Infectious endocarditis: symptoms and symptoms in older adults and children. Uwaga! Infectious endocarditis Infectious endocarditis clinically manifest

Infectious endocarditis (IIE) is a non-infectious polyposis-inflamed endocardial inflammation, so that vegetation on the valves or subvalvular structures is supervised, destructive, damaged valve function. The most frequent pathogenic microorganisms, for fungi attack earlier valve changes and subvalvular structures, including those with rheumatic heart disease, degenerative valve changes, PMC, piece valves, etc. Tse so ranks secondary infectious endocarditis. In the last cases of infectious endocardium, the endocardium develops on a number of uninfected valves (primary infectious endocarditis). In the last few years, the frequency of primary infectious endocarditis has grown to 41-54% in all cases of illness. They also develop hospitality and adolescents for infection with endocarditis. To reach wider in the last prolonged interruption of endocarditis in the Danish hour є the great rіdkіstu. Most often the mitral and aortic valves are at odds, and more often the tricuspid and the valve of the leg artery. The dissection of the endocardium of the right side of the heart is most characteristic of the Ukrainian drug addicts. The incidence of sickness for infectious endocarditis is 38 cases per 100 thousand population (M.A. In the remnants of rock, it is all over the place that there is an increase in the incidence of infectious endocarditis, and it is associated with a wide range of invasive instrumental technology, with more frequent operations during the winter, during the winter. The mortality rate in infectious endocarditis is at least 24-30%, and 34-44% can be reached in the case of a sickly and elderly person (O.M.Butkevich, T.L. Vinogradova, 1993). The figures speak about the complexity of free diagnostics and the treatment of this disease.

Ethiology

Perebіg of infectious endocarditis is characterized by a superficially wide range of illnesses, which can lead to illnesses. Tse bacteria, fungi, viruses, rickets, trash, mycoplasma and in. The most common cause of illness is streptococcus, in some cases of seizures, up to 60-80% of cases of infections in infectious endocarditis. Moreover, we will broaden the most with a broth from the whole microbial group (30-40%) є a green streptococcus (Streptococcus viridans), which will help you to associate with it in order to get rid of it. It is important to remember, as factors, which are responsible for this activation, for manipulation in the empty company, for surgical intervention, tonsillitis, pharyngitis, sinusitis, and the so-called "oral sepsis"

Infections - Streptococcus: Streptococcus viridans (green) Enterococcus, Staphylococcus: St. aureus (golden), gram aerobic stick, anaerobic, fungi, polymicrobial infection.

Enterococcal endocarditis, the frequency of which for the last 20 years has significantly increased, is characterized by an abnormal excess and stiffness to a large extent of widely vicious antibiotics. Enterococcal endocarditis is seen in ailments who have suffered empty operations on black empty for gynecological operations. On the other hand, for the significance in the etiology of infectious endocarditis (10-27%), the cost of golden staphylococcus (St. heart-vascular system, As well as osteomyelitis, abscesses in localization, drug addiction. Infectious endocarditis, viklicanii with golden staphylococcus, we are welcomed by the breakdown and frequent lesions of intact valves. In the last few years, there is an increase in the frequency of infectious endocarditis, which occurs with gram-negative microflora (kishkova, sygnogniina sticks, microorganisms of the NASEC group). It is tied, persh for everything, to the increase in the number of drug addicts, ailments, who suffer for chronic alcoholism and mental problems. In cich vipadkah, it usually contradicts important endocardial lesions, which are susceptible to antibiotics, as well as frequent arterial thromboembolism. In connection with the growth-tolerant implantation of drugs, the frequency of immunosuppressive stans, including those that are trivial in the implantation of cytostatics, the growth of the value of polymicrobial etiology of infectious endocarditis. Cich vipadkahs become ill with a burrhliv ear, bad valvular heart problems, frequent diseases up to a pathological process of the myocardium and a fast development of heart failure. The singing ethiological role is also introduced to mushrooms, rickets, chlamydii, viruses, microplasmas, and others. Sorry, in real CLINIC PRACTICE it is far from expecting to see a child with an infectious endocarditis from blood, which is tied, for everything, because of the signs of antibiotics until the blood for sterility and from vicarious in the laboratories of the middle-sensitive, elderly people. Approximately 20-40% of ailments become ill with etiology.

pathogenesis

per happy news Infectious endocarditis develops as a result of the foldable interaction of three main factors: bacterium; school endotelia; weakening of resistance to organism. Bacteremia is a process of circulation of quiet infectious agents in the bloodstream. Dzherelom bacteriєmia can serve: malignant infections in the diagnosis of chronic infections in organism (tonsillitis, sinusitis, dental caries, otitis media, osteomyelitis, furunculosis, proctitis and in.); whether operatively involved in the organs of the black empty, sechostatic organs, hearts, vessels, and to restore the extractions of teeth; invasive dosage internal organs, Including catheterization sectional mikhura, Bronchoscopia, gastroduodenoscopy, colonoscopy, be-like manipulation in mouth emptying, іrigoscopy and іn.; lack of sterility in case of parenteral injections (for example, in drug addicts). Slid memory, you can find a very special toilet, an empty company can lead to a short-hour bacterium. In such a rank, bacteriєmiya is to endure a frequent phenomenon, like being seen in the life of skin people. However, in order for the circulating infectious agents in the blood to be diagnosed, two of the most common obstructive minds are needed to get diagnosed with an infectious endocarditis.

School of endotelia. In case of secondary infectious endocarditis, it develops on the already formed dowry, or congenital heart defect, prolapse of the mitral or tricuspid valve and other diseases of the valve apparatus, it is practically essential for the little men and women. With the manifestation of valve pathology, the risk of transformation of bacterium into infectious endocarditis reaches 90% (M.A. Gurevich z spivavt., 2001). With the appearance of cobially invariable valves (primary infectious endocarditis), it is quite significant in the secondary endothelium to increase hemodynamic damage and metabolic problems, which are characteristic, for example, for bad It means, for example, a trivial inflow to the endocardium of uninterrupted valves in high-flow and turbulent blood flows. It is not for nothing that most often infectious endocarditis develops on the stools of the aortic valve, which are infused into high-flowing blood streams. Whether the change of the surface of the endocardium is produced before the adhesion (adhesion) of platelets, aggregation and the start of the process of muscular coagulation, and until the endothelium of platelet microthromatosis is established on the surface. To develop so the titles of non-bacterial endocarditis. As soon as there is a presence of bacteremia, microorganisms from the bloodstream adhere and colonize microthrombi. Above, there is a new port of thrombocytes and fibrin, which can capture microorganisms from both phagocytes and other officials of the anti-infectious organism. As a result, great light is formed on the surface, similar to polyp and is stored in thrombocytes, microbes and fibrin, which I call vegetation. Microorganisms in such vegetation are recognized ideally think for their own reproduction and life. Weakening of resistance to organisms є other necessary mental development of infectious disease in the heart on the basis of bacteria. The changes in the reactivity of the organisms are caused by the sudden change, overcooling, in the near-city flow of internal organs, the most uncomfortable officials in the midst of the community. At the same time, the change in the immune status may appear in the heart of the supervisor.
1. Destruction of the valve stools and subvalvular structures, cutting tendon threads, tearing the valve stools, it is natural to lead to the development of valve failure.
2.Immunological changes in vigels humoral immunityі nonspecific systems for the patient (M.A. Gurevich with sp_vavt.): · High titers of autoantitils (cryoglobulins, rheumatoid factor, antimyocardial antibodies and in.); · Decrease in the place of complement; · Osvita circulating immune complexes (CVC).
3. Numerical immunopathological reactions in the internal organs, dressings, sprouts, with the attachments of immunoglobulin and CVC on the basal membranes and development: · glomerulonephritis; Myocarditis; · Arthritis; Vasculitis etc.
4. Vinnennya thromboembolism in the arterial vascular bed of the leg, brain, intestine, spleen and other organs. day qih pathological changes viznachaє klinichnu picture of infectious endocarditis.

