Alfrin Antony

INFECTIVE ENDOCARDITIS Lecturer

Department of pathology
+919738286092
ENDOCARDITIS

 Inflammation of endocardium
A. Non-Infective
èRheumatic Endocarditis
èAtypical Verrucous Endocarditis
èNon bacterial thrombotic Endocarditis
B. Infective
èBacterial endocarditis
èOther Infective types (tuberculosis, syphilitic, fungal, viral, rickettsial)

INFECTIVE ENDOCARDITIS

It is characterized by colonization or invasion of heart valves by different forms of

bacteria leading to formation of thrombotic masses laden with organisms so called
infective vegetations.

BACTERIAL ENDOCARITIS

 DEFINITION:- Bacterial endocarditis is serious infection of the valvular and

mural endocardium caused by different forms of bacteria (other than tubercle
bacilli and bacterial micro organisms) and characterized by typical infected and
friable vegetations

CLASSIFICATION (depending on severity)

Acute bacterial endocarditis Sub acute bacterial endocarditis

is the fulminant and obstructive acute is caused by less virulent bacteria in a
infection of the endocardium by highly previously diseased heart and has a gradual
virulent bacteria in a previously normal down hill course in a period of 6 weeks to
heart (fatal2-6 weeks) months-years

ETIOLOGY

Acute bacterial endocarditis Sub acute bacterial endocarditis

1. Staphylococci (staphylococcus 1. Streptococci with low virulence
aureus) 2. Streptococcus viridans (mouth)
2. Pneumococci 3. Streptococci bovis (GIT)
3. Gonococci 4. Streptococcus pneumoniae
4. Beeta-streptococci 5. Staphylococcus epidermidis
5. Enterococci
PATHOGENISIS

a). The circulating bacteria are lodged much more frequently on previously damaged
valves from disease, chiefly RHD nad CHD than healthy valves

b). Conditions producing haemodynamic stress on the valves are liable to cause damage
to the endocardium, favouring the formation platelets thrombi which gets infected from
circulating bacteria

c). Non-bacterial thrombotic endocarditis occurs from prolonged stress

PATHOLOGIC CHANGES

MACROSCOPICALLY MICROSCOPICALLY
 Lesions are in mitral>aortic>both >  The out layer consists of
right heart eosinophilic material composed of
 SABE > ABE fibrin platelets
 Underneath layer is the basophilic
zone containing colonies of bacteria
 The deeper zone consists of non-
specific inflammatory reaction

SYMPTOMS
Acute Subacute
 High grade fever and chills  Low grade fever
 Arthralgias/ myalgias  Anorexia
 Abdominal pain  Weight loss
 Pleuritic chest pain  Fatigue
 Back pain  Arthralgias/ myalgias
 Abdominal pain

SIGNS
 Fever
 Heart murmur
 Nonspecific signs –
1). Petechiae :- Often located on extremities or mucous membranes
2). subungal or “splinter” hemorrhages:- Nonblanching, Linear reddish-
brown lesions found under the nail bed, Usually do NOT extend the entire length of the
nail
3). clubbing,
 4). splenomegaly,
5). neurologic changes

 More specific signs -

1). Osler’s Nodes:- Painful and erythematous nodules,
Located on pulp of fingers and toes
More common in sub acute IE

2). Janeway lesions:- Erythematous, blanching macules

Non painful
Located on palms and soles

3).Roth Spots:-Seen retina of eye

COMPLICATIONS

CARDIAC EXTRA CARDIAC

 Valvular stenosis or insufficiency
 Perforation, rupture and aneurysm
of valve and leaflets
 Abscesses in the valve ring
 Myocardial abscesses
 Suppurative pericarditis
 Cardiac failure
 Infracts in spleen, kidneys and brain
 Pulmonory abscesses
 Petechiae (skin conjunctiva)
 Osler’s nodes(SABE)
 Janeway’s spots (ABE)

Tuberculosis Endocarditis:- It is characterized by presence of typical tuberculosis on

the valvular as well as mural endocardium and form tuberculosis thrombo emboli

Syphilis Endocarditis:- Aortic valvular incompetence (severe)

Fungal Endocarditis:- Opportunistic fungal infections like candidiasis ans aspergillosis

are seen I patients receiving long term anti biotic therapy

Viral Endocarditis:- Only in experiment

Rickettsial Endocarditis:- Another rare cause of endocarditis is form infection in Q

fever