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Emergency: requires immediate attention
Subacute bacterial endocarditis in Child
See also in: Nail and Distal Digit
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Emergency: requires immediate attention

Subacute bacterial endocarditis in Child

See also in: Nail and Distal Digit
Print Images (5)
Contributors: Neil Mendoza MD, Paritosh Prasad MD
Other Resources UpToDate PubMed

Synopsis

Bacterial endocarditis is an infection of the endocardial surface of the heart. The most common structures of the heart affected are the heart valves. Historically, the term "acute" endocarditis was used to describe the rapidity of symptoms, as opposed to "subacute" endocarditis. However, these terms have fallen out of favor as it is well known that there is significant overlap in presentation. A more helpful description is to use the name of the pathogen causing endocarditis (eg, a physician might say "native aortic valve endocarditis due to Staphylococcus aureus").

Patients at increased risk of this infection include intravenous drug users and patients with a predisposing heart condition including the presence of cardiac devices or prosthetic cardiac valves.

Clinically, the patient may appear acutely ill, chronically ill and wasted, or in rare cases, the patient may be fairly asymptomatic. Patients typically have fever. Cardiac murmur is usually present. On physical exam, there may be conjunctival hemorrhages, splinter hemorrhages, Janeway lesions (nontender hemorrhagic macules and papules on the palms), Osler nodes (painful erythematous nodules located on the fingertips), or Roth spots (pale lesions with surrounding hemorrhage seen in the fundi, with an ivory or white center surrounded by a red halo). Palpable purpura may also be seen.

Imaging may reveal septic pulmonary infarcts, mycotic aneurysms, and stroke. Laboratory testing may reveal anemia, leukocytosis, elevated ESR, positive rheumatoid factor, hematuria, and red blood cell (RBC) casts in urine.

The diagnosis of endocarditis can be made by isolating the responsible organism in blood culture and by visualizing the vegetation on echocardiography. Treatment is with prolonged antibiotics and sometimes with surgery to remove the source of infection.

Codes

ICD10CM:
I33.0 – Acute and subacute infective endocarditis

SNOMEDCT:
73774007 – Subacute bacterial endocarditis

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

  • There are a variety of infections that can result in bacteremia without necessarily being associated with seeding of the heart valves. Cellulitis, septic joint, cholecystitis or cholangitis, and intraabdominal abscess are a few such infections.
  • Cardiac devices such as pacemakers or left ventricular assist devices or other intravascular devices such as PICC lines or ports can become infected and lead to prolonged bacteremia without the heart valves themselves necessarily being infected.
  • Some conditions are associated with noninfectious valvular vegetations – systemic lupus erythematosus, Lambl's excrescences.
  • Some conditions can be associated with skin findings that could appear similarly to those seen in endocarditis – cholesterol emboli, left ventricular thrombus with subsequent embolization, embolization of deep vein thrombosis in cases of right-to-left cardiac shunts, vasculitis.

Best Tests

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Management Pearls

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Therapy

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References

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Last Reviewed: 12/02/2012
Last Updated: 01/17/2017
Copyright © 2018 VisualDx®. All rights reserved.
Emergency: requires immediate attention
Subacute bacterial endocarditis in Child
See also in: Nail and Distal Digit
Print 5 Images
View all Images (5)
(with subscription)
Subacute bacterial endocarditis : Fever, Developed steadily over weeks to months, Heart murmur, Microscopic hematuria, Splinter hemorrhage, RBC decreased, RF positive, Osler nodes
Clinical image of Subacute bacterial endocarditis
Copyright © 2018 VisualDx®. All rights reserved.