The main pathological processes, which start a clinical picture of infectious endocarditis, are:
1. Osvita on stools valves and sub-valve structures of vegetation, which leads to destruction and failure of the valve.
2. Immunopathological reactions, associated with high titers of autoantitils, circulating immune complexes and inferior lesions, which can be superimposed on myocarditis, glomerulonephritis, arthritis, vasculitis, etc.
3. Destruction of all cells of the cell, humoral immunity and nonspecific zahist organism, drastically reducing its resistance.
4. Thromboembolic acceleration.

key picture

Suchasne klinichny interruption of infectious endocarditis is characterized by: · significant reversal of forms of endocarditis; · Increase in the number of atypical options for overcoming ailments due to erased clinical symptomatology; · Disorders of immunopathological manifestations (vasculitis, myocarditis, glomerulonephritis), and some of them come to the fore in the main picture of the disease. The majority of pre-adversaries prevent the development of a particularly chronic (recurrent) form of infectious endocarditis, some cases of recurrent illness - as a rule, the result of inadequate treatment of illnesses on the basis of The clinical picture of infectious endocarditis is seen as a great development of symptoms. Krіm types klіnіchnih proyavіv, endokardit Mauger protіkati atipovo, pid mask of іnshih zahvoryuvan, obumovlenih іmunopatologіchnim urazhennyam organіv abo tromboembolіchnimi uskladnennyami: glomerulonephritis, іnfarktu Nirk, gemoragіchnogo vaskulіtu, stenokardії abo IM, іnfarktu lung GOSTR torn down Mozkovy krovoobіgu, mіokarditu, sertsevoї nedostatnostі i t. etc.

skargi

Fever and intoxication - most of the early and post-mortem symptoms of infectious endocarditis, which are more likely to occur in all ailments. The nature of the temperature adjustment can be very good. With pidgostroma endocarditis of ailment, it is often necessary to repair it as a bile, with low-grade fever, non-fever, headache, backward weakness, swollen stomatomy, decreased appetite, emaciation. The subfebrile temperature is superfluous; At the end of the period of cardial scarg, as a rule, on the day, behind the blame of sinus tachycardia, as it is often unreliable to mate with the increased temperature of the body. The fever herself and her own symptoms of intoxication are unrepentant as they manifest tuberculous intoxication, chronic tonsillitis, chronic bronchitis, Viruses, infections, etc. Through a number of types (up to 4-8 types), a larger type of key picture is formed. An incorrect remitting type of fever (earlier hectic or postin) is established. The temperature of the body is moving up to 38-39 ° С and it is accompanied by swirling chills. In some cases the temperature fluctuates in short periods of decrease to subfebrile or normal numbers. When you see a red sticky pita s unacceptable smell... Cardial symptoms become more pronounced, with the form of aortic or mitral heart defect or myocarditis. On the smallest build-up of intoxication and increased temperature, there may be symptoms and the progress of the onset of symptoms: physically assigned for in peace; · Pain in the area of ​​the heart, often trivial, of the same intensity; in big ridkish vipaduyu more to inflate a hostile character and to fake an attack of angina pectoris; · Stika of sinus tachycardia, as it is not possible to lie down at the step of the temperature increase. More importantly, there may be a flared-up picture of a flunky lack.

Інші skargi. A trace of memory, which is infectious endocarditis, which is a multiorgan ailment, which can manifest symptoms, enlarging the lesions not only of the heart, but of the other organs and systems. At the connection with cymus on the first plan, there may be symptoms such as: • embarrassment of the ochim, shelter at the slaughter, head bile, bile at dylyantsi nirok, collapse of sevipuskannya (symptoms of glomerulonephritis or infarction of nirka); · Intense headaches, hypothermia, nudity, bloating, hyperthyroidism and intermediate neurological symptoms (cerebrovascular disease or thromboembolism of cerebral vascular disease with the development of an ischemic stroke); · small pains in livu pidreber'yi (splenic infarction); · Visipannya on shkіrі according to the type of hemorrhagic vasculitis; · Clinical manifest infarction pneumonia; · Raptova vtrata zoru; · More in the slopes і ін.

physical dosage

look around
With a typical classic interruption of infectious endocarditis, a backward examination allows the appearance of numerical nonspecific symptoms:
1. Blindness of small curves with siruvato-zhovtim vidtinkom (color "cavi with milk"). The problem of children is explained, in the main, characteristic of infectious endocarditis anemia, and the disease of children - patients with a pathological process of the liver and hemolysis of the erythrocytes.
2. Skhudnennya is typical for ailments on infectious endocarditis. In some ways, it grows more quickly, stretching out the decimals.
3. Variations of finger phalanges in the "drum sticks" and nigtyvs behind the type of "old glasses", which appear only when there is an occasionally trivial interruption of the disease (about 2-3 msec.).
4. Peripheral symptoms associated with vasculitis and embolism: The stench may not be large, do not faint with pressure, painless with palpation. Petechiae are not often localized on the anterior upper surface breast cancer, on foot. During the year, petechiae swell up a brownish appearance and become aware of it. · Some petechial hemorrhages are localized on the transitional fold of the lower conjunctiva - by the Lukin beaches or on the mucous membranes of the empty company. At the center of other hemorrhages in the conjunctiva and mucous membranes, a zone of blanching is characteristic. · Plami Rota - similar to those of Lukin's bloodshed in the eyes of the eye, in the center there is also a blanching zone, which appears at special preliminaries. Linear hemorrhage for patients. · Osler's universities - sickly chervonuvati strains of lightning with a size of a pea, roasting in shkiri and podshkirniy klitkoviny on hollows, fingers, pidoshvats. Osler's universities are small igneous infiltrates, thrombovascularization and embolism in other courts. Having appeared in a school or a child's bed, the stench is to get you to know it. Rumpel-Leede-Konchalovsky's test is positive, as to indicate the function of microsudin lamellae, but it is not often possible to be associated with secondary cases of the vertebral column in case of blood / platelet vasculitis (platelet disease) The test is carried out by the offensive rank: the cuff for vimіryuvannya arterial vise is applied on the shoulder, in which a permanent vise is opened, equal to 100 mm Hg. Art. After 5 minutes, evaluate the test results. When there is a breakdown of the thrombocyte hemostasis, the lower cuff is deprived of a small number of petechial (small-point) hemorrhages (less than 10 petechiae in the zone, surrounded by a colum with a diameter of 5 cm). In case of increased penetration of sudin or thrombocytopenia, the number of petechii in the petechial zone is 10 (positive test). As a result of memory, all peripheral symptoms of infectious endocarditis in the end of the day appear to end up pretty badly.
5. Signs of heart failure, how to develop in the form of aortic, mitral or tricuspid insufficiency and myocarditis (div. ін. 6. INSHI zovnіshnі Show hvorobi, zumovlenі іmunnim urazhennyam vnutrіshnіh organіv, tromboembolії and takozh rozvitkom septic vognisch in vnutrіshnіh bodies napriklad: · svіdomostі torn down, paralіchі, paresis that INSHI zagalnomozkovі i oseredkovі nevrologіchnі symptoms SSMSC Je Find our cerebral uskladnen (іnfarktu mozk, how to develop in cases of thromboembolism of cerebral vessels, intramuscular hematomas, brain abscess, meningitis too); Signs of thromboembolism of the legacy artery (BODY), it is not uncommon to appear when the tricuspid valve is severe (especially often in drug addicts) - backwardness, venom, bile behind the breastbone, cyanosis and in.; · Signs of thromboembolism and septic lesion of the spleen - splenomegaly, ailment in the left debris; · Ob'ktivnі signs of severe asymmetric arthritis of other joints of the hands and feet.

Palpation and percussion of the heart
Spend in the clinical picture of infectious endocarditis, the order of fever and symptoms of intoxication, in the heart, show sickness, mind the form of heart defect, myocarditis and (inodi) vascular disease (coronary artery disease) When GOSTR perebіgu іnfektsіynogo endokarditu, raptovomu rozrivі tendon thread mіtralnogo abo trikuspіdalnogo klapanіv rozvivaєtsya GOSTR lіvoshlunochkova abo pravozheludochkovayanedostatnіst, Find our yakih detail in opisanі rozdіlah 6 i 13. Naychastіshe sposterіgaєtsya urazhennya aortic valve (at 55-65% Khvorov) rіdshe zustrіchaєtsya nedostatnіst mіtralnogo valve ( in 15-40% of people with ailments). Combination of aortic and mitral valve lesions occurs in 13% of cases (M.A. Gurevich et al., 2001). The lack of a tristular valve in general is not so common (in 1-5% of cases), if drug addicts have a problem with localization (in 45-50% of patients). Dates of palpation and percussion of the heart begin to localize infectious lesions (aortic, mitral, tricuspid valve), as well as the apparent abnormalities of the disease, on the other end of the disease. In most cases, there are signs of the expansion of the LSH and the third hypertrophy: from the top to the highest postage and from the other between the common dullness of the heart, the bottled and the strengths from the top shipments.

Auscultation of the heart
Auscultatory signs of the formation of a defect of the heart start to fix it to appear after 2-3 months of a hot period. In case of severe aortic valve, stepwise repair weaknesses I and II heart tone. At the II mid-ribs on the right side of the sternum, and also at the point of Botkina there is a quiet noise of diastoli, which should be repaired immediately after the II tone. The noise is decrescendo and is carried out at the top of the heart. When the mitral valve is severe, there is a weakening of the first tone of the heart and there is a rough systolic murmur at the top, which is carried out in the left groin area. The dissection of the tristular valve is characterized by the appearance of a systolic murmur of tricuspid insufficiency, the maximum of which is localized in the V mid-ribs of the sternum. The symptom of Rivero-Corvallom (div. Rozdil 8) is not uncommon. Arterial pulse and arterial grip It is important to establish auscultatory data from the pre-existing powers of the arterial pulse and changes in the arterial grip. With the formation of aortic inadequacy of the development of a distal noise, start to associate with changes in the pulse for the type of pulsus celer, altus et magnus, as well as with a decrease in the frequency of AT and a tendency to an increase in the systolic arterial. At mіtralnoї failure є weakly rotated tendency to a change in systolic and pulse AT. Organ of empty splenomegaly - one s frequent signs Infectious endocarditis, which appears in all cases of illness. Splenomegaly is associated with generalized infection, the manifestation of abscesses and infarctions of the spleen.

