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Infectious endocarditis

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Infectious endocarditis
Treatment of an infectious endocarditis

Infectious endocarditis — a special form of sepsis at which the septic center is on valves of heart or a pristenochny endocardium. To a bowl of all the infectious endocarditis arises at persons with the inborn or acquired heart diseases (a secondary infectious endocarditis). Less often the infection affects anatomically not changed valves (primary infectious endocarditis). Fixing of an infection can happen also on an intima of abnormally developed vessels (an open arterial channel, aneurisms of vessels). Defeat of valves results from bacteremia which sources are diverse and can not always be explicit. Depending on virulence of the infectious agent and reactivity of a macroorganism the disease can proceed sharply or subacutely (the long infectious endocarditis meets less often) and without treatment usually comes to an end letalno.

Classification of an infectious endocarditis

On an etiology

On a current

On a condition of an endocardium

Special forms

Streptococci:
green and others
versions

Acute
Subacute

Primary (on intact valves)

Infectious endocarditis
right half of heart
(usually at drug addiction)

Staphylococcus:
golden

Long

Secondary (on the changed valves)

Infectious endocarditis
the fitted a prosthesis valves

epidermal

 

 

Mural endocarditis

Gram-negative
microorganisms

 

 

Infectious endocarditis
at a prolapse of the mitral valve

Mushrooms

 

 

 

Other activators

 

 

 

Endocarditis with negative crops
(10-15% of patients)

 

 

 

Main clinical manifestations (symptom complexes):
• septic state (septicaemia, septikoinemiya);
• defeat of valves of heart;
• heart failure;
• hemorrhagic syndrome;
• thromboembolic syndrome:
• immune defeats (nephrite, skin vasculitis, synovites).

On the frequency of occurrence of causative agents of an infectious endocarditis of native valves the leading place is taken by the green streptococcus, and also other kinds of a streptococcus (Str. bovis, Enterococcus faecalisu Ave.). Have essential value also staphylococcus (golden, epidermal).

A noticeable role in an etiology of an infectious endocarditis is played by colibacillus, a pyocyanic stick, proteas. More rare activators are pneumococci, gonokokk, anaerobe bacterias, mushrooms. At an infectious endocarditis of the right half of heart (usually at patients with drug addiction) and at an infectious endocarditis of the fitted a prosthesis valves the frequency of seedings of golden staphylococcus sharply increases (for more details see in appropriate questions).
It should be noted that the infectious endocarditis can be caused by activators which are part of usual microflora of an oral cavity and a nasopharynx. Especially distinguish microorganisms which are integrated by an abbreviation from them NOTCHED, i.e. include Haemophilus, Actinobacillus, Cardio-bacterium, Eikenellai Kimgella. the infectious endocarditis connected with the listed activators proceeds subacutely and is followed by education big vegetations. Allocation of these microorganisms from blood presents difficulties in view of their slow growth (from one to several weeks).

The microorganisms which settled on an endocardium quickly become covered by a layer of fibrin and thrombocytes, creating vegetation. At the same time high-pathogenic activators cause an ulceration and destruction of the valve that is connected with emergence of regurgitation. Less pathogenic infection does not cause an ulceration and destruction, but can lead to emergence big polypostural vegetations that is followed by either obstruction of the valve, or a rupture of vegetation with developing of an embolism. Distribution of defeats on a pristenochny endocardium, a penetration of a valve ring with formation of a septic aortic aneurysm, myocardium abscesses is possible. Defeat of chords can lead to their rupture and emergence of acute insufficiency of the valve.

The beginning of a disease gradual can also be imperceptible for the patient. Complaints — on weakness, fatigue, a hyporexia, decrease in body weight, night sweats, arthralgias. Embolisms can cause paralyzes, stethalgias owing to heart attacks of lungs or a myocardium, a pneumorrhagia, an abdominal pain, a melena, back pains, a gross hematuria, extremity pains, sudden deterioration in sight or its loss. Patients can complain of emergence of painful skin elements on fingers, palms, soles and other body parts. Sometimes in the next anamnesis stomatologic procedures (extraction of teeth, etc.), a tonsilectomy, an adenoidectomy, acute nasopharyngeal infections, pyodermas, tool researches of urinary tract and so forth are noted. In many cases, however, the source of an infection does not manage to be found out.

Skin pale or pale gray, sometimes "coffee with milk" colors, petechias on skin, and also on mucous membranes and a conjunctiva (on mucous membranes sometimes — with the pale center). Osler's nodes — red-violet, painful, with a diameter up to 1,5 cm are less often observed (on palms, fingers of hands and legs, feet). At a prolonged current — sometimes fingers in the form of "drum sticks". Often tachycardia. At auscultation — a picture of defect against which the infectious endocarditis developed. Considerable change of an auskultativny picture (at secondary an infectious endocarditis) or emergence of noise against an auskultativny picture, normal to a disease (at primary an infectious endocarditis) indicates an ulceration and destruction of the valve, a cardiomegaly or a valve ring, a rupture of chords or emergence of big vegetation. In certain cases noise is absent that can indicate an endocarditis of the right half of heart or infection of arteriovenous aneurism in lungs or on the periphery. The spleen is quite often increased, and in the presence in it heart attacks the capsule friction murmur is listened. The arthritis reminding rheumatic can be observed.



 
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