🛀🏻 👨🏾‍🤝‍👨🏻 🏐 Bacterial endocarditis: causes, symptoms, prevention and treatment 🖐🏾 ⏯️ 🔂

Bacterial endocarditis is a dangerous disease that is accompanied by acute inflammation of the inner connective tissue membrane of the heart. In the absence of timely medical care, an illness can lead to dangerous consequences, including heart failure and sepsis. Unfortunately, sometimes the pathology ends with the death of the patient.

Of course, many readers are looking for additional information. Causes, symptoms, treatment of bacterial endocarditis are information that you should definitely familiarize yourself with.

What is a disease? The list of possible pathogens

To begin with, it is worth familiarizing yourself with general information about the disease. Bacterial endocarditis (ICD-10 assigned this pathology code I33) is an acute inflammatory disease that develops against the background of the penetration of pathogenic microorganisms into the heart. The disease affects the inner lining of the heart, namely, the connective tissues that line the cavity of the ventricles, atria, cover the heart valves.

According to statistics, in 80% of cases, the causative agent of endocarditis is either Staphylococcus aureus or Strep green. The inflammatory process can also develop against the background of the activation of other bacteria, in particular, chlamydia, brucella, salmonella, pneumococci, enterococci, gonococci, meningococci, but similar cases are recorded much less frequently. By the way, viruses and fungal microorganisms can also lead to the development of endocarditis, in particular, its so-called “abacterial” form - such pathologies are usually characterized by a severe course, and their treatment is difficult.

It is worth noting that both adult patients and children are affected by this disease. The statistics in this case are not very comforting - in 30% of cases, the inflammatory process ends with the death of patients.

Risk factors: what increases the likelihood of developing an ailment?

Bacterial endocarditis develops against the background of intensive reproduction of pathogenic microorganisms. But there are factors whose exposure increases the likelihood of this disease. Their list includes:

the patient has congenital or acquired heart defects and valves;
damage to heart valves caused by rheumatism;
sagging valve flaps;
acute or chronic suppurative inflammatory processes (in any part of the body);
the presence of artificial valves in the patient;
improper diet, alcohol abuse, drug use;
uncontrolled intake of antibacterial drugs and some other drugs;
patient surgery or invasive diagnostic procedures;
infections in the tissues and structures of the oral cavity (even dental caries without timely treatment can be dangerous);
working conditions associated with the negative impact of the external environment, damage to the immune system;
some individual features of the anatomy of the heart also matter.

Bacterial endocarditis in children often develops if the birth canal of the mother was infected - pathogenic bacteria penetrate the body of a newborn baby, which can lead to the appearance of a mass of various diseases.

Classification of bacterial endocarditis

A similar disease can be classified in different ways. For example, depending on the occurrence factors, there are:

the primary form in which the inflammatory process occurs on healthy valves and heart structures;
the secondary form, which develops against the background of already existing heart injuries, as well as with atherosclerosis, after rheumatism.

If we take into account the features of the clinical course, then we can distinguish several forms of endocarditis.

Acute inflammation lasts up to two months. Its development is caused by the activity of a highly pathogenic pathogen. The patient has the appearance of severe symptoms of intoxication. High probability of sepsis.
The subacute form lasts more than two months. As a rule, its development is associated with a previous acute endocarditis or other infectious disease (the patient did not complete the full course of therapy or the treatment regimen was incorrect).
Sometimes endocarditis becomes chronic, which is characterized by a protracted course. This kind of ailment is difficult to treat.

If we are talking about the development of endocarditis in a child, then the following forms are distinguished:

congenital, in which pathology is formed during intrauterine development (in this case, the disease is usually due to the presence in the mother’s body of foci of acute or chronic inflammation);
acquired, which develops after the birth of the baby and can be associated both with the penetration of infection into the body, and with the presence of various heart defects.

Depending on the course of the disease, the characteristics of the clinical picture, the following forms are distinguished:

infectious toxic endocarditis is accompanied by transient bacteremia;
the infectious-allergic form is characterized by the formation in the body of specific antibodies to the pathogen antigens, as well as to its own tissues and structures;
dystrophic endocarditis is accompanied by chronic inflammation, the formation of various heart defects and blood vessels, the accumulation of calcifications on the valve cusps, the development of heart failure.

What symptoms are accompanied by pathology?