Laboratory and instrumental dosage

Foreign and biochemical analysis of blood
In typical types of sickness in blood analyzes, there is a characteristic triad of symptoms: anemia, leukocytosis and an increase in SHOE. Anemia, often of the normochromic type, appears approximately in ailments, especially in primary infectious endocarditis. Anemia is pummeled by the head rank due to the cystic marrow. · Zbіlshennya SHOE, in the range of vipadkіv reachє 50-70 mm / year, more often in all patients with infectious endocarditis. · Leukocytosis due to destruction of the leukocyte formula of blood is also characteristic for infectious endocarditis. Variations, hyperleukocytosis, start to depend on the admission of hyperleukocytosis. At the same hour, the number of leukocytes may be normal for the ailments, and in some cases leukopenia may be present.

In the biochemical analysis of blood, as a rule, dysprotheinemia starts to develop, it is accompanied by a decrease in albumin and an increase in the amount of g-globules and often a2-globules. It is also characteristic of the appearance of a C-reactive protein, an increase in the substitution of fibrinogen, seromucoid, and positive precipitation of a sample (formol, sublimate). In half of the ailments, rheumatoid factor shows up for infectious endocarditis, in 70-75% of the ailments, the titer of CVC, a high level of C3 and C4 components in the complement.

Donate blood for sterility
The results of microbiological preliminaries of blood are viral in the diagnosis of infectious endocarditis and the vibration of adequate antibacterial therapy. To reject reliable results, the first for everything, the necessary correct blood collection, which transfer of the offensive principles: · Taking blood away according to the rules of asepsis and antiseptics only by way of punctuation of veins or arteries and special systems; · Otrimanija zrazok krovі is guilty but secretly deliveries to the laboratory. Blood sampling technology. When carrying out blood sampling for microbiological preschool, the first for everything, a unique contamination of the animal flora. At the same time: · in the area of ​​the punctuation of the court, a two-way cleaning of the field with an antiseptic (2%) is carried out with an antiseptic (2%), iodine, 70% alcohol or an antiseptic); shaping of the shkiri is carried out in circular rods towards the center to the periphery; · Palpate the vein in the puncture of the skin only in sterile mittens; it is necessary to unicati the repeated tinkling with a bare shkiri; · For blood sampling, vikoristovyt sterile syringes with a volume of 10-20 ml or special attachments (vacuum bottles); · From veni take 5-10 ml of venous blood in 2 vials with vital medicinal products and safely send them to the laboratory. In case of a state of infectious endocarditis, if antibacterial therapy is inadequately repaired, they should take shelter three times at intervals of 30 min. In case of pidgostroma of infectious endocarditis, a three-time blood sampling can also be carried out for 24 years. For 48-72 years the growth of floris has not been taken away, it is recommended to grow more 2-3 times.

electrocardiography

EKG changes with nonspecific infectious endocarditis. When myocarditis is diagnosed (diffuse or vognischevy), there may be signs of AV block, smoothed or inverted T wave, depression of the RS-T segment. Thromboembolism in the coronary artery is superimposed on the characteristic EKG-signs of IM (pathological Q wave, changes in the RS-T segment and in.)

echocardiography

Echocardiographic dosage of the valve apparatus in case of infectious endocarditis is more important and practical, although there are some small indications in bagatio that allow direct signs of a disease - vegetative changes on the valves, which are 2-3 mm wide. Greater informativeness (close to 70-80%) in this particular type of display is less M-modal. Vіdrіznyayuchis more high razdіlnіyu zdatnіstyu, however, allowing to develop low-amplitude, high-frequency systolic vibrations, tied to the stools of the valves. Vegetables appear at the sight of anonymous additional signals, as they "raise" the images of loose valve stools ("baggy" stools) Loose vegetation may start to twist the shape. One end of the stench will attach itself to the chairs, and the last stop will move with the flow of blood, as it is just across the ruins of the chairs themselves. For example, when the vegetative tristle valve is damaged, it is either flushed into the empty PP (in systole), then it is in the empty pan (in the diastole). Unruly vegetation є small draining on the valve stools, which are often tied to them and will repeat the hands of the stools. One of the important factors in the acceleration of infectious endocarditis is the dissection of the tendon threads of the mitral valve, as well as the pathological collapse of the stool. The chords of the rear or front stools are superimposed on chaotic large-scale stools and systolic prolapse into the empty drug. With two-world echocardiography, it is possible to visually change the color of the chordi without a second, and move freely in the empty LSh.

Criteria for the diagnosis of infectious endocarditis

Diagnosis of infectious endocarditis is primed on emerging decilkoh providnye signs: · fever at 38 ° C; · Evidently the form of lack of aortic, mitral, or tricuspid valves; · Evidence of supportive immune disorders (glomerulonephritis, myocarditis, Osler's universities, hemorrhages, Lukina and іn.); · Echocardiographic appearance of vegetation on the stools of valves or signs of a "new" defect of the heart; · Positive results and inoculation of blood for sterility; · Anemia, leukocytosis with neutrophilia, improvement of SHOE; · Improvement of the spleen and in. Diagnostic value of skin pererahovanih sign is not the same. Therefore, for the correct and timely diagnostics of infectious endocarditis, it is necessary to analyze the entire clinical picture of an illness, anamnestic data, the results of laboratory and instrumental methods in the past. In the last classic signs of infectious endocarditis, there were three symptoms: fever, anemia, noise. In the day of the greatest expansion in clinical practice, the so-called Duke-criteria for diagnostics of infectious endocarditis were considered, so that one can see the ample possibilities of diagnostics of a disease.

Duke-criteria for diagnostics of infectious endocarditis (in modification)

great criteria
1. Positive results of inoculation of blood A. Evidence in two blood samples from one of the typical diseases of infectious endocarditis: · S. viridans · S. bovis · HACEK group · S. aureus · Enterococci B. start: for two or more blood samples taken at intervals of 12 years,
2. Echocardiographic signs of endocardial damage A. EchoKG-changes characteristic of infectious endocarditis:

little criteria
1. The occurrence of heart disease, predisposing to the development of infectious endocarditis, or intravenous drug administration
2. Likhomanka vische 38 ° C
3. Sudinni accelerated (great arteries embolism, septic lung infarction, mycotic aneurysms, intracranial hemorrhage, hemorrhage in the conjunctiva)
4. Immune manifest (glomerulonephritis, Osler's universities, Rota plyami, rheumatoid factor)
5. Microbiological data (positive results of inoculation of blood, but not the main criteria, but serological signs of active infection of microorganism, healthy infections)
6. Echocardiographic data (as a result of diagnoses of an infectious endocarditis, but not as the main criteria).

lykuvannya

Treatment of patients with infectious endocarditis is carried out in a hospital based on the following basic principles (M.A. Gurevich, sp.):
1. Lіkuvannya is guilty of being ethiotropic, so that we can direct to a specific zestnik.
2. For drug use, only antibacterial drugs that can cause bactericidal action are used.
3. Therapy of infectious endocarditis is guilty of but uninterrupted and trivial: · in case of streptococcal infection - not less than 4 types; · In case of staphylococcal infections - not less than 6 types; · With gram-negative flora - not less than 8 types.
4. Likuvannya is guilty of transferring a high concentration of antibiotics in the vessel bed and vegetation (it is important to introduce antibiotics internally).
5. Criteria for detecting antibiotic treatment for the next day of decile effects: · Normalization of laboratory indicators (detection of leukocytosis, neutrophilia, anemia, viral tendency to a decrease in SHOE); · Negative results of bacterial preliminaries of blood; · Knowledge of the key manifestations of the activity of the disease.
6. In case of an increase in signs of immunopathological reactions (glomerulonephritis, arthritis, myocarditis, vasculitis), there is an increase in the number of: · Antiplatelet agents; · Hyperimmune plasmas; · Immunoglobulin of people; · Plasmapheresis too.
7. In case of ineffectiveness of conservative treatment with a stretch of 4 types and / or the obviousness of these indications (div. Lower), surgical treatment is shown.

antibacterial therapy
Unimportant to the mainstream in the last years of the great number of highly effective antibiotics and chemotherapy drugs, the treatment of infectious endocarditis should be supervised by foldable employees. Tse obumovleno zbіlshuєtsya frequency visіvannya visokovіrulentnih shtamіv zbudnikіv (stafіlokok, sinognіyna palichka, gramnegativnі mіkroorganіzmi groupies liqueurs), resistance to antibakterіalnoї terapії, znizhennyam іmunologіchnoї rezistentnostі bіlshostі ailing, ailment zbіlshennyam number Pokhil that starechogo vіku that іnshimi reasons. In addition, the effect of antibacterial therapy is abundant in the fact that there is enough concentration of antibiotics in the blood so that it can be poured into the brain, so that it can be localized in the thrombosis of burning (vegetation) Prior to the most frequent antibiotics for elimination of infectious endocarditis, antibiotics are used for bactericidal treatment: Іngіbіtory synthesis of bіlka (amіnoglіkozidі, rifampіcin); Іngіbіtory synthesis of nucleic acids (fluorochіnoloni).

