Microbiology of Cardiovascular

System
2020/2021
Bacteremia

 Bacteria presence in the blood

 Asymptomatic
Septicemia
 Sepsis of the blood

 Large numbers of organisms enter (actively multiply)

and persist in the blood stream

 Clinical signs and symptoms

- hypotension
- fever
- rigors
Septicemia and sepsis syndrome
 Systemic response to microbial products or constituents circulating
in the blood mediated by inflammatory cytokines

 Predisposing factor
- Abdominal sepsis
- Infected wounds, burn
- Osteomyelitis
- Pneumonia
- Intravascular devices
- Food poisoning
- Meningitis
- Immunosuppressed patients
Clinical manifestations
 Hypotension
 Fever
 Rigors
 Oliguria
 Renal failure
 Disseminated intravascular coagulation DIC
 Bleeding disorder
Infective endocarditis
 Infective endocarditis (IE) is an infection of the valves
of the heart

 Two major predisposing causes

- Susceptible cardiovascular substrate
- Source of bacteremia
 Endocarditis
 Infective
or
 Non-infective
Causes of Infective Endocarditis
 Major Bacterial Causes
- Staphylococcus aureus
- Streptococci (Viridans)
- Coagulase negative Staphylococci
• Other Causes
- Enterococci

- HACEK
Haemophilus species
Aggregatibacter species
Cardiobacterium hominis
Eikenella corrodens
Kingella species
- Fungi
Classification
➢ Progression:
 Acute: days - 6 weeks, Staphylococcus aureus
 Subacute: 6 weeks - 1yr, Viridans streptococci

 Valve:
 Native

 Prosthetic

 Iv drug abusers
Microbiological Characteristics
 Staphylococcus aureus

 Streptococcus veridans
Staphylococcus
 General Characteristics

 Virulence Factors

 Diseases
Important Features of Pathogenesis by
Staphylococcus
Streptococcus
 General Characteristics

 Virulence Factors

 Diseases
Important Features of Pathogenesis of
Streptococcus
 Pathogenesis
Pathogenic Process Contributing Factors
Normal valvular endothelium
Platelet aggregation Endothelial damage
Fibrin deposition Local hypercoagulation
Exogenous stress factors

Nonbacterial thrombotic en-docarditis (sterile vegetation)

Microbial adherence
1. Dextran (strep.v.)
2. Lipoteichoic acid (S.a., Ent.)
Pathogenesis
Pathogenic Process Contributing Factors
- Transient bacteremia
1. Frequency
2. Inoculum size
3. Reticuloendothelial clearance
4. Complement-mediated lysis

- Microbial multiplication

- 2nd bacteremia
Diagnosis Criteria
 The diagnosis of infective endocarditis requires the
integration of

- Clinical
- Laboratory
- Echocardiographic data
Clinical Manifestations
 Signs and symptoms
 Fever

 Malaise and fatigue

 Weight loss, and anemia

 Coughing

 Night sweats, rigors, spleen enlargement

 A new or changing heart murmur

Signs and symptoms
 Vascular phenomena:
- Septic embolism (causing thromboembolic problems

- Janeway lesions
- Painless hemorrhagic cutaneous lesions on
palms & soles

- Intracranial hemorrhage

- Conjunctival hemorrhage
- Splinter hemorrhage, kidney infarcts, and splenic
infarcts
 Signs and symptoms
 Immunological phenomena:

- Glomerulonephritis

blood and albumin enter to urine,

- Osler`s nodes
painful subcutaneous lesions in the distal fingers

- Roth`s spots on the retina

- Positive serum rheumatoid factor

Clinical Manifestations
Clinical Manifestations
Clinical Manifestations
Diagnosis
 Blood culture

 Culturefrom sites suspected to be

causing the infection

 Echocardiogram
Culture Negative

 Reasons for Culture negative IE

??????????
Treatment

- Aggressive bactericidal intravenous

antimicrobial therapy

- Stabilization of hemodynamic status

- Identification of the focus of infection

Treatment
 Medical:
 Antimicrobial Agents :
 Anticoagulant Therapy: not commanded
 Surgical:
 Indications:
 Congestive heart failure is the strongest indication for surgery

 Special microorganisms:
 Pseudomonas aeruginosa, brucella species, Coxiella
burnetii, candida species, other fungi, and probably
enterococci

 IE involving a prosthetic valve

Antibiotics
 Bactericidal

 Single (organism is highly susceptible in vitro)

 Combination
Empirical Therapy:
Vancomycin + either Ceftriaxone or Gentamycin

 Parenteral therapy then oral

 Prolonged therapy
Antibiotics
Antibiotics
Prophylaxis
 Used in
- Persons with known congenital or acquired cardiac
lesions
- Person undergo procedures known to cause transient
bacteremia
- Dental manipulations
- Surgery URT, GIT, GUT)

 Administration of high doses of ATB just before

operation and lasted 6 to 12 hours after
Prophylaxis
Myocarditis
 Is infection of heart muscle

 Following hematogenous spread (viral pathogens)

 Signs and symptoms of heart failure + signs and

symptoms of systemic infection

 Diagnosis

 Treatment & Prevention

Pericarditis
 Refers to inflammation of pericardium

 Chest pain, fever , cardiac tamponade + symptoms of

heart failure

 Pathogens (???)
 Bacteria

 Viruses

 Fungi
Pericarditis
 Diagnosis:
 Culture of pericardial fluids or pericardial tissues
 ECG

 Echocardiogram or MRI
 X-ray

 Treatment depends on the cause

 Prevention: Vaccine against S. pneumoniae , Tx of

Tuberculosis
Clinical Case
 A 70 year old man presented with microscopic
haematuria, proteinuria and fever five weeks after having
a transurethral resection of the prostate (TURP)

 Initially urological review was arranged as the family

doctor thought that a urinary infection was the most likely
diagnosis
 The patient was concerned that he was not getting
better and he self-referred to a physician

 He had continuing fever, weight loss, and malaise

 The physician detected a mitral pan-systolic murmur

that had not been heard before
 Questions
 What is the initial diagnosis? Why?

 What is the definitive diagnosis? Why?

 Will blood Culture be positive or negative?

 What are the causative agents of IE?