TUGAS ANALISIS JURNAL

KEPERAWATAN DEWASA I

Disusun Oleh :

Nurma Juniati

2111102411165

Program Study S1 Keperawatan Alih Jenjang

Fakultas Ilmu Keperawatan

Universitas Muhammdiyah Kalimantan Timur

Tahun 2022
Title Dental infections as cause of bacteremia in infective endocarditis

Name Journal Baiturrahmah university journal of dentistry

Volume & Page Vol 6, No. 2 : page 142-151

Year 2019

Author Dian Puspita & Citra Kiki Krevani

Abstract Description Infective endocarditis is a deadly disease with a high morality rate of
20% in 30 days. The cause of infective endocarditis in this case was
streptococcus viridans which is an oral floral. The patient was
diagnosed with definite infective endocarditis based on complaints,
clinical findings, and investigations.

Keyword Journal Dental infections, infective ebdocarditis, streptococcus viridans

Preliminary Infective endocarditis (EI) is an infection of the endocardinal lining of

the heart, including the heart valves. Infective endocarditis is a deadly
disease, although there has been improvement in therapeutic
management, infective endocarditis still has a high morality rate of
20% in 30 days. There are three factors that contribute to the
development of infective endocarditis namely the entry of bacteria into
the bloodstream, the presence of disorders of the heart valves, and the
virulence of the bacteria. Because a preexisting valve is compromised
(such as a congenital defect, rheumatic heart disease or a prosthetic
heart valve), a sterile thrombus is formed. This thrombus is a place for
bacteria to attach which eventually forms vegetation. An increase in
the number of bacteria from the bloodstream will enlarge the
vegetation and impair valvular function. Eventually this vegetation can
lead to congestive heart failure. Oral bacteria can enter the
bloodstream from infected teeth by brushing. Staphylococcus aureus
and Streptococcus viridans can be present in the oral cavity and are the
most common organisms causing infective endocarditis.

Discussion In this journal, we discuss Definite infective endocarditis caused by

Streptococcus Viridans. Infective endocarditis is a disease caused by
microbial infection of the endothelial lining of the heart. This infection
most commonly occurs in one or more leaflets, but infection can also
extend to the mural endocardium, chordae, myocardium, and
pericardium. The clinical picture of endocarditis is often non-specific.
However, in patients with fever and valvular abnormalities or there are
predisposing factors known to be associated with EI, further
investigations should be carried out to establish the diagnosis of EI.
In this study, the major and minor criteria are used as follows:
 1. Major Criteria
Positive blood culture for EI. Typical microorganisms
consistent with EI from 2 separate blood cultures: Viridans
streptococci, Streptococcus bovis, HACEK group,
Staphylococcus aureus or Community-acquired enterococci, in
the absence of a primary focus. Microorganisms consistent
with EI from persistently positive blood cultures were defined
as follows: At least 2 positive culture blood samples drawn >
12 hours apart; or All or majority of 4 separate blood cultures
(with first and last blood sampling at least 1 hour apart). One
positive blood culture for Coxiella burnetiid or an anti-phase I
antibody titer IgG > 1: 800. Evidence of endocardinal
involvement. Positive echocardiogram for EI (TEE is
recommended for patients with prosthetic valves, including at
least Clinically Criteria Possible EI or EI with complications
(paravalvular abscess); TTE first examination in other patients,
defined as follows: Intracardiac mass in valve or supporting
structures, in pathway regurgitant jet or implant material in the
absence of alternative anatomic explanation, or abscess, or new
partial dehiscence of a prosthetic valve New valve
regurgitation (inadequate worsening or alteration of the
previous murmur)
2. Minor Criteria
Predisposing, predisposing heart conditions or use of injection
drugs. Fever, temperature > 38℃. Vascular phenomena, major
arterial embolism, septic pulmonary infarction, mycotic
aneurysms, intracranial haemorrhages, conjunctival
haemorrhages, and Janeway slesions. Immunological
phenomena: glomerulonephritis, Oaler's nodes, Roth spots and
rheumatoid factor. Microbiological evidence, positive blood
culture, but not one of the above major criteria or serological
evidence of active infection with an organism consistent with
EI. Minor echocardiographic criteria were excluded.
Based on the findings from the history, physical examination, and
investigations of the patient, based on the definition used in the
modified Duke criteria for the diagnosis of infective endocarditis, 1
minor criterion was obtained, namely fever > 38.4℃. Therefore,
according to the modified Duke criteria the patient was diagnosed with
definite infective endocarditis. Based on the results of blood cultures
and consuls from the teeth and mouth, the suspected cause of infection
in this patient was a dental infection, poor dental health and dental
procedures, known to be associated with Streptococcus viridans
infection.
Strength & Weekness 1. Advantages
In this journal using technology in examination and diagnosis, the
explanation of the disease is quite good and this journal includes
suggestions for readers to maintain dental hygiene and health. In this
journal there are also recommendations for readers to prevent
infection.
2. Weaknesses
This paper does not explain the spread mechanism associated with
dental infections that can cause endocarditis.