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{{Endocarditis}}
{{Endocarditis}}
{{CMG}} {{AE}} {{Maliha}}
{{CMG}} ; {{AE}} {{Maliha}}


==Overview==
==Overview==
Endocarditis may be classified based on the underlying pathophysiology of the process (infective vs. non-infective), the onset of the disease (acute vs. subacute or short incubation vs. long incubation), results of the cultures (culture positive vs. culture negative), the nature of the valve (native vs. prosthetic) and the valve affected ([[aortic]], [[mitral]], or [[tricuspid valve]]).
[[Endocarditis]] may be classified based on the underlying [[pathophysiology]] of the process ([[Infective Endocarditis|infective]] vs. [[Non-infective endocarditis|non-infective]]), the onset of the [[disease]] ([[Acute (medicine)|acute]] vs. [[subacute]] or short [[Incubation period|incubation]] vs. long [[Incubation period|incubation]]), results of the cultures (culture-positive vs. culture-negative), the nature of the [[valve]] (native vs. [[prosthetic]]) and the [[valve]] affected ([[aortic]], [[mitral]], or [[tricuspid valve]]).


==Classification==
==Classification==
endocarditis may be classified into 4 subtypes based on:


* Infective Endocarditis vs. Non-Infective Endocarditis
[[Endocarditis]] may be classified into 8 subtypes based on:<ref name="pmid25501052">{{cite journal| author=Ortiz C, López J, García H, Sevilla T, Revilla A, Vilacosta I | display-authors=etal| title=Clinical classification and prognosis of isolated right-sided infective endocarditis. | journal=Medicine (Baltimore) | year= 2014 | volume= 93 | issue= 27 | pages= e137 | pmid=25501052 | doi=10.1097/MD.0000000000000137 | pmc=4602814 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=25501052  }}</ref><ref name="pmid19352296">{{cite journal| author=Fernández Guerrero ML, González López JJ, Goyenechea A, Fraile J, de Górgolas M| title=Endocarditis caused by Staphylococcus aureus: A reappraisal of the epidemiologic, clinical, and pathologic manifestations with analysis of factors determining outcome. | journal=Medicine (Baltimore) | year= 2009 | volume= 88 | issue= 1 | pages= 1-22 | pmid=19352296 | doi=10.1097/MD.0b013e318194da65 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=19352296  }}</ref><ref name="pmid18402924">{{cite journal| author=Selton-Suty C, Doco-Lecompte T, Freysz L, Chometon F, Duhoux F, Blangy H | display-authors=etal| title=[Non-valvular cardiac devices endocarditis]. | journal=Ann Cardiol Angeiol (Paris) | year= 2008 | volume= 57 | issue= 2 | pages= 81-7 | pmid=18402924 | doi=10.1016/j.ancard.2008.02.005 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=18402924  }}</ref>
**Infectious endocarditis is due to bacterial infection but other organisms may also be responsible.
**[[Endothelium]] valve damage improves the ability of [[bacteria]] to bind to the valve surface.
**Non-infective or marantic endocarditis is a rare condition.
**[[Libman-Sacks endocarditis]] is a form of sterile [[endocarditis]], which mostly happens in [[systemic lupus erythematosus]] and [[antiphospholipid syndrome]] patients.
**Non-infective endocarditis may also occur in patients with [[cancer]], particularly mucinous [[adenocarcinoma]] in the setting of Trousseau syndrome.


* Short Incubation vs. Long Incubation
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center
**Traditionally, infective endocarditis has been clinically divided into [[acute]] and [[subacute]] endocarditis. This classifies both the rate of progression and severity of disease.
|valign=top|
**Subacute bacterial endocarditis (SBE) is often due to [[streptococci]] of low virulence and  is a mild to moderate illness which progresses slowly over weeks and months.
**Acute bacterial endocarditis (ABE) is a fulminant illness that progresses rapidly over days to weeks and is more likely to be due to ''[[Staphylococcus aureus]]'', which has much greater virulence.
**The terms short incubation (<6 weeks) and long incubation (>6 weeks) are preferred.
 
