复旦大学附属中山医院：《内科学》课程教学资源（PPT课件，双语版）感染性心内膜炎（周京敏）

感染性心内膜炎 Infective Endocarditis

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) 右心瓣膜感染性心內膜炎 right heart valve endocarditis: drug abuse, AIDS, catheterization

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 AI 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

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

Mechanism Heart structural Disturbance abnormality of blood flow Endocardial injury thrombosis: -Adhesion of bacteri Endocarditis

Endocarditis Heart structural abnormality Endocardial injury thrombosis Adhesion of bacteria Disturbance of blood flow Mechanism

Pathology Thrombus and bacteria Endocarditis vegetation Immune system activation Systematic embolism, abscess Kidney, Liver, Joint diseases

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

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

Clinical manefestation 血管损害: Systematic embo|ism Skin: petechiae Spleen, kidney, limbs Brain Messentric embolism 免疫反应表现: Often seen in SIE No characteristics Osler node, Toth

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 Staphylococcus aureus endocarditis A B

Embolic lesions on the feet of a patient with Staphylococcus aureus endocarditis

Skin and Nail Lesions in staphylococcal endocarditis Typical subungual splinter hemorrhage and numerous petechiae on the skin of the abdomen

• Skin and Nail Lesions in staphylococcal 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

Lab findings • Blood culture: – Most important diagnostic method – Vein blood X 3 times – Negative does not exclude the diagnosis