Schemes of antibacterial therapy for patients with infectious endocarditis

(Antibiotics, Dozi and frequency of introduction, triviality of treatment)

Penicillinsensitive streptococci (S. viridans, S. bovis, S. pneumoniae, S. pyogenes and іn.) 1. Penicilin 2-4 mln OD of skin 4 years 4 months 2. Ceftriaxone 2 g intravenously 1 time to add 4 tyzhenitsil 3. Benzylin + + Gentamicin 2-4 mln OD skin 4 years 1 mg / kg skin 12 years 2 months 4. Ceftriaxone + + Gentamicin 2 g intravenously 1 time to add 1 mg / kg skin 12 years 2 months 5. Vancomycin 15 mg / kg skin 12 hours 4 days

Penicillin Streptococcus 1. Penicilin + + Gentamicin 4 mln OD for skin 4 years 1 mg / kg skin 12 years 4-6 months 2. Ceftriaxone + + Gentamicin 2 g intravenously 1 time to add 1 mg / kg skin 12 years 4-6 months 3. Vancomycin 15 mg / kg skin 12 years 4-6 months

Enterococci (E. fecalis, E. faecium і n.) I penicilinous streptococci 1. Penicilin + + Gentamicin 2-4 mln OD skin 4 years 1 mg / kg skin 8 years 4-6 months 2. Ampicilin + + Gentamycin 2 g skin 4 h 1 mg / kg skin 8 years 4-6 months 3. Vancomycin + + Gentamicin 15 mg / kg skin 12 years 1 mg / kg skin 8 years 4-6 months

Staphylococcus (S. aureus, S. epidermidis i n.) 1. Oxacillin + + Gentamicin 2 g skin 4 years 1 mg / kg skin 8 years 4-6 days 10-14 days 2. Cefazolin + + Gentamicin 2 g skin 8 years 1 mg / kg skin 8 years 4-6 months 10-14 days 3. Vancomycin 15 mg / kg skin 12 years 4-6 days

Gramnegative bacteria (E. coli, Proteus spp., Pseudomonas spp., Klebsiella spp., Enterobacter spp., Serratia spp.) 1. Cefepime + + Gentamicin 2 g skin 12 years 1 mg / kg skin 8 years 4 days 10-14 days 2. Cefepime + + Amіkatsіin 2 g skin 12 years 1 mg / kg skin 8 years 4 months. 10-14 days 3. Imipenem 0.5 g skin 6 hours 4 days

Fungi Candida spp., Aspergillus spp. Amphotericin B + + Fluconazole 1 mg / kg 1 time per dose 400 mg 1 time per dose 4-6 days 4-6 days

surgical treatment

The essence of operative involvement in case of infectious endocarditis in the rehabilitation of the heart chambers and radical correction of the internal cervical hemodynamics (Yu.L. Shevchenko, 1995). At the same time, it is carried out mechanically visualized tissue tissue with a further rational antibiotic therapy. If necessary, replace the prosthetic valve. The best results are indicated in patients operated on in the early term of infectious endocarditis, with spared myocardial reserves (M.A. Gurevich). Main shows up to surgical treatmentє:
1. Perforation, or by driving the stool of the valve with the rosette of the heart defect.
2. Arterial thromboembolism. It is shown promptly when the first episode of thromboembolism is shown, the risk of repeated thromboembolism reaches a high one (about 54%).
3. Abscesses of myocardium, valvular fibrous ring, splinters away conservatively hopelessly and permanently fatal result.
4. Fungal endocarditis, which can lead to a fatal result in 100% of cases, if it does not happen quickly and promptly.
5. Infectious endocarditis of the valve prosthesis, obumovaniya especially virulent flora. Mortality with advanced conservative therapy reaches 35-55%.
6. Ineffectiveness of etiotropic therapy with a stretch of 3-4 types (saving fever, progressive destruction of the valve, etc.).

prophylaxis

Prophylaxis of infectious endocarditis in the first place should be carried out in particular with the advancement of the disease. Rysics of the incidence of discomfort during the extraction of the tooth, the knowledge of dental stones, tonsillectomy, bronchoscopy, cystoscopy, adenomectomy, surgery on the cheeks and intestines. Zahvoryuvannya at yakih pіdvischeny rizik rozvitku endokarditu - aortal sericite, asymmetry indices HCM (subaortic stenosis) koarktatsіya aorta, aortic sclerosis of zvapnіnnyam, mіtralna nedostatnіst prolapse mіtralnogo valve of regurgіtatsієyu, vіdkrita arterіalna duct іnfektsіyny endokardit in anamnezі, piece valve vices tristolkovy valve, IVS defect, valve defects of the leg artery, Marfan syndrome, intramuscular non-valve prostheses, mitral stenosis, thromboendocarditis, postinfarction aneurysm, implantation of electrocardiostimulators.

Bacteremia, which is common in patients with overwhelmed pathological camps, is especially often supervised by the development of infectious endocardial inflammation. As a prophylaxis for endocarditis, vikoristovuyu a short course of antibacterial therapy:

Porozhnina company, stravohid, dickheads Standard scheme Amoxicilin (2 g vseredin) 1 year before the procedure either azotromicin / clarithromicin (500 mg) in the middle 1 hour before the procedure Shlunkovo-intestinal abnormal urogenital tract 120 mg, i / v or i / m) 30 minutes before the procedure. After 6 years, ampicilin (1 g i.v. or i.m.) or amoxicilin (1 g vseredin) A group of high rhizic with allergy to penicilin vancomycin (1 g i.v. for 1-2 hours) in the second with gentamicin (1, 5 mg / kg, ale not more than 120 mg, i / v or i / m); the introduction of the end 30 min before the procedure Amoxicilin (2 g vseredin) 1 year before the procedure and ampicilin (2 g i / v or i / m) 30 min before the procedure i.v. for 1-2 hours); the introduction of prophylactic antibiotics for the prescribed schemes, making it possible to increase the number of cases of infection for infectious endocarditis. On the other hand, it’s a bit of a memory that endocarditis is not often diagnosed in particular, but it’s not referred to a group of people who suffer from rhizik, and also when bacteria are not associated with overwhelmed medical maneuvers.

Infectious endocarditis is one of the most severe diseases of the heart-vascular system. Without a gostr response, the form of infectious endocarditis will end with a lethal result in 4-6 months, and for a period of 4-6 months. On the basis of adequate antibacterial therapy, the lethality of reach is, in the middle, 30%, and in ailments with infected valve prostheses - 50%.

Infectious endocarditis is a firing process of infectious progression, which is hostile to the inner shell of the heart (endocarditis), like the whistling of the chamber and valve.

The incidence of infectious endocarditis, according to the data of other authors, is 3 to 10 per 100,000 population. Women are ill twice as fast for children.

Infectious endocarditis - the whole endocardium is inflamed

Causes and factors of rizik

For the development of infectious endocarditis, it is necessary to follow the following deciliters:

• the ear for the endothelium of the blood vessels and the endocardium;
• transient bacteria (time of circulation in the bloodstream of pathogenic or intellectually pathogenic microorganisms);
• reduction of outbound immunity;
• impaired hemodynamics and hemostasis.

The reason for the diagnosis of a transient bacterium is to blame for the obvious in the body in the middle of chronic infection, for in the case of a visitor of the invasive medical management.

Most of the time state form Infectious endocarditis vistupa green streptococcus.

Gostru form of getting sick can wiklicati:

• golden staphylococcus;
• pneumococcus;
• enterococcus;
• gut stick.

It is even more important to prevent infection endocarditis, enlargement of fungal infection, anaerobic and gram-negative diseases. The cause of fungal endocarditis is a trivial antibiotic therapy or a catheter in the vein.

Sensitive, like microorganisms in the bloodstream, penetrate the empty heart and stick to endocarditis. The whole process is called adhesion, the minds of its resistance and damage to immunity, as well as the appearance of a valve device.

Infectious endocarditis can be seriously delayed, and can lead to a lethal result: septic shock, Polіorganna lack of іn.

Victims of heart defects, hemodynamic damage, are susceptible to microtraumas of the endocardium and valves. Through these injuries, infectious agents penetrate into the endocardium. Microbial colonies have a very fast control of the valves, as a result of which the stench can no longer show its function, and the patient develops a very progressive heart failure.

On a tlі infectious endocarditis, there is an immune lesion of the endothelium (inner ball) of the capillaries of the mucous membranes and of the worms. Tse manifest symptoms of hemorrhagic capillary toxicosis and thrombovasculitis.

formy get sick

The most common cause of the diagnosis of infectious endocarditis is:

• Primarily - the infectious process in endocarditis develops on a set of uninterrupted valves;
• secondly - the infection in endocarditis develops on the also obvious pathology of the valvular apparatus or blood vessels.

For the nature of the transition, I see the onset of the form of infectious endocarditis:

• gostra - vinikak yak accelerated medical manipulations on blood vessels, heart and septic camp, triva 1.5-2 months;
• підгостра - vinikє with a lack of active love the main ailment abo the state of the endocarditis, three more than 2 months;
• protracted - characterized by a general interruption and visibility of an obvious primary gn_septic septic tank.

for activity ignition process Infectious endocarditis is active and inactive (congestion).

