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Infective endocarditis

(Acute endocarditis에서 넘어옴)

감염성 심내막염(Infective Endocarditis)

임상 양상

원인균

진단

  • Duke criteria: > 2 Major or 1 Major+3 Minor or 5 Minor (Duke criteria calculator)[1]
    • Major Diagnostic Criteria
      • Positive blood culture for typical Infective Endocarditis organisms (S. viridans or bovis, HACEK, S. aureous without other primary site, enterococcus), from 2 separate blood cultures or 2 positive cultures from samples drawn > 12 hours apart, or 3 or a majority of 4 separate cultures of blood (first and last sample drawn 1 hour apart)
      • Echocardiogram with oscillating intracardiac mass on valve or supporting structures, in the path of regurgitant jets, or on implanted material in the absence of an alternative anatomic explanation, or abscess, or new partial dehiscence of prosthetic valve or new valvular regurgitation
    • Minor Diagnostic Criteria
      • Predisposing heart condition or IV drug use
      • BT > 38.0
      • Vascular phenomena: arterial emboli, pulmonary infarcts, mycotic aneurysms, intracranial bleed, conjunctival hemorrhages, Janeway lesions
      • Immunologic phenomena: glomerulonephritis, Osler nodes, Roth spots, rheumatoid factor
      • Microbiological evidence: positive blood culture but does not meet a major criterion as noted above or serological evidence of active infection with organism consistent with endocarditis (excluding coag neg staph, and other common contaminants)
      • Echocardiographic findings: consistent with endocarditis but do not meet a major criterion as noted above

치료

예방

다음에 해당하는 경우 Amoxicillin or Ampicillin으로 예방(알레르기시 clindamycin)

  • 인공 판막
  • 이전 감염성 심내막염 병력
  • 교정되지 않은 청색증 심질환
  • 수술로 완전히 교정된 선천성 심질환의 수술 후 6개월 이내
  • 불완전하게 교정된 선천성 심질환에서 인공삽입물질 주위에 결손이 남은 경우
  • 심장 이식 후 판막병증
  • 예방 권유 시술
    • 잇몸이나 치아 뿌리 끝 주위를 조작하는 치과 시술 전: 발치, 임플란트 등
    • 구강 점막 천공되는 시술 전
    • 감염된 비뇨생식기계, 피부, 연조직 관련 시술 전