1 / 71

Infective Endocaditis

2. ???? 1 . ?? 30 ???? ????? ?????? ??? ??? ??-?????? ?????? ?????? ????? ????. ???????: ???? ???????????: ?????, ?????-?? ?????.?????? ?????? ????????? ???? ????????.?????? ????? -????? ??????? ?- mitral stenosis ??????? ????? - ???? ????? ?? ??????? ???? ???. ????? 3 ?????? ?? -S. viridans. 3.

ondrea
Download Presentation

Infective Endocaditis

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

    1. 1 ???? ??????? ?? ???? ??? Infective Endocaditis ?"? ???? ???? ?????? ?????? ???????? ???? ????? ??-????

    2. 2 ???? 1

    3. 3 ???? 2

    4. 4 ???? 3

    5. 5 ???? 4

    6. 6 Infective endocarditis ???? ??????? ?? ???? ???

    7. 7 ??????? II

    8. 8 ??????? III

    9. 9 ??????? IV

    10. 10

    11. 11 ????? ?????? IE - INFECTIVE ENDOCARDITIS SBE - SUBACUTE BACTERIAL ENDOCARDITIS ABE - ACUTE BACTERIAL ENDOCARDITIS HA IE -Health care associated-NOSOCOMIAL IE PVE - PROSTHETIC VALVE ENDOCARDITIS - Early vs. Late CULTURE NEGATIVE ENDOCARDITIS

    12. ????????????? ??? ????? ?"? ??????. ?????? – ????? ????? 109-1011 ???????, ????? ???????. ???? ??????? ??????? ??????? ??? ????????? ????? ??????? ?????? ????? ?? ??????? ????????? – ???????? 12

    13. 13

    14. 14

    15. ??????? ???????? ???????? 15-35% ?????? ?????? ???????? ??????? ? 45-65% ????? ? PM ?????? ????????? ?? – ??? ????? ?????? ????? -> CHF ??? ?? ??? ?????-> Acute AR/MR ????? – ???? ???? – 56% Glomerulonephritis 15

    17. Mycotic aneurysm – ??? ??? ???? ????? ?? ???? ?????? ?? ???? ?????. ?????? – ????? ??????? ????? ????? ?????, ????? ???? ???? ?? ????? ??????? ????? ?vasa vasorum ????? IC ???? ????? ?????. ??? ??????? ?????? ?? ???? ?????? ????? ?????? "???" ?? ???? ??? ????. 17

    18. CNS – ???????? ?????? – ? 20-40% ??????? Stroke – ??????? ????? ?? ??? ?? Mycotic aneurysm. ???? ?????? ? 44%. ??? ?????. 18

    19. Splenic infarct

    20. 20

    21. ??????? ???, "????? ?????" ????????? ?????? ???????? ???????? – ???????? ?????? ???????? ???? ?"? – ?????? ??????? ?? ????? ???????? ???????? ?????? ?????? ????? ??????? ?????? ?? ????? ??????. ?????? ???????? – Immune complex ??????? ????? ????? ?? ?????. 21

    22. ??????? - ????????? ???- 80% ????? – 40% ???? ????? – 40% ????? ????? – 25% Stroke – 20% ??? ??? – 20% ??? ?? – 10% 22

    23. ??????? - ?????? ??? – 90% ?????? – 85% ?????? ???? -5-10% ?????? ???????? - >50% Osler nodes – 10-23% Splinter hemorrhage – 15% ?????? – 20-40% 23 ?????? – ????????? ????? ?? ????????.?????? – ????????? ????? ?? ????????.

    24. Janeway lesions - <10% Splenomegaly – 20-57% Clubbing – 10-20% Mycotic aneurysm – 2-10% 24 Mycotic – ??? ????, ???. ???? ????? ? SAH.Mycotic – ??? ????, ???. ???? ????? ? SAH.

    25. 25 ?? ?????? ??? ????????????? ?????? ??? ???????????