The ignition-destructive process can be interrupted (only the stools of the heart valve are affected), or else it goes beyond the intervening valve.

stages of becoming ill

V key interruption Infectious endocarditis is seen in several stages:

1. Infectious and toxic. It is characterized by transient bacteria and microbial vegetation (colonies) on the valves of the heart and endocarditis.
2. Immuno-ignition (infectious-allergic). Characteristic symptoms of internal organ damage, so signs of splenomegaly, nephritis, hepatitis, myocarditis.
3. Dystrophic. To develop on aphids of progressive heart failure and septic process. To appear as important non-gutting lesions of internal organs, including myocardial necrosis.

Without treatment of infectious endocarditis, it will end with a lethal result within 1.5-6 months from the moment the first symptoms appear.

symptoms

The gostra form of infectious endocarditis is clinically characterized in the main by signs of toxemia and bacterium. To them are admitted:

• zagalny weakness is rotated;
• p_dvischena stomatomy;
• decreased appetite;
• loss of oil;
• zadishka;
• increased temperature up to high values, which supervises with a shuddering chill;
• clear sweat at low temperature;
• saline deficiency anemia;
• earthy color of shkiri;
• petechia (small punctate hemorrhages) on mucous membranes and shkirny covers;
• a pinch symptom (osvita sintsya with minor trauma to the shkiri).

At the same time of infectious endocarditis in larger patients, it is possible to prevent the reduction of heart disease itself (myocarditis). During auscultation of the heart, there is a hearing of functional noises, the appearance of which can be explained by different valves and anemia.

The dissection of the stools of the aortic and (abo) mitral valve is superimposed on the appearance and progress of signs of deficiency, as well as heart failure.

In case of pidgostroma of infectious endocarditis, thrombotic overlaps of the stools of the heart valves occur, as a result of which there may be an increase in the embolism of the blood-bearing vesicles of the spleen organ, niroc, and the brain of the necrotizing cysts) When obstructed, they appear:

• improvement of liver and spleen (hepatosplenomegaly);
• polyarthritis;
• diffuse (r_dsche - vognischevy) glomerulonephritis.

diagnostics

When taking a history of particular respect, it is necessary to come to the transfer of earlier medical involvement and the manifestation of chronic infections. To support the diagnosis of infectious endocarditis, follow the data of laboratory and instrumental patient care, including:

• zagalny analysis of blood (leukocytosis, zsuv leukocyte formula alone, meaning a better SHOE);
• bacteriological sowing of blood based on sensitivity to antibiotics. Tsei analiz repeat a few times, moreover, taking blood is the most beautiful work on the face of a feverish woman;
• biochemical analysis of blood. There are changes in immune status (an increase in the concentration of anti-tissue antibodies, a decrease in the hemolytic activity of a complement) and a blue spectrum (an increase in the concentration of α-globules - and in the underworld;
• EhoKG. Additional visualization on the valves of the heart of microbial vegetation with a diameter of more than 5 mm;
• magnetic resonance or multispiral Computer tomography... Allows with a high level of accuracy to assess the valve body, as well as the heart in general.

lykuvannya

In case of infectious endocarditis, the patient is hospitalized; indications suvoriy postіlny mode. An important element of therapy and organization correct eating... Diet is guilty of being balanced for vmist living talk, Vitamin and microelements, fold up from easily salted strains.

Basically lіkuvannya - medication. Antibiotics recognize the sensitivity of microflora to the sensitivity of microorganisms, before discarding the results in antibiotics, use antibiotics wide rangeдії.

The incidence of infectious endocarditis, according to the data of other authors, is 3 to 10 per 100,000 population. Women are ill twice as fast for children.

Therapy of fungal etiology of infectious endocarditis should be carried out with amphotericin B in a trivial course (up to decile months). Complex drug therapy becoming ill with antimicrobial powers (anti-staphylococcal globulin, anti-staphylococcal plasma, dioxidin).

Shown are the methods of extracorporeal detoxification (intravascular ultraviolet blood detection, plasmapheresis, hemosorption).

In the presence of symptoms of ailments (nephritis, polyarthritis, or myocarditis), non-steroidal anti-fatigue diseases should be added to the therapy regimen.

When the valves are ruptured, the heart with the development of the defect, the loss of the ignition process is lost surgical involvement on prosthetic valves.

Possible acceleration and inheritance

Naybіlsh not safe acceleration of infectious endocarditis, should lead to a lethal result, є:

• gostra sertseva lack of;
• respiratory distress syndrome;
• embolism in the brain or the heart;
• septic shock;
• polyorganna lack.

forecast

The prognosis for infectious endocarditis is severe. Without getting sick, it will end with a lethal result for 1.5-6 months at the moment the first symptoms appear. When antibacterial therapy is quickly distributed, the lethality rate becomes 30%. Approximately 15% of patients with infectious endocarditis have chronic interruption, during any period of remission they change with periods of aggravation.

prophylaxis

Patients who are admitted to a group of patients for the development of infectious endocarditis (with congenital or swollen heart vads, prosthetic valves, pathological vertebrates, symptoms of chronic medical infections)

For the prevention of bacterial diagnostics during invasive medical procedures, antibacterial drugs of a wide spectrum of diy should be recognized.

Also, for the prevention of development of infectious endocarditis, it is necessary:

• regularly carry out sanitation of chronic infections in the body;
• unique bacterial and foreign infections, And when you appear - zd_ysnyuvati vztochasne lykuvannya;
• unicati overcooling;
• dotrimuvatisya correct eating;
• carry out garter procedures.

Videos from YouTube on the topic of statistics:

Endocarditis is a firing process, localized at the inner whistle of the heart, most often in the valve area. Particularly ill-fated є feast of tilka with good fabrics: Myocardium and pericardium (membrane to the organ) will not get sick. With a quick progressing and adequate therapy for ailments, it is possible to provoke the rupture of the valves of the heart.

The endocardium is the center of the inner heart shell, which whistles the empty and the valve pumping the body and the shape of the stool to the left. Infectious endocarditis most often develops on tissue damage, if there is evidence of infection and lowered immunity of the body. In a healthy country, for the rakhunok of its own budov, the internal whistle is insensitive to pathogenic microorganisms.

budova endocarda

The heart is made up of three lastly expanded spheres: epithelial, internal (endocardium), myasal (myocardium), and epicardial (epicardium), which is the serous membrane of the body (pericardium).

Budova endothelial cells, which are without middle contact with blood in empty spaces and valves, is identical to the endothelium of sudin and similar mucous membranes of visceral organs. Cyclinic growth on the basal membrane, which controls proliferation (rospodil). The top of the ball, which can be covered with blood, is covered with atrombogenic speech - glycocalyx, as I lower the rubbing of the line about the walls of the heart and the change of blood clots.

The offensive - pendotelial - the ball is stored from a complete fabric. Її cells are not very differentiated, so they allow, if necessary, they can be quickly distributed.

The myazo-elastic layer of the endocardium of motivations from the myazovyh fibers, stretched into the resulting fabric. The name, the biggest ball, will again be stored from semi-tissue cells. There are two layers behind its own analogous middle and lasting obolonts of blood-bearing vessels.

pathogenesis of endocarditis

For a rakhunok sudin, you lie in your pumping ointment, you grub only gliboki balls of the endocardium. The name of the ball of the heart is to receive all the necessary speech from the blood, to pass through the empty spaces and valves of the heart. Apparently, the appearance of fecal infections in the pericardial zone and organisms in the whole can provoke the ignition process.

With rheumatic and non-infectious diseases, the inner tissue of the heart swells and vomits. On the other hand, there may be other blood clots, which can cause blood flow through the valves, or a little bit in the coronary artery.

The process can be developed according to the vocal mechanism. In case of endothelial malformations or heart defects, platelets adhere to the microtrauma, forming a sterile clot from a cob. Infectious diseases migrate into a ready thrombus, transforming it into vegetation (breast of young blood cells, small endocardium and microorganisms).

In such a rank, infectious endocarditis vinikє with the presence of decile minds:

• microtrauma of the seated sudin and the endocardium itself;
• low immunity;

• malnutrition in hemodynamics (abnormally viscous blood viscosity);
• the appearance of pathogenic agents in the middle of the heart or blood.

Having accepted the thrombus to shrink, take a polypodic or warty form (polypoid and endocarditis is common). Beef fabric blood clot can ruinuvatisya, around the part - spread across the vessels, thromboembolism and infarction of internal organs. On the microscopic stage, tissue necrosis occurs, which provokes deformity of the heart valve (inferior endocarditis).

Reason for the development

The main cause of infectious inflammation of the inner shell of the heart is the penetration of pathogenic microorganisms. Feelings can be developed primarily, however, such a form is developed more, less secondarily, because of low absorption of healthy endothelial fabrics to beetles.

Secondary endocarditis is found on the valves with the presence of heart disease or systemic ailments (rheumatism, vovchak). See also allergic, intoxicating, post-traumatic, fibroplastic and thromboendocarditis. The growth of the spoluchnoi tissue or the prolapse of the valves to produce the stagnation of the blood and the destruction of the hemodynamics. The rate of injury of the membrane and the detection of blood clots.

