Subacute Bacterial Endocarditis

 

Subacute Bacterial Endocarditis

This is also known as infective endocarditis.

subacute bacterial endocarditis (SBE) is a gradual heart lining infection caused by bacteria entering the bloodstream and attacking heart valves.

 

Aetiology

1.Damage to the endocardium due to any of the following conditions:-

                 .Rheumatic heart disease with valvular involvement.

                 .Congenital heart disease.

                 .Atrial septal defect.

                 .Ventricular septal defect.

                 .Patent ductus arteriosus.

2.Infection at any septic focus may spread t the blood stream and reach the heart to cause subacute infective endocarditis. Common septic foci in the body are as follows:-

                                  -Tonsil.

                                  -Pharynx.

                                  -Paranasl sinuses.

                                  -Dental caries.

                                 -Pelvic inflammatory disease.

                                 -Chronic Osteomyelitis.

Clinical features

1.Fever with chills, relieved by sweating.

2.Fever over prolonged periods.

3.Toxicity.

4.Cardiac murmurs: changing murmur, sudden onset of new murmurs.

5.Features of embolism of the bacterial nodules formed on the valve cusps (see following table).

 

Site	Effect
Brain	Coma. Hemiplegia.
Kidney	Lion pain. Haematuria.
Skin	Splinter hemorrhages. Hemorrhages undr the skin.

 

 

Investigations

1.      Blood culture.

2.      Fundoscopy.

3.      Urine analysis for microscopic haematuria.

4.      Echo cardiograph.

 

Treatment

1.Broad spectrum antibiotics: Cephalosporin plus aminoglycoside plus metronidazole or tinidazole.

2.Paracetamol for fever.

3.Treatment of complications.

 

Prevention

1.Treatment of all septic foci.

2.Antibiotic prophylaxis at the time of all surgical procedures and childbirth.