2.5.1.8 Aspek Mikrobiologi Bakteri Penyebab Infeksi Pada Jantung
2.5.1.8 Aspek Mikrobiologi Bakteri Penyebab Infeksi Pada Jantung
2.5.1.8 Aspek Mikrobiologi Bakteri Penyebab Infeksi Pada Jantung
Cardiovascular System
Andani Eka Putra
Cardiovascular infections: Outline
• Viral infections
• acute myocarditis
• acute pericarditis
• Bacterial and fungal infections
• endocarditis
• other intravascular infections
• mycotic aneurysm and aortitis
• septic thrombophlebitis
• indwelling device infections
• tuberculous pericarditis
• spirochetal diseases (syphilis, Lyme disease)
• Parasitic infections
• American trypanosomiasis
• Possible infectious etiology
• endomyocardial fibrosis (EMF)
Viruses associated with acute myocarditis and
Pericarditis
• Most common:
• enteroviruses (particularly coxsackie B)
• Others
• adenoviruses
• herpesviruses
• CMV
• EBV
• HHV-6
• parvovirus B19
• HIV
• influenza (Note: acute or chronic
myocarditis can also be non-
infectious, e.g., allergic, toxic, or
autoimmune in origin)
Endocarditis
• Bacteraemia
• Bacteraemia occurs when a heavily colonised mucosal
surface is traumatised
• Dental extraction
• Periodontal surgery
• Tonsillectomy
• Operations involving the respiratory, GI or GU tract mucosa
• Oesophageal dilatation
• Biliary tract surgery
• Transient bacteraemia
• Most cases of endocarditis are not preceeded by a specific event
• Tooth brushing, chewing
ENDOCARDITIS
1. Streptococci
• Viridans streptococci/α-haemolytic streptococci
• S. mitis, S. sanguis, S. oralis
• S. bovis
• Associated with colonic carcinoma
2. Enterococci
• E. faecalis, E. faecium
• Associated with GU/GI tract procedures
• Approx. 10% of patients with enterococcal bacteraemia develop endocarditis
Aetiological Agents
2. Staphylococci
• Staphylococcci have surpassed
viridans streptococci as the most common cause of
infective endocarditis
• S. aureus
• Native valves
• acute endocarditis
• Coagulase-negative staphylococci
• Prosthetic valve endocarditis
Aetiological Agents
4. Gram-negative rods
• HACEK group
• Haemophilus aphrophilus, Actinobacillus
actinomycetemcomitans, Cardiobacterium hominis, Eikenella
corrodens, Kingella kingae.
• Fastidious oropharyngeal GNBs
• E. coli, Klebsiella etc
• Uncommon
• Pseudomonas aeruginosa
• IVDA
• Neisseria gonorrhoae
• Rare since introduction of penicillin
Aetiological Agents
5. Others
• Fungi
• Candida species, Aspergillus species
• Q fever
• Chlamydia
• Bartonella
• Legionella
Pathogenesis
• Bacteraemia
• Bacteraemia occurs when a heavily colonised mucosal
surface is traumatised
• Dental extraction
• Periodontal surgery
• Tonsillectomy
• Operations involving the respiratory, GI or GU tract mucosa
• Oesophageal dilatation
• Biliary tract surgery
• Transient bacteraemia
• Most cases of endocarditis are not preceeded by a specific event
• Tooth brushing, chewing
Site of Infection
1. Blood culture
2. Echo
• TTE
• TOE
3. FBC/ESR/CRP
4. Rheumatoid Factor
5. MSU
Culture Negative Endocarditis
• Syphilis:
• Heart involvment occurs in the tertiary stage of disease,
many years after acquisition
• Small numbers of spirochetes invade the aortic root and
induce destructive granulomatous inflammation
• Long-standing disease causes enlargement of the aortic
root and aortic valve insufficiency
• Older adults with acquired aortic root dilation and/or
aortic insufficiency should have syphilis serology
performed.
Cardiovascular syphilis:
syphilitic aortitis
Source unknown
Any adult with aortic root dilation or aortic valve insufficiency should
have serologic testing for syphilis and receive treatment for tertiary
syphilis if confirmed positive.
RHEUMATIC HEART DISEASE
• Throat culture
• Throat culture findings for group A beta hemolytic Streptococcus are usually negative
by the time symptoms of rheumatic fever or rheumatic heart disease appear.
• Rapid antigen detection test
• This test allows rapid detection of group A streptococcal antigen and allows the
diagnosis of streptococcal pharyngitis