Infections type endocarditis

Permanently in the form of an infectious agent, endocarditis buv:

• bacterial (microbial);
• fungal (most often candidiasis - the vicious fungus Candida);
• virusnim;
• provoked by the simplest.

Pathogenic microflora can be consumed in the interior of the decalcoma by way:

• Through shkіri or slizoіy with advancing її infections in people with low immunity or prostheses in the area of ​​the heart (a piece valve or an electrocardiostimulator).
• In case of invasive diagnostic procedures and promptly(Catheterization of vessels for the introduction of contrasting speech, endoscopy, cystoscopy, surgical treatment of vaginosis, visible teeth).
• From the bloodstream with the presence of the great vognische of infection (with bacterial congestion of the legends, nirok, maxillary sinuses, the intestinal tract, rukhovoy apparatus, Abscesses, gangrene) with reduced immunity, the presence of a prosthesis of chi wadi valves.
• Through іn'єktsії drugs with insufficient sterility (typical lesion of the tristula valve).
• Per hour of operations on the heart, including the installation of leg, valve prostheses and rhythm.

Riziku factories

Up to the number of factors that lead to the diagnosis of endocarditis, the following are included:

• There are signs of abnormalities of the valves, the appearance of defects in the septum and the mucous membranes, and ulceration of the aorta.
• The presence of a heart abo-leg prosthesis, cardiac pacemaker in the patient.
• Transfers before endocarditis of the infectious type.

• Treatment with immunosuppressants for tissue transplantation or with regular blood transfusions.
• Trivial nasal catheters in peripheral vessels.
• Immunodeficiency of disease etiology (including SNID).
• Trivial reception of antibacterial drugs (growth of fungal growth in a weakened body).
• Structural changes functional breakdown myocardial robots (hypertrophy, heat).
• Pathology of nirok (glomerulonephritis), hemodialis.
• Systemic ailments from the resulting tissue, including genetic (Marfan syndrome).
• hypertension, ischemic ailment heart.

The group also has children and people who have been kidnapped. Patients older than 55 years of age in the middle age are reduced in immunity and in reality heart-and-heart disease, Yaki vimagayut drug therapy and operations. If the protocols are not managed, the infection can occur for an hour or even immediately. With the presence of vad hearts in the child, the development of the development of the growth in the number of development.

In older patients, the frequency of development of endocarditis is approximately 6-15 clinical symptoms per 100,000 inhabitants.

The most common classification of illnesses: according to the triviality of the interruption, the localization of the problem, the child, the manifestation of the supportive diagnoses, the circumstances of the infection. The formula can be applied to the activity of the ignition process.

For the criterion of triviality and intensity, they see endocarditis, such as:

• gostry (trivia not more than 2 months);
• pidgostry.

Chronic interruptions rarely develop with infectious etiology (more typical for rheumatic illness). Likari vikoristovuyt The single ICD code for the state and the onset of endocarditis is I33.0. If necessary, specify the originator for an additional supplementary code B95-98 (streptococci and staphylococci, іnshi bacteria, viruses, іnshі infectious agents).

For the localization of the lesion, ailments of the mitral, aortic, tricuspid valve and the valve are seen on the stick with the leg artery. The two remaining flames are mainly among patients with drug addiction.

Childish endocarditis pre-classifies on congestion (internal uterine) and embankments.

bacterial endocarditis

In most cases, the internal whistles are lit by the hearts of viclicanoes with bacteria of different species. The main prototypes of backendocarditis є:

• Streptococcus. According to the statistics, microbiology is seen during analysis in 40% of cases of discomfort (according to deyakim data - up to 80%).
• Enterokoki. The penetration of pathogenic microorganisms into the shelter and infection of the endocardium occurs during operations on the intestines and low immunity. At the same time, it is brought up to 15% of ailments.

• Golden staphylococcus. Є a typical "lykarny" infectious disease, which develops when moving to a stationary. Staphylococcal bacterial endocarditis develops as an important breakdown and strong structural damage to the heart. We see strepto- and staphylococcus provoke sickness in a lighter form.
• Pneumococci. Viklikayut fired endocard yak accelerated legacy infection.
• Gram-negative bacterium. The inner shell of the heart is at odds with only a great deal of infection and localization. Klinika zmishana, including signs of pathology of kilkoh systems.
• Інші інфекційні agents. Ailments can also become rickets, trash, bruceli. In a number of diagnostics, due to the shortcomings of diagnostics, the bacterium does not seem feasible. For example, the microbi of the NASEC group is characterized by spores to endocarditis, and is rarely cultivated in laboratory livestock centers.

After the decile of infectious agents, the patient's prognosis was quickly overcome.

septic endocarditis

Septic endocarditis is one of the names of a severe infectious process. Winning in case of extended diseases from the diagnosis of infection, for generic endometritis, surgical reversal of vaginosity. To catch a glimpse of an accelerated sepsis, for a classic picture there are also characteristic signs of a zagalny infection:

• hyperthermia with sharp changes of temperature and chills;
• anemia;
• entanglement of property;
• dryness in the mouth;
• hemorrhagic visip;
• zbіlshena pechinka, inodі - spleenka.

On the inner whistle there is a sprinkle of polyp, then a turn. When listening to the heart, there is a sensitive noise, which is characteristic for the control of the valve apparatus.

Symptoms of the ignition process

Endocarditis is manifested by both the backward signs of an infectious process (hyperthermia, chills, fatigue), as well as specific symptoms. A number of ruined hearts will affect the heart (tachycardia, broken rhythm, noises, zadishka, swelling).

Infectious endocarditis: symptoms and causes

As soon as glomerulonephritis is slowed down, or because of the blockage of the nirkova artery, which is indicated by the table, it is a sign of swelling, pain in the area across, there is a change in a good deal, in now there is a house of blood. With thrombosis of the spleen thrombosis, there is a strong pain syndrome from the ribs on the left side. For the blockage of the legacy artery, it is characteristic that the color is exposed to the bluish color of the violet, zadishka, retrosternal beard, loss of svidomosty.

The intensity of the manifestation of symptoms in the form of a type of ignition process:

• In case of severe endocarditis, the temperature reaches 39-40 0 C, hyperthermia is super-feverish, clear-headed, head-headed, supine-like. I am sick, Bloodshed on the eyes. Shkіrny pokriv naduvat siruvaty, іnodі zhovtuvatii vіdtіnok. On its surface, red plums appear. On the fingers and lobes, there are not many chervoni vuzliki, ailing under pressure.
• When the process is undergone, the temperature does not change 38.5 0 C, it means sleeplessness, loss of vagina, darkening of the skin cover. Hemorrhagic visip and Osler's universities also bends.

diagnostics

Differential diagnostics of ailments is carried out with other sickness of the heart - spine, rheumatic endocarditis - and including anamnesis, laboratory and instrumental methods. To determine the localization and stage of the exercise, carry out:

If necessary (for example, if there is a puffiness or metastasis), an MRI and CT scan of the heart area is performed.

For the selection of the most effective antibiotic, bacteriological analysis is taken. In case of a negative result, the analysis is repeated by the PLR ​​method. In the course of diagnostics, rheumatic test is also recommended, back-to-back analyzes slash and blood (control SHOE).

The results of the instrumental Infectious disease membranes, and laboratory indicators show the norm, endocarditis is called PLR or culture-negative.

lykuvannya endocarditis

Likuvannya of infectious endocarditis is complex and is stored in decile groups of drugs, the main ones are antibacterial. Doctor Komarovskiy's assistant will have the following schemes of therapy for different types of pupils:

• Greening streptococcus: "Penicilin" 250,000 MO for dobu per 1 kg of carriage (up to 20 * 10 6 MO / dobu). Intra-shniovenno 1/6 dose of skin for 4 years.
• Golden staphilokok: "Oksallitsin" 200 mg / dob per 1 kg of vagi according to the scheme, similar to the description of the food. In case of a gostromy outbidding, it’s stagnant to get “Gentamycin”, in times of intolerance of peniciliniv - “Vankomitsin”, “Imipenem”, “Linezolid”.
• Enterokkokі: "Ampicilin" 300 mg per 1 kg of wagi for doba. For ¼ dose of skin 6 years. When given from "gentamicin" - skin 8 years.

The triviality of antibacterial therapy, it is easy to remember, becomes from 1 to 3 months. Efficiency control is carried out according to the bactericidal titer of the sirovat і SHOE.

Fungal endocarditis is necessary to remove "Amikacin", "flucytosin", in important cases - "amphotericin B".

Krim antibiotics, vikoristovyutsya so likarski zasobi, yak:

• antiagreganti ("Heparin");
• hormones (glucocorticoids) for heat;
• antimycotic drugs;
• Ingibitories of proteolytic enzymes;
• immunoglobulin, anti-phylococcal plasma;
• medications for the prevention and treatment of ailments.