Symptoms of bacterial endocarditis directly depend on the stage and form of development of the disease. In many patients, the first stages of inflammation are hidden. Nevertheless, it is important to carefully monitor your own condition and well-being.

Symptoms of bacterial endocarditis in adults (as well as in children) can be as follows:

first, general signs of the inflammatory process appear in the body - the body temperature rises, chills, body pain, muscle weakness, increased sweating;
patients often begin to lose weight dramatically;
many patients suffer from constant headaches, lethargy;
due to progressive anemia, the skin becomes earthy or yellowish-gray;
a characteristic sign is a hemorrhagic rash - multiple small subcutaneous hemorrhages appear, which is associated with a weakening of the walls of the capillaries; the same picture can be observed when examining the mucous membranes;
small nodules begin to form on the fingers - the phalanges take the form of “drum sticks”.

Endocarditis leads to damage to the heart valves and myocardial tissues, which entail the development of heart failure.

Subacute bacterial endocarditis occurs with the formation of blood clots - this process sometimes leads to embolism of the vessels of the spleen, kidneys, and brain. Pathology can lead to the development of polyarthritis and arthralgia. Also, sometimes there is an increase in the size of the liver and spleen, damage to the kidney tissue.

List of possible complications

Acute bacterial endocarditis is a serious disease that can in no way be ignored. In the absence of timely therapy, a huge number of dangerous complications can develop:

endocarditis primarily affects the heart, which leads to a violation of the structure and functioning of the valves, the development of pericarditis and myocarditis;
possible renal impairment, in particular, the appearance of nephrotic syndrome, renal infarction, diffuse glomerulonephritis, progressive development of renal failure;
the inflammatory process negatively affects the lungs - it is possible to develop pneumonia, heart attack of lung tissue, abscess, severe pulmonary hypertension;
the disease affects the work of the liver, provoking the development of hepatitis, cirrhosis, abscesses;
pathology sometimes affects the nervous system - patients often suffer from meningitis, strokes, meningoencephalitis;
enlargement, abscess, heart attack or even rupture of the spleen is possible;
sometimes there are complications from the vessels - it is possible the development of thrombophlebitis, thromboembolism, thrombosis, hemorrhagic vasculitis, the formation of aneurysms with their further development;
in some cases, pathology leads to the rapid development of acute forms of heart failure.

The most dangerous is bacterial-septic endocarditis, which often ends in septic shock. The list of dangerous complications includes cerebrovascular embolism, respiratory distress syndrome, multiple organ failure — such pathologies often end in the death of the patient.

Laboratory diagnostics and general examination

In the presence of alarming symptoms, it is very important to consult a doctor on time. Diagnosis of bacterial endocarditis includes a lot of procedures, because it is important to determine not only the presence of a pathology, but also the stage and form of its development, the nature of the pathogen.

To begin with, a history is collected. It is important for a doctor to know about the presence of certain symptoms. It is likely that the specialist will be interested in information about the patient’s lifestyle, previous illnesses, trying to determine the presence of certain risk factors.
Doctors examine the skin, eyes, mucous membrane of the mouth and eyes. As already mentioned, against the background of endocarditis, a very characteristic hemorrhagic rash appears on the tissues.

In the future, various laboratory tests are carried out.

A general analysis of urine and blood helps confirm the presence of an inflammatory process in the body. In addition, the study makes it possible to detect certain concomitant diseases (for example, kidney damage).
A biochemical blood test is also mandatory. Changing the level of cholesterol, uric acid and other substances helps to draw conclusions about the presence of lesions of the internal organs.
A coagulogram is also performed, which makes it possible to assess the rate of blood coagulation, to determine the likelihood of blood clots.
Informative is back sowing. Such a study makes it possible to cultivate the culture of the pathogen, to determine its variety, to check the sensitivity of bacteria to certain drugs.
An immunological blood test is also included in the diagnostic plan. During the procedure, specific antibodies can be found in the patient’s body that are produced by the immune system in response to the penetration of a specific pathogen. Such a study helps to determine the type of pathogen.
PCR diagnostics can detect traces of the genetic material of pathogenic microorganisms in the blood and human tissues.

Instrumental diagnostic methods

The test results give the doctor the opportunity to detect the inflammatory process, determine the type of pathogen. However, an examination of the internal organs is necessary in order to find out the extent of their damage.

