is often found in the mouth, dental procedures are the most common cause of bacterial endocarditis. This can put children with congenital heart conditions at risk. As a result, it is common practice for children with some forms of congenital heart disease to start on antibiotics prior to any dental work.
Signs and tests
A history of congenital heart disease raises the level of suspicion. A physical examination may show an enlarged spleen. The examiner may detect a new heart murmur, or a change in a previous heart murmur. Examination of the nails may show splinter hemorrhages. Eye examination may show retinal hemorrhages with a central area of clearing, called Roth's spots.
Hospitalization is required initially to administer intravenous antibiotics. Long-term, high-dose antibiotic therapy is required to eradicate the bacteria from the heart chambers and vegetations on the valves. Therapy up to 6 weeks is not uncommon. The chosen antibiotic must be specific for the organism causing the condition. This is determined by the blood culture and the sensitivities tests.
Expectations (prognosis)Early treatment of bacterial endocarditis generally has a good outcome. Heart valves may be damaged if diagnosis and treatment is delayed.
Calling your health care provider
Call your health care provider if you note the following symptoms during or after treatment:
Preventive antibiotics are often given to people with predisposing congenital or valvular abnormalities before dental procedures or surgeries involving the respiratory, urinary or intestinal tract. Continued medical follow-up is advised for people with a previous history of infective endocarditis.
Intravenous drug users are also at risk for this condition because unsterile injecting practices increase the exposure of the bloodstream to infectious agents. Treatment for addiction should be sought. If this is not possible, use of a new needle for each injection, avoiding sharing any injection-related paraphernalia and use of alcohol pads to sterilize the injection site can reduce risk.
Update Date: 4/14/2004Daniel Levy, M.D., Ph.D., Infectious Diseases, Greater Baltimore Medical Center, Baltimore, MD. Review provided by VeriMed Healthcare Network.
Last updated: Tue, 06 Jan 2009 00:20:03 GMT