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


==Overview==
==Overview==
Endocarditis is classified based upon the underlying pathophysiology of the process (infective versus non-infective), the acuity of the process (acute versus subacute or short incubation versus long incubation), the fastidiousness of the infectious agent (i.e. how hard it is to culture and isolate as culture positive versus culture negative), the type of valve involved (native versus prosthetic) and the valve infected (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]]).


== Infective Endocarditis ==
==Classification==
Given the poor vascular supply of the heart valves, entrance of infection fighting components of the bloodstream (such as [[white blood cell]]s) are reduced. So if an organism (such as [[bacterium|bacteria]]) establishes a foothold in the valves, the bodies ability to fight the infection inside the valve structures is reduced.


Normally, blood flows smoothly through these valves. If they have been damaged (for instance in [[rheumatic fever]]) the trauma of non-laminar flow can increase the risk of infection.  Likewise, damage to the endothelium or lining of the vascular structures improves the ability of bacteria to bind to the surface.
[[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>


== Non-Infective Endocarditis ==
{| style="border: 0px; font-size: 90%; margin: 3px; width: 600px" align=center
Non-infective or marantic endocarditis is [[rare disease|rare]].  A form of sterile [[endocarditis]] is termed [[Libman-Sacks endocarditis]]; this form occurs more often in patients with [[lupus erythematosus]] and the [[antiphospholipid syndrome]]. Non-infective endocarditis may also occur in patients with [[cancer]], particularly mucinous [[adenocarcinoma]].
|valign=top|


==Short Incubation Versus Long Incubation==
|+
Traditionally, infective endocarditis has been clinically divided into ''acute'' and ''subacute'' (because the patients tend to live longer in subacute as opposed to acute) endocarditis.  This classifies both the rate of progression and severity of disease. Thus subacute bacterial endocarditis (SBE) is often due to [[streptococci]] of low virulence and mild to moderate illness which progresses slowly over weeks and months, while acute bacterial endocarditis (ABE) is a fulminant illness over days to weeks, and is more likely due to ''[[Staphylococcus aureus]]'' which has much greater virulence, or disease-producing capacity.
! 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==
{{Reflist|2}}
[[Category:Cardiology]]
[[Category:Emergency medicine]]


This terminology is now discouraged.  The terms ''short incubation'' (meaning less than about six weeks), and ''long incubation'' (greater than about six weeks) are preferred.
[[Category:Intensive care medicine]]
 
[[Category: Up-To-Date]]
==Culture Positive Versus Culture Negative==
{{WH}}
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]].
{{WS}}
 
==Native Valve Endocarditis Versus Prosthetic Valve Endocarditis==
Finally, 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.  The infection often extends into the anulus and cardiac tissues.

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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