Bacterial endocarditis is a dangerous disease that is accompanied by acute inflammation of the inner connective tissue lining of the heart. In the absence of timely medical care, the disease can lead to dangerous consequences, including heart failure and sepsis. Unfortunately, sometimes the pathology ends in the death of the patient.
Of course, many readers are looking for more information. Causes, symptoms, treatment of bacterial endocarditis - this is information that you should definitely read.
What is a disease? List of possible pathogens
First, you should read the general information about the disease. Bacterial endocarditis (ICD-10 assigned the code I33 to this pathology) is an acute inflammatory disease that develops against the background of penetration of pathogenic microorganisms into the heart. The disease affects the inner lining of the heart, namely,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 streptococcus viridans. 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 such 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 fraught with difficulties.
It is worth noting that both adult patients and children are susceptible to such a disease. The statistics in this case are not too comforting - in 30% of cases, the inflammatory process ends in the death of patients.
Risk factors: what increases the likelihood of developing an ailment?
Bacterial endocarditis develops against the background of intensive multiplication of pathogenic microorganisms. But there are factors that increase the likelihood of the occurrence of this disease. Their list includes:
- the patient has congenital or acquired heart and valve defects;
- heart valve disease caused by rheumatism;
- sagging valve blades;
- acute or chronic purulent-inflammatory processes (in any part of the body);
- availabilitypatient artificial valves;
- malnutrition, alcohol abuse, drug use;
- uncontrolled intake of antibacterial drugs and some other drugs;
- patient's previous 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 mother's birth canal was infected - pathogenic bacteria enter the body of a newborn child, which can lead to a host of various diseases.
Classification of bacterial endocarditis
This disease can be classified in different ways. For example, depending on the factors of occurrence, they distinguish:
- primary form, in which the inflammatory process occurs on he althy valves and heart structures;
- secondary form, which develops against the background of already existing heart damage, as well as with atherosclerosis, after suffering rheumatism.
If we take into account the characteristics of the clinical course, we can distinguish several forms of endocarditis.
- Acute inflammation lasts up to two months. Its development is due to the activityhighly pathogenic pathogen. The patient has the appearance of severe symptoms of intoxication. Sepsis is highly likely.
- 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 type of disease 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 the pathology is formed during fetal development (in this case, the disease is usually due to the presence of foci of acute or chronic inflammation in the mother's body);
- acquired, which develops after the birth of a child and can be associated with both the penetration of an infection into the body and the presence of various heart defects.
Depending on the course of the disease, the characteristics of the clinical picture, the following forms are distinguished:
- toxic endocarditis accompanied by transient bacteremia;
- the infectious-allergic form is characterized by the formation in the body of specific antibodies to the antigens of the pathogen, as well as to its own tissues and structures;
- dystrophic endocarditis is accompanied by chronic inflammation, the formation of various malformations of the heart and blood vessels, the accumulation of calcifications on the valves, the development of cardiacfailure.
What are the symptoms of 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. However, 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 there are general signs of an inflammatory process in the body - body temperature rises, chills appear, body pain, muscle weakness, increased sweating;
- patients often start losing weight drastically;
- 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 weakening of the capillary walls; the same picture can be observed when examining the mucous membranes;
- small knots begin to form on the fingers - the phalanges take the form of "drumsticks".
Endocarditis causes damage to the heart valves and myocardial tissue, leading to 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 may lead to the developmentpolyarthritis and arthralgia. Also, sometimes there is an increase in the size of the liver and spleen, damage to the tissues of the kidneys.
List of possible complications
Acute bacterial endocarditis is a serious disease that should never be ignored. In the absence of timely therapy, a huge number of dangerous complications may develop:
- endocarditis primarily affects the heart, which leads to disruption of the structure and functioning of the valves, the development of pericarditis and myocarditis;
- renal disorders are possible, in particular, the appearance of nephrotic syndrome, kidney infarction, diffuse glomerulonephritis, progressive development of renal failure;
- inflammatory process negatively affects the lungs - possible development of pneumonia, infarction of lung tissue, abscess, severe pulmonary hypertension;
- the disease also affects the liver, provoking the development of hepatitis, cirrhosis, abscesses;
- pathology sometimes affects the nervous system - patients often suffer from meningitis, strokes, meningoencephalitis;
- possible enlargement, abscess, heart attack or even rupture of the spleen;
- sometimes there are complications from the vessels - thrombophlebitis, thromboembolism, thrombosis, hemorrhagic vasculitis, the formation of aneurysms with their further development are possible;
- 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 cerebral embolism, respiratory distress syndrome, multiple organ failure - such pathologies often end in the death of the patient.
