周京敏－感染性心内膜炎.ppt

感染性心内膜炎
Infective Endocarditis
Definition and classification
心(血管)内膜(瓣膜)感染
急性(AIE):毒力强,病程短,中毒症状明显
亚急性(SIE, SBE):毒力低,病程长
自体瓣膜感染:native valve endocarditis
人工瓣膜感染:prosthetic valve endocarditis (PVE)
右心瓣膜感染性心内膜炎
right heart valve endocarditis: drug abuse, AIDS, catheterization
Etiology and Mechanism
草绿色链球菌,50%
葡萄球菌,葛兰氏阴性杆菌
AIE:
葡萄球菌,可发生于无器质性心脏病患者
SIE:
链球菌,esp. 院外感染,几乎均有心脏病基础
PVE:
表皮葡萄球菌,术后1年内
Endocarditis
Heart structural
abnormality
Endocardial injury
thrombosis
Adhesion of bacteria
Disturbance
of blood flow
Mechanism
vegetation
Systematic embolism, abscess
Endocarditis
Kidney, Liver, Joint diseases
Immune system activation
Pathology
Thrombus and bacteria
Clinical Manefestation
全身表现:
发热,高热,低热,无发热
乏力,多汗,贫血,体重减轻,食欲不振
心脏:
Murmur appearance or change
Heart failure
Arrhythmia: heart block, severe
血管损害:Systematic embolism
Skin: petechiae
Spleen,
kidney,
limbs,
Brain,
Messentric embolism
免疫反应表现:
Often seen in SIE
No characteristics
Osler node, Toth
Clinical Manefestation
Embolic lesions on the feet of a patient with us aureus endocarditis
Skin and Nail Lesions in al endocarditis.
Typical subungual ("splinter") hemorrhage and numerous petechiae on the skin of the abdomen
Lab findings
Blood culture:
Most important diagnostic method
Vein blood X 3 times
Negative does not exclude the diagnosis