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Pathology – Infective endocarditis
Definition
• An infection of the inner surface of the heart, typically involving a heart valve.
Classification
• Acute endocarditis is induced by pathogenic organisms infecting a structurally intact heart. Subacute endocarditis is a gradual sickness induced by mildly pathogenic organisms invading a structurally compromised heart. Epidemiology • Rare, yet crucial to identify.
Microbiology
• Acute endocarditis is typically caused by Staphylococcus aureus. Subacute endocarditis is predominantly caused by Streptococcus (S.) viridans or Enterococci.
Pathogenesis
S. aureus typically enters the bloodstream through the skin via indwelling vascular catheters or intravenous medication usage. S. viridans enters the bloodstream from the oropharynx subsequent to tooth brushing or dental procedures. Enterococci enter the bloodstream subsequent to intestinal instrumentation (endoscopy) or bladder instrumentation (cystoscopy or catheterization).
Presentation
Left-sided acute endocarditis manifests abruptly with fever and indications of valve impairment. Significant systemic embolic occurrences are prevalent; septic emboli may disseminate to several organs and induce abscess formation. Right-sided acute endocarditis manifests with fever, chills, and significant pulmonary symptoms resulting from many septic emboli in the lungs. Subacute endocarditis induces low-grade fever and systemic symptoms. The diagnosis may be challenging and readily disregarded.
Macroscopy
• The affected endocardial surface is adorned with fragile vegetations. • Acute cases may exhibit significant underlying tissue damage and abscess development.
Histopathology
Vegetations consist of a combination of fibrin, inflammatory cells, and bacterial colonies, predominantly comprising Gram-positive cocci in nearly all instances.
Prognosis • immediate endocarditis has a high death rate due to swift valve degradation and the onset of immediate heart failure. • Subacute endocarditis follows a more extended trajectory, although remains a grave condition if not recognized and treated.
Definition
• An infection of the inner surface of the heart, typically involving a heart valve.
Classification
• Acute endocarditis is induced by pathogenic organisms infecting a structurally intact heart. Subacute endocarditis is a gradual sickness induced by mildly pathogenic organisms invading a structurally compromised heart. Epidemiology • Rare, yet crucial to identify.
Microbiology
• Acute endocarditis is typically caused by Staphylococcus aureus. Subacute endocarditis is predominantly caused by Streptococcus (S.) viridans or Enterococci.
Pathogenesis
S. aureus typically enters the bloodstream through the skin via indwelling vascular catheters or intravenous medication usage. S. viridans enters the bloodstream from the oropharynx subsequent to tooth brushing or dental procedures. Enterococci enter the bloodstream subsequent to intestinal instrumentation (endoscopy) or bladder instrumentation (cystoscopy or catheterization).
Presentation
Left-sided acute endocarditis manifests abruptly with fever and indications of valve impairment. Significant systemic embolic occurrences are prevalent; septic emboli may disseminate to several organs and induce abscess formation. Right-sided acute endocarditis manifests with fever, chills, and significant pulmonary symptoms resulting from many septic emboli in the lungs. Subacute endocarditis induces low-grade fever and systemic symptoms. The diagnosis may be challenging and readily disregarded.
Macroscopy
• The affected endocardial surface is adorned with fragile vegetations. • Acute cases may exhibit significant underlying tissue damage and abscess development.
Histopathology
Vegetations consist of a combination of fibrin, inflammatory cells, and bacterial colonies, predominantly comprising Gram-positive cocci in nearly all instances.
Prognosis • immediate endocarditis has a high death rate due to swift valve degradation and the onset of immediate heart failure. • Subacute endocarditis follows a more extended trajectory, although remains a grave condition if not recognized and treated.
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