* Culture Positive vs. Culture Negative
**Infective endocarditis may also be classified as culture-positive or culture-negative.
**Culture-negative endocarditis is due to micro-organisms that require a longer period of time to be identified in the laboratory. Such organisms are said to be [[Growth medium|fastidious]] because they have demanding growth requirements.
**Some pathogens responsible for culture-negative endocarditis include ''[[Aspergillus]]'' species, ''[[Brucella]]'' species, ''[[Coxiella burnetii]]'', ''[[Chlamydia]]'' species, and [[HACEK organism|HACEK bacteria]].
 
* Native Valve Endocarditis vs. Prosthetic Valve Endocarditis
**The distinction between native-valve endocarditis and prosthetic-valve endocarditis is clinically important.
**Prosthetic-valve endocarditis constitutes 10-20% of cases of endocarditis.
**The greatest risk is during the first 6 months after valve surgery.
**''[[Staphylococcus epidermidis]]'' is the most common cause of prosthetic-valve endocarditis.


|+
! style="background: #4479BA; width: 200px;" | Classification criterion
! style="background: #4479BA; width: 400px;" | Subgroups
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
:Underlying pathophysiology
| style="padding: 5px 5px; background: #F5F5F5;" |
*[[Infective Endocarditis|Infective endocarditis]] vs. non-infective [[endocarditis]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Onset of the disease
| style="padding: 5px 5px; background: #F5F5F5;" |
* Short [[Incubation period|incubation]] vs. long [[Incubation period|incubation]]
|-
| style="padding: 5px 5px; background: #DCDCDC;font-weight: bold" |
:Culture result
| style="padding: 5px 5px; background: #F5F5F5;" |
* Culture positive vs. culture negative
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold" |
:Nature of the valve
| style="padding: 5px 5px; background: #F5F5F5;" |
*Native [[valve]] [[endocarditis]] vs. [[Prosthesis|prosthetic]] valve [[endocarditis]]
|-
|}<br />
==References==
==References==
{{Reflist|2}}
{{Reflist|2}}

Latest revision as of 21:00, 3 March 2020

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] ; Associate Editor(s)-in-Chief: Maliha Shakil, M.D. [2]

Overview

Endocarditis may be classified based on the underlying pathophysiology of the process (infective vs. non-infective), the onset of the disease (acute vs. subacute or short incubation vs. long incubation), results of the cultures (culture-positive vs. culture-negative), the nature of the valve (native vs. prosthetic) and the valve affected (aortic, mitral, or tricuspid valve).

Classification

Endocarditis may be classified into 8 subtypes based on:[1][2][3]

Classification criterion Subgroups
Underlying pathophysiology
Onset of the disease
Culture result
  • Culture positive vs. culture negative
Nature of the valve


References

  1. ↑ Ortiz C, López J, García H, Sevilla T, Revilla A, Vilacosta I; et al. (2014). "Clinical classification and prognosis of isolated right-sided infective endocarditis". Medicine (Baltimore). 93 (27): e137. doi:10.1097/MD.0000000000000137. PMC 4602814. PMID 25501052.
  2. ↑ Fernández Guerrero ML, González López JJ, Goyenechea A, Fraile J, de Górgolas M (2009). "Endocarditis caused by Staphylococcus aureus: A reappraisal of the epidemiologic, clinical, and pathologic manifestations with analysis of factors determining outcome". Medicine (Baltimore). 88 (1): 1–22. doi:10.1097/MD.0b013e318194da65. PMID 19352296.
  3. ↑ Selton-Suty C, Doco-Lecompte T, Freysz L, Chometon F, Duhoux F, Blangy H; et al. (2008). "[Non-valvular cardiac devices endocarditis]". Ann Cardiol Angeiol (Paris). 57 (2): 81–7. doi:10.1016/j.ancard.2008.02.005. PMID 18402924.

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