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Infective Endocarditis Essay


Infective endocarditis is a major cause of morbidity and mortality especially in most parts of the world. However, based on epidemiological studies the predisposing factors, etiology and outcomes based on different parts of the world. Infective endocarditis occurs at a mean age of 45-60 in the West while it occurs at a much younger age in the developing countries. This case report is more consistent with an age of presentation in developing countries.

Globally, the most common pathogen responsible for the causation of infective endocarditis is S aureus. S aureus has overtaken the S viridians streptococci. Overall, S aureus is the most frequently isolated pathogen, accounting for nearly 30-40% of cases. The cultures in the case scenario grew Streptococcus mutants which is not one of the most common strains of organism cultures globally.

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The trend seen developed countries can be attributable to an aging population, more frequent intravenous drug use in the community, and an increased frequency of nosocomial, prosthetic valve, and iatrogenic endocarditis. This is in marked contrast to developing countries where the trend in causation is majorly contributed by rheumatic and congenital heart diseases (Choudhary). Developing counties rarely perform prosthetic valve insertion therefore streptococci still dominate their patient population, as in other studies from poorer countries.

One in eight cases of infective endocarditis is caused secondary to bacteremia caused by dental procedures (in most cases due to Streptococcus viridians, which reside in the oral cavity) (Shanson). Antibiotics are administered to patients with certain heart conditions as a precaution. In this case antibiotics were not administered and therefore might have caused the infective endocarditis in the patient.

The clinical presentation of infective endocarditis has been clinically as acute or sub-acute depending on the causative organism. The more acute forms of bacteria are Syaphlyoccus aureus which is the ore metastatic and more virulence. The sub-acute forms are the Streptoccocus viridians and mutants which are less aggressive and virulent. The case presentation is less virulent and more prevalent affect the patient.

The Duke and modified Duke criteria both depend on echocardiographic, microbiologic, and pathologic criteria and patients with clinically-suspected IE are classified as “definite”, “probable”, and “rejected” cases based upon these criteria. In this case, the patients echo showed valvular vegetation’s complemented with an elevated ESR which is consistent with many studies on diagnosis of IE. These criteria are associated with 99% specificity for diagnosis in follow-up studies (Chambers et al.)

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Works Cited
Chambers, John B., et al. “Antibiotic prophylaxis of endocarditis: the rest of the world and NICE.” (2011): 138-140.
Choudhary, Shiv K., et al. “Mitral valve repair in a predominantly rheumatic population: long-term results.” Texas Heart Institute Journal 28.1 (2001): 8.
García-Rinaldi, Raúl. “Tricuspid anterior leaflet replacement with autologous pericardium and polytetrafluoroethylene chordae, followed by edge-to-edge repair.” Texas Heart Institute Journal 34.3 (2007): 310.
Shanson, David. “New British and American guidelines for the antibiotic prophylaxis of infective endocarditis: do the changes make sense? A critical review.” Current opinion in infectious diseases 21.2 (2008): 191-199.

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