Even after 3-4 years the therapy does not show efficacy, it is recommended to perform an operation to sanitize the empty organ, and in important cases, it is seen that there are fewer valves and the installation of individual ones. If abscesses, fistulas, great lumpy growths or pseudoaneurysms are evident, the opening and perforation of the valve stems, the state of the heart's functions are carried out in an extra surgical way. Vilikuvatisya residual additional assistance to the onset 7-14-day course of antibiotics.

accelerating

Until the young unfailing heritage Infectious endocarditis is referred to:

prophylaxis

Prior to the development of the heating of the inner shell of the heart, it is possible only for a small part - for the addition of the hourly and frequent treatment of infectious diseases of the ethology.

Infectious endocarditis (IIE) infectious nature with lesions of the valves of the heart and the parietal endocardium, which should lead to the destruction of the valve apparatus. Perebіg zvoryuvannya gostriy or pidgostria by type of sepsis with circulatory disease in the blood, thrombohemorrhagic and immune symptoms and delayed.

Epidemiology of endocarditis

The preoccupation of the IIE is being restructured in all countries of the world and becomes from 16 to 59 per 1,000,000 people, in Russia - 46.3 per 1,000,000 people in rik and unhealthy growth. People are sick 1.5-3 times more often than women. Most often, the endocard's performance is brought to close to 50 years, and all types of endocard are used by all groups from 60 years and older.

Growth of incapacitation of ІЕ accumulations of significant changes in the number of cardio-surgical involvement, surgical involvement and post-production of abscesses. Vvazhaєtsya, the degree of immaturity of the diagnosis of septic endocarditis in individuals who use non-sterile syringes (for example, for drug addiction) 30 times in food, not in healthy people.

Classification of endocarditis

A. Outside the transition

• gostry - from decilkoh days up to 2 days;
• pidgostriy infectious endocarditis;
• chronic recurrent interruption.

B. For the nature of the exercise of the valve apparatus

• primary infectious endocarditis (Chernogubovskaya form), scho vinikє on unimpaired heart valves;
• Secondary endocarditis - develops on the last pathology of the valves of the heart or the great Sudins (including patients with piece valves).

B. For ethiological factor

• streptococcal,
• staphylococcus,
• Enterokokov,
• vernier,
• іnshі

When staging a diagnosis, we can use the following: diagnostic status - EKG with a typical picture; activity to the process - active, persistent or repeated; pathogenesis - ІЕ vlstnykh valves; IIe valve prostheses, IIe for drug addicts. Localization II: from the striation of the aortic abo-mitral valve of the tricuspid valve, from the lesion of the valve legendary artery; from parietal localization of vegetation.

Causes and pathogenesis of endocarditis

Infectious endocarditis diseases - gram-positive and gram-negative bacteria (strepto- and staphylococci, enterococci, intestinal and cygnosis palichka, proteus), ridsche - fungi, rickets, chlamyrudia.

Transient bacteremia is diagnosed as in case of early infections (sinusitis, sinusitis, cystitis, urethritis, etc.) An important role in the development of infectious endocarditis is the reduction of immunity in cases of family problems, abductions, and therapy with immunosuppressive drugs.

Symptoms of infectious endocarditis

Show cleverly in the case of IIE developmental. In case of severe endocarditis of streptococcal and staffylococcal etiology, such symptoms are indicated, such as rapid changes in temperature, a sharp chill, signs of a serious lack of lesions of the valves and heart failure. Gostriy endocarditis ovidlyat yak accelerated zagalny sepsis.

Poisoning of up to 6 types of disease on the cob, characteristic rapid destruction and perforation of the stools of valves, multiple thromboembolism, progressive heart failure. In case of unprecedented surgical entrusted with ІE, it can be done quickly to produce a lethal result.

Pediatric endocarditis often develops in people 35-55 years old and older. Symptoms of illness are manifested in one or two months after the bacterium.

A number of symptoms of intoxication are susceptible to: fever, chills, weakness, lack of fatigue, obesity, decrease in muscle mass, arthralgia, mialgia. Poisoning can be counteracted by the viglyadi "repeated GDZ" with short courses of antibiotics treatment.

With a trivial and severe interruption of ailments, some ailments show the following characteristic symptoms:

• The symptom of Janeway (Janeway) is one of the extra-cardiac manifestations of infectious endocarditis: IMUNOZAPALNA reaction in wiglyads of red dogs to beaches (echimosi) up to 1-4 mm in size on podoshes.

• Osler's universities - also a symptom of septic endocarditis - are a red heart disease (vuzliki) in a pediatric cell or a school.

• Petechial visceralis in case of septic endocarditis is not often found on the mucus empty of the mouth, conjunctiva and folds of the capital - a symptom of Lukin-Libman.

• The symptom of "drumsticks" and "old glasses" is the tightening of the distal phalanges of the fingers and the appearance of a vipucule form of nigtiv.

• Plami Rota - hemorrhage on a day-to-day basis, but the contact center is not a pathognomonic symptom.
• In patients with infectious endocarditis, a pinch symptom (Hecht's symptom), or a jgut symptom (Konchalovsky-Rumpel-Leede symptom), as a rule, positive: when pinched by the fingers of the skin folds.

Mossy development of glomerulonephritis, arthritis, myocarditis, thromboembolic diseases.

There are options for overcoming infectious endocarditis without fever, for lesions of a certain organ - nephropathy, anemia.

To suspect the presence of endocarditis followed when there is a noise over the area of ​​the heart, embolism of the cerebral and nirkovy arteries; septicemia, glomerulonephritis and adolescent infarction; dashing with the appearance of prosthetic valves in the heart; for the first time slunochkovyh destructions to the rhythm were growing; type show on skiri; multiple abo "flying" infiltrates in the lungs, peripheral abscesses unclear ethology... After a fever and impaired cerebral circulation in a young patient, the manifestation of an infectious endocarditis is inflated to quiet fever, as long as the etiology of an affliction is not brought to the test.

diagnosis of endocarditis

Anamnesis and physical condition. It is necessary to feed the patient about the heart defects, transferring the operative involvement on the heart valves for 2 months; rheumatic fever, endocarditis in history; transfer of infectious diseases in the last 3 months; brutalize respect on the shkirnі show - blіdіst (signs of anemia), ekhіmozi.

Ophthalmologic manifestations - with the Rota beaches (bloodshed in the link with the big center, with the Lukin-Libman beaches (petechia at the transitional conjunctival fold); transient, often one-sided slap, or broken polyvor.

A sign of infectious endocarditis is a change in the nature of the noises in the heart as a result of the deterioration of the valves in the heart.

When aortic malformation is formed - a systolic murmur of the beating on the edge of the sternum and in the V point (Botkina-Erba point), as a result of stenosis of the aortic thyroid after vegetation on similar valves; The fifth point, you can do it in the position of standing and lying on the left boat. In the world of ruptured valves, the intensity of a random noise build-up, II tone on the aorta is weak.

Symptoms of central nervous system damage are manifested in vigilance of abnormalities, delirium, paresis and parallels as a result of thromboembolism, meningoencephalitis.

With a state of infectious endocarditis, there are signs of a rotated heart failure - bilateral wheezing, tachycardia, a third tone of the heart, swelling of the lower symptoms.

In half of the ailments - spleno-abnormally hepatomegaly, it is not easy to notice the development of the sclera and slight yellowness of the sclera; lymphadenopathy. Mossy development of thromboembolic infarctions in small organs (leg, myocardium, nirok, spleen).

It is promoted in 30-40% of cases of broadening of the muscle and arthralgia in the large areas of the shoulder, colony and in some other slopes of the hands and feet. Myositis, tendinitis and enthesopathies, septic mono- or oligoarthritis of the developmental localization develop very rarely.

Laboratory and instrumental support:

zagalny blood analysis in case of gastrointestinal endocarditis - normochromic normocytic anemia, due to destruction of the leukocyte formula, thrombocytopenia (20% of the vapors), accelerated SHOE.

In the biochemical analysis of blood, dysprotheinemia from the increase in the level of gamma globulin, the increase in CRL in 35-50%.

Zagalny analysis of the section: macro- and microscopic hematuria, proteinuria, with the development of streptococcal glomerulonephritis - erithrocytic cylindria.

In the blood є to the active patients of the infectious nature of endocarditis in the case of an illness, allowing the sensitivity of the infectious agent to antibiotics.

In 5-31% of cases with IE, a negative result is possible. Effective for IIE serological methods.

EKG - on aphids with myocarditis or abscesses of the myocardium - impaired conduction, before paroxysms of the atrial tachycardia or atrial fibrillation.

EchoKG - is carried out for all patients with adolescence at IIE not less than 12 years old first look around patient. Through stravohidna EchoKG is more sensitive for the development of vegetation, lower transthoracic EchoKG, however, it is more sensitive.

Chest x-ray - in case of infectious endocarditis of the right type of heart, there are many or "flying" infiltrates in the legends.

Diagnostic criteria for infectious endocarditis

Diagnosis of infectious endocarditis should be placed on the basis of modified criteria, broken down by the Endocarditis Service at Duke University:

1) blood culture is positive;

2) prove the endocardium - data of transthoracic echocardiography - from vegetation on the valves, or to its structures, or to the implanted material.