    26. 26

    27. 27 ??????? ?????? ????? ??' ?"?. ????? ??? ????-????. ???? ????? ?????. ?? ??????- ???? ?? ? SLE??????? ?????? ????? ??' ?"?. ????? ??? ????-????. ???? ????? ?????. ?? ??????- ???? ?? ? SLE

    28. 28 ?????? ???????, ?? ??????, ????? ?? ???? ????? ???????. ????? ??' ????. ???- ??????- ???? ? SA.?????? ???????, ?? ??????, ????? ?? ???? ????? ???????. ????? ??' ????. ???- ??????- ???? ? SA.

    29. 29

    30. 30

    31. 31 ?????? –????? ?????. ???? ???????, ????? ???, ??? ??????. ???? ??????? ??????. ?????? ??? 2-3 ????.?????? –????? ?????. ???? ???????, ????? ???, ??? ??????. ???? ??????? ??????. ?????? ??? 2-3 ????.

    32. 32

    33. 33

    35. 35

    36. 36

    37. ????? ????? - 70-90% ???????????? – 20-30% (????? ????? ??) ?.? ????? – 90-100% ?????????????????? ???? ??? – ???????????, ??????? 37

    38. ?????? ?? Continuous low grade bacteremia 3 ?????? ?? ?????? ? 24 ????. ??? ????? 10cc ?? ?????? ????????? ???????? ???????? - 64% ?????? ??????? ??????? ? 100% ??? ???????????. ???? ?????? ?????? ?????? ??????????. ????? ? 3 ??????

    39. ??????? Streptococci – 60-80% S. Viridans -30-40% Enterococci – 5-18% other Strep – 15-25% Staphylococci – 35-40% S. aureus – 35% S. coagulase negative – 1-4% 39

    40. Gram negative bacilli – 2-13% Fungi – 2-4% Culture negative – 5-24% 40

    41. 41

    42. ??? ?? TransThoracic Echocardiography – ?????? 60-65%. ?????? ??????, ???? ??????, ???? ????. ?????? ???? ? IE ?? ?? ????. TransEsophageal Echocardiography- ?????? ?? 90-95% ?????? ??????? ?????? ????? ????? ????. 42 ??????? ?? ??? ????? ?? ????? ??????? ????? ???? ?????????? ????? ???????. ??????? ?? ??? ????? ?? ????? ??????? ????? ???? ?????????? ????? ???????.

    43. ????? ?????? ?????? ??????? – ??? ????, ???? ????? ?????. ???? cost-effective ?????? ?? ??? ???? ? IE. FN-6-18% => ???? ?? ?????? ???? 7-10 ????. 43

    45. 45

    46. 46

    47. 47 ??????????? - ????? ??????? ??? ?????? - ???? ???? ??????????? ??????:  ?????? ?? ?????? ?????? PERSISTENT BACTEREMIA    TEE ?????? ??????

    48. 48 ?????????? ?????? ??????????? I DUKE CRITERIA Durack DT, Am J Med 1994;96:200-209 MAJOR SIGNS 1. ?????? ?? ??????? ???????? ???????????? ?. ????? ?? ????? ??????? ???? ?????? ??????: Viridans Strep, Strep bovis, Staph aureus, Enterococcus, HACEK group ?? ?. ???? ???????? ?????? ?"? ????????????? ?????:        ·   ????? ???? ?????? ????? ?? ????? 12 ???? ?? ???.        ·   ????? ? 3/3 ?????? ?? ???? ??????? ???? ???? ?? ???? ????? ??? ?????? ???? ??? ?? ????? ??? ???. ?? ?. ???????? ?????? ? C.burnetii ?? Anti phase 1 >1:800 2. ???? ????? ???????? ???? ????? ???? - ??????, ????? ,?????? ???? ?? ???? ???? ,?? ????? ???? ?? ????.

    49. 49 ?????????? ?????? ??????????? II DUKE CRITERIA MINOR SIGNS ????????????: ???? ???? ????? ?? ????? ????? ???? ?????? ??? ??? C 380 ?????? ?????????: ???????? ???????, ?????? ????? ?????, ????????? ???????, ???? ??? ????, ???? ???????, ???? ?"? JANEWAY ?????? ????????????: ???????????????, ?????? ?"? OSLER, ROTH SPOTS, Rheumatic factor ???? ???????????: ?????? ?? ????? ??????? ?- MAJOR SIGNS ?? ???? ???????? ?????????????? ????? ????????????

