Complications of Infective Endocarditis - Essay Example

Complications of Infective Endocarditis Introduction Infective endocarditis is a relatively uncommon condition, which can attack both normal and damaged cardiac valves, affecting only between 1.7 – 6.2 cases per 100,000 patient years ( Willacy 2009). These figures are higher if the person concerned takes intravenous drugs and /or has a preexisting cardiac problem. The condition is often a result of ‘nonbacterial thrombotic endocarditis’, which is the result of injury to the heart’s endothelial surface. (Brusch and Cunha, 2011.) Willacy ( 2009) points out that it is easy to miss and is often only recognised when side effects occur. Spelman and Sexton ( 2011) point out how it is difficult to even obtain accurate statistics because of varying definitions of the condition. In every case there is nonbacterial thrombotic endocarditis. Most commonly the mitral valve alone is affected. The pulmonary valve is affected only rarely. Other valves may be affected alone or in combination. The infective organisms are likely to be staphylococcus aureus, various types of streptococci, pseudomonas aeruginosa and fungi among others (Willacy 2009). These organisms may be resistant to antibiotics. Cure rates vary according to which infective agent is involved. Possible Complications Spelman and Sexton ( 2011) describe the condition as having a myriad complications , and the more the subject is investigated the more this point is proved to be correct. These various complications can affect many different parts of the body and can be divided into two main types - cardiac types and extra cardiac ones, i.e. those which affect the heart and those which are caused by clumps of infective material travelling around the body. Meningitis and brain abscesses - although often with sterile cerebro-spinal fluid. Emboli can cause a number of possible problems depending upon where they end up including hemiplegia, myocardial infarction and pulmonary emboli. There may be back pain caused by deposits between the vertebrae. Some patients may develop nodules (Osler’s nodes ) on their digits. 10% of patients show finger clubbing. Spleen problems, such as splenomegaly, can occur in long term conditions. Arthritis is another of many complications which may only occur rarely, as does blindness (Spelman and Sexton, 2011) . Habib et al ( 2011) list even more possible complications including splenic abscesses, rheumatics and infective aneurism Cardiac valve and organ complications are common, caused by clumps of bacteria and broken off cell fragments ( vegetations), ( Mayo Clinic 2011). The valvular difficulties can lead to congestive heart failure (Brusch and Cunha, 2011). The authors also describe myocardial abscesses, and state that a number of mechanisms are involved in systemic problems. According to Mocchegiani and Nataloni ( 2009) it is congestive heart failure which has the greatest negative effects upon future prognosis. Graupner et al ( 2002) add to this that periannular complications, i.e. calcification which extend valvular problems , make the prognosis even gloomier, finding perivalvular complications in as many as 37% of the patients in their Spanish and Argentinean studies. This in itself led on to even further complications which the authors of this study name as infection of the aorta and prosthetic endocarditis, atrioventricular block where there are problems with conduction between atria and ventricles . They also add that coagulase-negative staphylococcal infection is also a risk when there are periannular complications. As long ago as 1885 William Osler described various neurological endocarditis ( B.M.J. 1970). There have been many studies since that time which back up his conclusions. Mayo Clinic staff ( 2011) describe the possibility of abscesses in many different parts of the body ,including the brain. Severe abscesses in such cases may need surgery. Mocchegiani and Nataloni ( 2009) describe how in 57% there is only one complication, but in 26% of those affected there are two complications and in a further 14% there are more than this. Spelman and Sexton ( 2011) add to this that some 6% of suffers have as many as 6 complications or even more. Mocchegiani and Nataloni ( 2009) also state that the frequency with which specific complications occur depends upon a number of variables which include the type of infective pathogen, the duration of the condition before treatment began, and the type of intervention made. This conclusion suggests that early treatment is important and more effective than any treatment administered later. However, according to recent writing (Spelman and Sexton , 2011), with modern advances in diagnosis and therapy , both the frequency and type of complications that occur has altered. They give the example of renal failure which, in earlier times was a frequently observed complication of infective endocarditis, but which has decreased in frequency since the advent of modern antibiotic therapy. The criteria for diagnosis has varied over time. Sexton (2011) describes how there is no one test which is definitive, but that diagnosis occurs as a result of an an accumulation of clinical findings. Although diagnosis is usually made based upon only two factors i.e. several positive blood cultures taken in the presence of a predisposing cardiac injury taken together with proven endocardial involvement, this does not always happen. Sexton points out for instance that many patients have no positive blood culture at the beginning of their condition and more than a quarter of them have no cardiac problem , at least in the early days of the disease, and give a large number of references to prove their point. This difficulty in diagnosis means that many complications from which patients suffer may not necessarily be immediately associated with infective endocarditis and so even more damage occurs. Conclusion This is a condition which is both difficult to diagnose and to treat, due to the variety and possible types of complications. However, as Spelman and Sexton ( 2011) point out, undiagnosis can lead to fatalities which might have been prevented. This is especially so because in many cases causative organisms are drug resistant, in particular to penicillin and its derivatives. As well as a wide range of other complications, it can so badly damage the heart, especially its lining and, if untreated, or left too late, the resulting heart failure can be fatal. References BRITISH MEDICAL JOURNAL,( 13th June1970) Neurological Complications of Endocarditis, available from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1700734/pdf/brmedj02292-0019a.pdf BRUSCH,J., and CUNHA,B., 27th July 2011, Background, Infective Endocarditis, Medscape, available from http://emedicine.medscape.com/article/216650-overview ( accessed 24th November 2011) GRAUPNER,C, VILACOSTA, I., SANROMÁN, J., RONDEROS,R., SARRIÁ,C., FERNÁNDEZ, C., MUJICA, R., SANZ,O., SANMARTIN, J. and PINTO,A., ( 2002) Periannular extension of infective endocarditis, Journal of the American College of Cardiology, 39.1204-1211, available from http://content.onlinejacc.org/cgi/content/full/39/7/1204 ( accessed 24th November 2011) HABIB, G., HOEN,B,. 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( 2011) Diagnostic Approach to Infective Endocarditis, UpToDate, available from http://www.uptodate.com/contents/diagnostic-approach-to-infective-endocarditis?source=see_link ( accessed 24th November 2011) SPELMAN , D. and SEXTON,D.,( 2011) Complications and Outcomes of Infective Endocarditis, UpToDate, available from http://www.uptodate.com/contents/complications-and-outcome-of-infective-endocarditis ( accessed 24th November 2011) WILLACY,H., 2009, Infective Endocarditis, Patient.co.uk, available from http://www.patient.co.uk/doctor/Infective-Endocarditis.htm ( accessed 24th November 2011) Read More