Differential diagnosis of infectious endocarditis

Conducted from:

• severe rheumatic fever,
• systemic chervoniy vovchak,
• nonspecific aortoarteritis,
• aggravated chronic pyelonephritis,
• children who are ill

lykuvannya endocarditis

The cycle of treatment: the elimination of the teacher, the loss of speed.

Shown before hospitalization: patients without acceleration and stable hemodynamics - in the ward of the outbound profile; ailments with a swelling heart failure and accelerated - in the form of intensive therapy.

Drug treatment

Antimicrobial therapy is repaired immediately for setting a diagnosis. Stagnate bactericidal antibiotics, which can be administered parenterally. In case of an unhealthy fetus, an empiric antibiotic therapy should be carried out in high doses. All patients with a reported streptococcal etiology are liable to stay in the hospital for at least 2 years.

Infectious endocarditis, Streptococcus viridans viciousness, with lesions of the vascular valves:

benzylpenicillin ( natrієva sil) IV or IM for 12-20 million OD 4-6 r / day, 4 hours, or gentamicin 3 mg / kg for dobu (not more than 240 mg / dobu) 2-3 r / dobu; ceftriaxone i / v abo i / m 2 g / day 1 r / day, 4 hours. The given therapy allows clinical and bacteriological remission in 98% of IIE types.

The dosage of gentamicin in mg / kg in patients who suffer from obesity, to dissolve a higher concentration in high blood, less in thin patients. By special indications until the payment of gentamicin to patients over 65 years old, nirkova lack, Acoustic neuritis.

In the capacity of alternative antibiotics, it is found that:

Amoxicilin / clavulanic acid i.v. abo i / m at 1.2-2.4 g 3-4 r / day, 4 tonic or ampicilin / sulbactam i / v or i / m at 2 g 3-4 r / day, 4 tijn_v.

Vankomitsin is a Vibor drug for ailments from allergy to penicillin and lactamites. with trivial internal storage vancomycin can be a fever, allergic visip, anemia, thrombocytopenia. Wine Volodya from Nephro-toxicity

Infectious endocarditis, Staphylococcus aureus viciousness:

Oxacillin i / v abo i / m 2 g 6 r / dob, 4-6 tijniv + gentamicin i / v abo i / m 3 mg / kg 1-3 r / do ), 4-6 types; abo cefazolin abo cephalothin i / v abo i / m 2 g 3-4 r / day, 4-6 hours + gentamicin i / v or i / m 3 mg / kg 1-3 r / day, 4-6 hours ; either cefotaxime i.v. or i / m at 2 g 3 r / day, 4-6 doses + gentamicin i / v or i / m at 3 mg / kg 1-3 r / dob dobu), 4-6 types; abo imipenem / cilastatin i / v or i / m 0.5 g 4 r / day, 4-6 hours; either meropenem i / v or i / m at 1 g 3 r / day, 4-6 days; abo vankomidin i / v abo i / m 1 g 2 r / dobu, 4-6 tyzhniv; abo rifampicin vseredin 0.3 g 3 r / day, 4-6 hours.

Penicilin is recognized in the sensitive to new S. aureus in the capacity of an alternative drug: benzylpenicilin (sodium hydroxide) i.v. at 4 million OD 6 r / dob, 4-6 tijniv.

Treatment for detection of methicilin-resistant strains of staphylococcus. As a rule, the stench is resistant to cephalosporins and carbapenems, so the indication of these drugs is insufficient: vancomidin i / v 1 g 2 r / dob, 4-6 tijniv; linezolide i / v 0.6 g 2 r / dobu, 4-6 tijn_v. Linezolide is characterized by high bioavailability, 100% reach, and good formulation in the intestinal tract, to be used for frequent antimicrobial therapy: an ear of percussion from internal diseases.

Treatment of infectious endocarditis, vicious methicilin-sensitive staphylococcus with a stretch of 1 rock for the operation of a prosthetic valve:

Oxacillin IV, 2 g 6 r / dobu, 4-6 teens + gentamicin i / v 3 mg / kg 1-3 r / dobu, 2 teas, + rifampicin i / v, 0.3 g 2 r / dobu (you can sign the middle), 4-6 types. With the presence of an allergy to penicilin, oxacilin can be substituted for cephalosporin or vancomicin.

In case of ineffectiveness of adequate antibiotic therapy by stretching of tension, in case of swelling lesions of hemodynamics and development of refractory heart failure, formed abscess of the myocardium or valvular ring, a cardiac defect is shown - a type of damaged valve

Forecast for endocarditis

With timely antibiotic therapy, the prognosis is to reach the splendid. In case of fungal infectious endocarditis, the mortality rate reaches 80% and is higher. In case of chronic heart failure, the lethality becomes 50% in the nearest 5 years.

prevention of endocarditis

Slіd priznachati antibіotiki patsієntam of group temple i serednogo riziku: protezuvati valve sericite, gemodіalіz, foldable vrodzhena väda sericite, hіrurgіchnі sudinnі konduїti transferred іnfektsіyny endokardit in anamnezі prolapse mіtralnogo valve terapіya kortikosteroїdnimi drugs i cytostatics, іnfіkuvannya vnutrіshnovennogo catheter hіrurgіchnі vtruchannya i postіn 'кційні abscesses.

Venous catheter;

cardiostimulants;

Prostheses for vessels or heart valves;

Diseases of the heart;

microtraumas;

Hirurgic involvement.

Some bacteria penetrate into the endocardium without any additional tissue. Thus abscesses, fistulas and defects occur.

symptoms

You can declare yourself brightly and clearly, and perhaps at the earliest times of turbulence, you have less swelling, noises in the heart, faintness, and more dangerous symptoms grow step by step. To them are admitted:

fever woman;

I don't see sweat;

Sickness of meat and loam;

Vagi waste;

Zmіna koloru shkіri (st siruvatoyu, slightly zhovtuvatoyu);

Visip on mucus.

Osler's universities are known to have symptoms. Some fachivtsi are characteristic of the general and general familiarity of infectious endocarditis, navpaki, occasionally a rare manifestation, when you get sick, take place in the form of a child.

Osler's universities, pathogenesis

The decision is made on the lobes, the pads of the fingers, the feet through the vicious infection of the blisters of other blood-bearing blisters and the infiltration. With histological advances in universities, venules and arteries are expanded in them. Inodi їkh cheat with an allergic visip or septic purple. Yak viglyadayut vuzlik Osler, show the photo by hand. Tse opukly, in size from a pea, or some less crumbling, light a red or purple vidtinku, some sickly, some mute. The stench develops quickly, you know yourself by yourself, we will not let you get sick, so we can’t use pills or ointments. As soon as Lyudin took care of such vuzliks, she was guilty of inaccurately turning to the doctor for conducting additional laboratory and clinical studies.

Plami Rota

Krym of Osler's universities, with infectious endocarditis, can be manifested in character on the flanks and kintzivki, bloodshed along with nigtovy plates, the beaches of Janevie, as well as in Osler's universities, on the footsteps. Ale, on the vidminu of vuzliks, with absolutely painless beaches, not like peas and with a slight rush of blood to capillaries.

With infectious endocarditis, krym shkiri, there may be suffering and eyes. One of the most popular signs of such a reaction to Rota's fiery beaches. Describing їх Swiss lіcar Roth. Plami Rota є micro-bloodshot into the gaze of the eyes. Behind the shape, the stench is oval or round with white specks in the middle. In the case of the children, they can be reduced to a decrease, as the result of the main illness is renewed.

Plami Rota є a symptom not only of infectious endocarditis, but of anemia, colagenosis. To make a diagnosis, it is necessary to carry out additional information.

Іnshі symptoms in case of infectious endocarditis

There are nearly a dozen symptoms that allow the suspicion of endocardial inflamed through the infection.

Osler's universities, Lukin's beaches (or the symptom of Lukin-Libman is correct), the symptoms of Rock, Dmitriyonko, Januei and others help the doctors to diagnose, especially in quiet cases, if there are some characteristic indications of an accident

The symptom of Lukin-Libman polyaga is in the appearance of point petechias with a bluish center on the folds of the capital and conjunctiva.

Symptom of Rock is manifested in the extended area of ​​the eye.

The symptom of Janewey is the center of erythematosity, like the Rota's beaches, which can be heard on the lobes and feet, only in this particular stench the stench is small behind the size.

Symptom Dmitriyonko, polyagaє in deyakom pom'yakshennya timbre I tone, through which it is called "oxamite voice". Sposterіgaєtsya tsya sign on the best stages of the disease.

lykuvannya

Reinstall a reason to appear specific symptom maybe just a likar. As a rule, for many needs laboratory dosage blood, EKG, EchoKG. In a general order, carry out bacterial sowing of blood, schob vyaviti of an infectious disease. Also, the analyzes showed the presence of infectious endocarditis in the patient, antibiotics of the specific group. In important cases, surgical intervention (plastic, heart valve prosthesis).

With a free production correct diagnosis and 50-90% of sick people live more than 5 years every hour. To improve the diagnosis of infectious endocarditis, a special technique has been developed for people in the group. We have a few preventive regimens, which were adopted at the reception lykarsky zasobiv in the meaning of the methodology of situations.