Medicine an Surgery notes

Apr 25th, 2015
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INFECTIVE ENDOCARDITISDefinition Infection of the endocardialsurface of the heart.HISTORY1823 Lazaire Riviere gross Autopsyfindings of the disease.1885 William Osler 1st comprehensivedescription of endocarditis.1966 Lerner and Weinstern infectiveendocarditis in the antibiotic eraCLASSIFICATIONBased on course of disease- Acute- Sub acuteAETIOLOGYAcute B- haemolytic streptococciS- AureusS. pneumococciSubacute coagulase ve staph- Viridans- Enterococi- HACEKcontd- Commonest-S.Viridans (50 60% subacute cases)- Streptococcus intermedius group acute/subacute(15%of streptococcal I.E. cases)- Gp D streptococci mainly subacute- Gp B steptococciStaplylococus aureus- Most common in PVE, acute IE, IVDA IE- 35 60% of staph bactaeremia conplicated by I.E- 50% of cases no underlying disease.RISK FACTORSI.V LinesSteroidsCancerD.M.IVDA.AlcoholicsRenal failureCoagulase -ve staph-usually subacute-Common with indwelling catheters.Pseudomonas aureginosaAcuteSurgery commonly required for cureCommon in IV drug usersHACEKSub acuteMost common gram -ve organismGp D enterococci- common after lower GI or GU.manipulationcontdFungi usually subacute.-Commonest candida Albicans-Others Histoplasma, AspergillusPolymicrobialAbout 10% - blood culturenegativeEPIDEMIOLOGY-M:F = 3:1,incidence 2-6/100,000 per year-Rar

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