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Microbial Infection of the CVS

Dr.D.Y.Riyanto,MSc. Dept.of Microbiology Sriwijaya Univ.Sch.of Medicine/ RSUP Dr.M.Hoesin Palembang


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Heart and blood vessels always sterile


Isolation of bacteria or fungi: infection! Bacteria:bacteriemia Fungi:fungaemia Virus:viremia Microbe:microbemia

Cardiovascular Infection
1.Pericarditis 2.Myocarditis 3.Endocarditis 4.Pancarditis 5.Septic shock (SIRS)

Etiologic agents Gram (+) coccus Staphylococcus aureus S.epidermidis Streptococcus viridans S.pneumoniae S.pyogenes Enterococcus Gram(-) coccus Neisseria meningitidis N.gonorrhoeae
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Gram(-) bacil : Haemophylus influenzae & many others (E.coli,K.pneumoniae) Chlamydia trachomatis Chl.psittaci Rickettsia
Fungi : Candida albicans

Virus : HIV,DHF
nonInfection: exotoxin C.diphtheriae Rheumatic heart disease

S.pneumoniae
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E.coli

Streptococcus viridans

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Enterococcus

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Chlamydia:inclusion bodies

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Diphtheria :child

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Treponema pallidum

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Source of Infections
Teeth:dental procedure,poor dental hygienne Lung infection Throat Bacteriaemia IVFD & IV drug abuser Catheterization Others (surgery)

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Previous condition / predisposing factors


1.Underlying heart disease Congenital valve deformities Ventricular septal defect Tetralogy of Fallot Transposition of Great Vessels Patent ductus arteriosus Botalli Others (cardiomyopathy) 2.Rheumatic fever (post streptococcal)
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Bacterial Endocarditis
(acute & subacute bacterial endocarditis)

Bacterial infection of the endocardium Symptoms of systemic infection,embolic pneumonia, and endocardial vegetations.
The course of infection maybe acute or subacute, depending on the virulence of infecting bacteria.

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Symptom and signs


-Insidious onset of SBE -May mimic many systemic diseases without early signs of cardiac involvement -Fever,remittent,irregular or sustained, seldom > 39 C -malaise,fatigue,weight loss,skin petechiae -embolic infarction of vital organs -valve dysfunctioncongestive heart failure

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Severe Inflammatory Response Syndrome (septic shock)


Etiology:Gram (-) enteric bacilli Gr(+)cocci,C.albicans. Pathogenesis:release of inflammatory mediators local circulatory failuremulti organ failure Manifestation:hypotension,hypoxia,respiratory failure, lactic acidosis,renal failure,DIC & bleeding.

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Laboratory Diagnosis

Specimens: blood,taken during fever,3-4x/day


Culture in Bactec machine (otomatic blood culture) BHI and blood agar/other agar media. (MacConkey,MTM,or anaerobic media) antimicrobial susceptibility testing

Serology
PCR
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Pathogenesis
Microbelymphatic systembloodheart valvesbacterial attachmentcolonization infection:- covered by fibrin & platelets - protect from phagocytes & complement - embolism if dislodge

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Treatment
1.Antimicrobial / antibiotics 2.Antifungal 3.Antiviral 4.Supportive therapy

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Thank you

Thank You

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