Electrocardiography is a simple and affordable procedure that allows you to determine the presence of heart rhythm disturbances.
A phonocardiogram makes it possible to detect uncharacteristic heart murmurs, which may indicate damage to one or another part of the myocardium and valves.
Chest x-ray helps to evaluate the size of the heart, to determine the presence of pulmonary infarction or stagnation of blood.
One of the main diagnostic methods for this disease is echocardiography. During the procedure, the doctor can measure the thickness of the myocardium in a specific place, determine the size of the cavities and holes, the existing heart defects. By the way, transesophageal echocardiography is more informative, since in this case the sensor is inserted through the esophagus.
Magnetic resonance imaging and computed tomography are also performed. The obtained images allow the doctor to learn more about changes in the structure of the heart, to determine the presence of violations from other organs.

Drug treatment

The sooner therapy is started, the more likely it is to recover quickly. The treatment regimen depends on many factors.

It is mandatory to take antibacterial drugs that will help cope with the pathogen of the inflammatory process. Penicillin antibiotics are considered effective. The course of treatment in this case lasts at least a month.
Sometimes antifungal, antiviral and antiparasitic drugs are added to the treatment regimen (if secondary infection occurs).
Non-steroidal anti-inflammatory drugs, for example, Nurofen, Diclofenac, Ibuprofen, are used to relieve the inflammatory process.
In more severe cases, patients are prescribed steroid drugs that cope with the inflammatory process much faster.
Also included in the treatment regimen are anticoagulants and antiplatelet agents (for example, Heparin), which help prevent blood clots and embolism.

Treatment of such a disease is carried out exclusively in a hospital setting - the patient must constantly be under the supervision of medical personnel. In this case, round-the-clock monitoring of vital signs is extremely important.

Bacterial endocarditis: clinical recommendations

Of course, correctly selected medicines can eliminate the pathogen and stop the symptoms of the inflammatory process. But there are other measures that should be included in the treatment regimen for bacterial endocarditis. The recommendations of experts relate to the regimen and lifestyle of patients.

A person is recommended a bed or half bed regime. During treatment, it is important to limit physical activity, to avoid stress.
Of course, you should abandon bad habits, including alcohol and smoking.
An essential part of therapy is a proper diet. Food should be light and high-calorie, saturate the body with vitamins and nutrients. The menu must include fruits and vegetables (in the form of mashed potatoes), fresh juices, dairy products, oatmeal, low-fat varieties of fish (cook steamed or grilled). Rich broths, spicy and fried foods, smoked meats, coffee, cocoa and chocolate are prohibited.

Surgery

An operation is indicated if drug therapy does not give the desired result or if a person has dangerous complications (for example, embolism requires emergency surgery).

The purpose of the procedure is to remove structures that are foci of bacterial reproduction. In this case, the doctor often removes damaged and affected valves, which are then replaced with new ones (valves of biological origin, or prostheses made of special synthetic materials). According to statistics, the mortality rate among patients undergoing surgical treatment with bacterial endocarditis is 10%.

Preventive measures and prognoses for patients

Prevention of bacterial endocarditis comes down to the timely treatment of all bacterial diseases - in no case should you refuse therapy or self-medicate, even if it is a common cold.

After operations and some diagnostic procedures, it is important to undergo a course of antibacterial therapy - this will help prevent the development of complications. If the chronic foci of inflammation are present in the human body, then their rehabilitation should be carried out at least 2-4 times a year.

Prevention of bacterial endocarditis in children (especially newborns) comes down to protecting the mother's body from various infections. Do not skip medical examinations. It is recommended to be tested periodically, as this will help determine the presence of an inflammatory process at an early stage. Patients with heart and valve defects should be registered with a doctor and undergo regular examinations.

As for the forecasts, much depends on the form of the disease, stage of its development, general condition and age of the patient. In the absence of therapy, infectious bacterial endocarditis ends in the death of a person in about a month, subacute inflammation in six months. Timely started therapy helps save the patient's life. The most dangerous situation is when the disease is associated with the development of complications such as sepsis and embolism. It is also proven that children and elderly patients suffer the disease much harder. In 30% of cases, bacterial endocarditis ends lethally.

Bacterial endocarditis: causes, symptoms, prevention and treatment