    50. 50 ?????????? ?????? ??????????? III ???????? ???????? 1. ????? ??????????: ????? ????? ???????? ?? ????? ?? ???? ??????????. 2. ????? ??????: ??? ?????????? MAJOR, ?? ??? MAJOR+????? MINOR ?? ????? MINOR 3. ????? ??????: ??? Major + ??? Minor 3 Minor 4. ????? ?????: ????? ????? ?????? ??????, ??????? ?????? ???? 4 ??? ???? ????????? ??? ???? ???????????? ????? PM ???? 4 > ??? ????

    51. 51

    52. Prosthetic Valve Endocarditis ?????? ????? ???? ??????? ???? ?????? – 1-3% ????? PVE. ?????? ????? ??? ??? ??? ???? ???? ????????. ????? ? 15 ????, ? 17% ????? PVE. 52

    53. ????? Early – ?? ??????? ???? ?????? Intermediate – 2-12?' ???? ?????? Late – ??? ??? ???? ?????? 53

    54. ?????? Early – Staph. 40-60% (SCN–35%), GNB, Fungi Intermediate – Staph., Strep., Enterococci Late – like NVE + SCN. 54

    55. ????? – ?????? ?? + TEE ??????? ????? – ????? ?????? ??????? ?????? ??????. ???????? – ????? ????? ? Early ?? late. ????? – 10-30% 55

    56. ?????? ???? - IVDU ??? ???????? ?????? -> ??? ???? ? IE ? 2/3 ??? ???? ?????? ????. ???, ????? ?? TCV. ?? ? 35% ????? ?????? ??? ?????. ??????- ??? ????????. ?????? ???- Septic pulmonary emboli ???? 2/3 ??? ?????? ????. 56

    58. 58

    59. IVDU 2 ?????? S.aureus – 60% Streptococci – 16% Pseudomonas – 13% Polymicrobial – 8% Candida 59

    60. 60

    61. 61

    62. 62

    63. 63

    64. ????? IE ???? IE ????? ???? ????? ?"? ??????? S.viridans ????? ????? ?????? ????? ????? ????? ????? ???????? ???? ?????? ?????? ?????? ??????? ?? ????? ?? ???? ?????? ????? IE ???? ????? ?????? 64

    65. ?????? ???"? ???? ?? ???? ????? IE ?"? ????? ????????? ????? ????????? ???? ????? ?????? ???? ??????? ????? ????????? ???????? ?? ???? ????-> ???? IE 65

    66. ????? ?? ???? ?? ????? ???? ????? ?????? IE ??????. ?? ???? ?? ????? ???? ??? ???? IE ??????? ???? ?????? ?????? ?????? ???? ???? ?????? (?? ???? ???? ?????) ??? ???? ????? ??????. ?????? ???? IE ???? ?????? ?????? ?????? ???? ???? ?? 154000 ??????? ?????? ??. 66

    67. ????? ???? ??????? ?????? ?????????? ????? ???? ??????? ???? ?? ????. ????? ???????????? ???? ??????? ????? ????? ??????? ???? ????? ?? ????? ????? ????? ???? 67

    68. ????? ????? ??? ?? ??? ????? ???? ???? ???? ??? ??? ????? ???? ???? ? IE ????? ?? ???? ?? ???????? (????????? ??? ?????, ????? ? 6?' ????????) ?????? ?? ?? ????? ?????? ??? ?????? 68

    69. ?????? ??? ???? ????? ???? ?????? ?????? ??? ?? ????? ?????? ??????. ???? ????? – ???? ?? ????? ?? ??????. ??' ????? – ???? ?? ????? ?????? ?????? ???????? ????? ???. ??' ??? ???? – ???????? ??? ??????. 69

    70. 70

    71. 71

    72. ??? 72

More Related