Summary about Disease
Bacterial endocarditis is an infection of the inner lining of the heart chambers and heart valves (endocardium). It occurs when bacteria or other germs enter the bloodstream and travel to the heart, where they can attach to damaged heart tissue and form vegetations (clusters of bacteria and blood clots). If left untreated, it can damage the heart valves, leading to heart failure, stroke, and other life-threatening complications.
Symptoms
Symptoms of bacterial endocarditis can develop slowly or suddenly. Common symptoms include:
Fever
Chills
Fatigue
Night sweats
Muscle aches
Cough
Shortness of breath
New or changed heart murmur
Small, painful nodules on the fingers or toes (Osler's nodes)
Painless, flat, red spots on the palms of the hands or soles of the feet (Janeway lesions)
Tiny, splinter-like hemorrhages under the fingernails (splinter hemorrhages)
Swelling in the feet, legs, or abdomen.
Causes
Bacterial endocarditis is most commonly caused by bacteria entering the bloodstream. This can happen through:
Infections in other parts of the body (e.g., skin infections, pneumonia, urinary tract infections)
Dental procedures
Intravenous drug use
Catheters, especially central lines and hemodialysis catheters
Surgery, especially heart surgery People with pre-existing heart conditions, such as damaged heart valves, congenital heart defects, or a history of endocarditis, are at higher risk of developing the infection.
Medicine Used
The primary treatment for bacterial endocarditis is intravenous (IV) antibiotics. The specific antibiotic used depends on the type of bacteria causing the infection and its sensitivity to different drugs. Common antibiotics used include:
Vancomycin
Penicillin
Gentamicin
Ceftriaxone
Daptomycin The duration of antibiotic treatment is typically 4-6 weeks. In some cases, surgery to repair or replace damaged heart valves may be necessary.
Is Communicable
Bacterial endocarditis itself is generally not considered communicable in the typical sense (i.e., not spread person-to-person through casual contact or airborne transmission). However, the underlying bacterial infections that cause endocarditis can be communicable. For example, a skin infection that leads to endocarditis could potentially spread to another person through direct contact. The endocarditis itself is a consequence of the infection reaching the heart.
Precautions
To prevent bacterial endocarditis, the following precautions are recommended:
Good oral hygiene: Regular brushing, flossing, and dental check-ups
Preventing infections: Prompt treatment of skin infections, pneumonia, and other infections
Antibiotic prophylaxis: Antibiotics before certain dental or surgical procedures for people at high risk
Avoiding intravenous drug use
Proper care of catheters and IV lines
How long does an outbreak last?
Bacterial endocarditis is not generally considered to occur in "outbreaks" in the same way that a highly contagious illness like influenza might. Rather, it occurs as individual cases. The duration of the illness itself varies from weeks to months, depending on when the disease is diagnosed, the severity of the infection, the type of bacteria involved, the individual's overall health, and how promptly and effectively treatment is administered.
How is it diagnosed?
Bacterial endocarditis is diagnosed based on a combination of factors, including:
Medical history and physical exam: Assessing risk factors and looking for signs and symptoms.
Blood cultures: Identifying the bacteria causing the infection. Multiple blood cultures are usually taken.
Echocardiogram: An ultrasound of the heart to visualize the heart valves and look for vegetations or other abnormalities. (Transthoracic echocardiogram or transesophageal echocardiogram)
Electrocardiogram (ECG or EKG): To assess the heart's electrical activity.
Chest X-ray: To check for signs of heart failure or pneumonia.
Complete blood count (CBC) and other blood tests: To assess overall health and inflammation markers. Modified Duke Criteria are often used to establish the diagnosis based on major and minor criteria.
Timeline of Symptoms
The timeline of symptoms can vary widely.
Acute endocarditis: Symptoms develop rapidly, often within days or weeks.
Subacute endocarditis: Symptoms develop more slowly, over weeks to months. The timeline of symptoms after antibiotic treatment begins also varies. Fever and other symptoms may improve within a few days, but the full course of antibiotics is necessary to eradicate the infection.
Important Considerations
Early diagnosis and treatment are crucial to prevent serious complications.
People at high risk of endocarditis should discuss antibiotic prophylaxis with their doctor before certain procedures.
Long-term follow-up with a cardiologist is important to monitor for complications and recurrence.
Patients need to understand the signs and symptoms of endocarditis and seek medical attention promptly if they develop.
Antibiotic resistance is an increasing concern, so it is important to use antibiotics judiciously and to follow the prescribed course of treatment.