Laboratory diagnosis and general examination
In the presence of alarming symptoms, it is very important to consult a doctor in time. Diagnosis of bacterial endocarditis includes a lot of procedures, because it is important to determine not only the presence of pathology, but also the stage and form of its development, the nature of the pathogen.
- To begin with, an anamnesis is being collected. It is important for the 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 diseases, trying to determine the presence of certain risk factors.
- Doctors examine the skin, eyes, oral mucosa and eyes. As already mentioned, a very characteristic hemorrhagic rash appears on the tissues against the background of endocarditis.
Various laboratory tests are being carried out in the future.
- General analysis of urine and blood helps to 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. Changes in the level of cholesterol, uric acid and other substances help to draw conclusions about the presence of lesions of the internalorgans.
- A coagulogram is also carried out, which makes it possible to assess the rate of blood clotting, to determine the likelihood of blood clots.
- Bakseev is informative. Such a study makes it possible to grow a culture of the pathogen, determine its variety, and test the sensitivity of bacteria to certain drugs.
- The diagnostic plan also includes an immunological blood test. During the procedure, specific antibodies can be detected in the patient's body, which are produced by the immune system in response to the penetration of a certain pathogen. Such a study helps to determine the type of pathogen.
- PCR diagnostics can detect traces of the genetic material of pathogenic microorganisms in human blood and tissues.
Instrumental methods of diagnostics
The results of the tests give the doctor the opportunity to detect the inflammatory process, to determine the type of pathogen. However, an examination of the internal organs is necessary in order to determine the extent of their damage.
- Electrocardiography is a simple and affordable procedure that allows you to determine the presence of cardiac arrhythmias.
- 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, determine the presence of a pulmonary infarction or blood stasis.
- 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 certain place, determine the size of the cavities and holes, existing heart defects. By the way, transesophageal echocardiography is more informative, since in this case the sensor is inserted through the esophagus.
- Also performed magnetic resonance and computed tomography. The resulting images allow the doctor to learn more about changes in the structure of the heart, to determine the presence of violations from other organs.
Medicated treatment
The sooner therapy is started, the greater the chance of a quick recovery. The treatment regimen depends on many factors.
- It is mandatory to take antibacterial drugs that will help to cope with the causative agent of the inflammatory process. Antibiotics of the penicillin series 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 therapy regimen (if there is a secondary infection).
- Non-steroidal anti-inflammatory drugs, such as Nurofen, Diclofenac, Ibuprofen, are used to relieve the inflammatory process.
- In more severe cases, patients are prescribed steroid drugs, which cope with the inflammatory process much faster.
- Anticoagulants and antiplatelet agents (such as Heparin) are also included in the treatment regimen, which help prevent the formation of blood clots and the development of embolism.
Treatment of similardiseases are carried out exclusively in a hospital - 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 guidelines
Of course, properly 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 specialists relate to the regimen and lifestyle of patients.
- A person is recommended bed or semi-bed rest. During treatment, it is important to limit physical activity, avoid stress.
- Of course, you should give up bad habits, including drinking and smoking.
- Extremely important part of therapy is the right diet. Food should be light and high-calorie, saturate the body with vitamins and nutrients. The menu must include fruits and vegetables (possible in the form of mashed potatoes), fresh juices, dairy products, oatmeal, low-fat fish (steamed or grilled). Rich broths, spicy and fried foods, smoked meats, coffee, cocoa and chocolate are prohibited.
Surgical treatment
Surgery is indicated if drug therapy does not give the desired result or if the person has dangerous complications (for example, an embolism requires emergency surgical intervention).
The purpose of the procedure is to remove structures that are breeding grounds for bacteria. At the same time, the doctoroften 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 for bacterial endocarditis is 10%.
Preventive measures and prognosis 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 take a course of antibiotic therapy - this will help prevent the development of complications. If there are chronic foci of inflammation in the human body, then their sanitation 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. Don't skip medical checkups. It is recommended to periodically take tests, as this will help determine the presence of an inflammatory process at an early stage. Patients with heart and valvular disease should be registered with a doctor and have regular check-ups.
As for prognosis, much depends on the form of the disease, the stage of its development, the general condition and age of the patient. Infective bacterial endocarditis in the absence of therapy ends with the death of a person in about a month, subacute inflammation -after six months. Early treatment helps save the patient's life. The most dangerous is the situation in which the disease is associated with the development of complications such as sepsis and embolism. It has also been proven that children and elderly patients endure the disease much more severely. Bacterial endocarditis is fatal in 30% of cases.
