COLOR ATLAS OF INFECTIVE ENDOCARDITIS

COLOR ATLAS OF INFECTIVE

ENDOCARDITIS

COLOR ATLAS OF INFECTIVE

ENDOCARDITIS

David R. Ramsdale BSc, MB ChB, FRCP, MD

Consultant Cardiologist, The Cardiothoracic Centre Liverpool, UK

With 231 Figures including 159 in Color

David R. Ramsdale BSc, MB ChB, FRCP, MD The Cardiothoracic Centre, Liverpool, UK

British Library Cataloguing in Publication Data Ramsdale, David R.

Color atlas of infective endocarditis 1. Infective endocarditis – Atlases I. Title

66.1
1 ISBN 1852339373

Library of Congress Control Number: 2005923775

ISBN-10: 1-85233-937-3 e-ISBN 1-84628-136-9 ISBN-13: 9781852339371

Printed on acid-free paper

C

Springer-Verlag London Limited 2006

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This book is dedicated to Drs Geoffrey Wade and Derek Rowlands, who first introduced me to clinical cardiology and electrocardiography at Manchester University Medical School, and to Drs Colin Bray and David Bennett at Wythen- shawe Hospital for the time, training and encouragement they gave to me as their research fellow. Their extraordinary knowl- edge as well as their great love and dedication to the specialty of cardiology were an inspiration to me.

“We shall never learn to feel and respect our real calling and destiny, unless we have taught ourselves to consider every thing as moonshine, compared with the education of the heart”

—J. G. Lockhart (August 1825), quoted in Lockhart’s

Life of Sir Walter Scott, vol. 6 (1837), ch. 2.

FOREWORD

Infective endocarditis, a dreaded complication of acquired valvular and congenital heart disease, has long been a source of fascination and a challenge to physicians, mi- crobiologists and cardiac surgeons. Despite the landmark development of antibiotic therapy in the 1950s that, for the first time, offered the possibility of cure and the subse- quent introduction of cardiac surgery and improved mi- crobiological and imaging techniques, mortality remains high, diagnosis is often difficult and, arguably, many cases could be prevented. With an annual incidence in the United Kingdom of under 1000 cases per year, few cardiologists will have great experience of endocarditis, but it is a condi- tion that requires clinical judgement of the highest order and a multi-disciplinary approach if complications and mortality are to be minimised.

David Ramsdale has a particular interest in and long experience of endocarditis. This book is the culmination of

that experience combined with an exhaustive review of the literature carried out during his leadership of a project, on behalf of the British Cardiac Society, to develop guidance on its diagnosis and management. Entitled a Color Atlas of Infective Endocarditis because of the large number of superb clinical photographs, many from his own practice, the scope of this monograph far exceeds that of a compre- hensive collection of illustrations of the protean manifes- tations of this disease. Dr Ramsdale has provided us with an authoritative textbook on the contemporary approach to the prevention, diagnosis and management of infective endocarditis. It will provide a valuable source of learning and reference for students, microbiologists, sonographers, dentists, and physicians of all specialties.

Nicholas Brooks Manchester July 2005

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PREFACE

Infective endocarditis is a life-threatening disease with sub- stantial morbidity and mortality (20% or more) despite improved techniques to aid diagnosis and modern an- tibiotics and surgical therapies. It affects individuals with underlying structural cardiac defects who develop bac- teremia, often as a result of dental, gastrointestinal, geni- tourinary, respiratory, or cardiac invasive/surgical proce- dures. Most organ systems can be involved and the manner in which infective endocarditis may present to doctors in a variety of specialties demands that they be made aware of infective endocarditis as a potential diagnosis warranting prompt specialist investigation and treatment.

This illustrated book aims to present the clinical manifestations—both cardiac and extracardiac, the diag- nostic techniques currently used in clinical practice, the range of microorganisms that are responsible, and the clinical scenarios that are often associated with initiat- ing bacteremia. The guidelines for prophylactic antibiotic therapy to prevent infective endocarditis following dental or invasive/surgical procedures and the medical treatment indicated for both native and prosthetic valve endocarditis are presented in detail. Finally, the indications, timing, and outcome of cardiac surgical intervention and prognosis are discussed.

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ACKNOWLEDGMENTS

I acknowledge the expert advice of several colleagues with whom I worked in developing Guidelines for the Manage- ment of Infective Endocarditis in Adults on behalf of the Clinical Practice Committee of the British Cardiac Society.

These include: Consultant Microbiologists Professor Tom Elliott and Dr Paul Wright; Consultant Cardiothoracic Surgeon Mr Brian Fabri; Specialist Cardiology Registrar Dr Nick Palmer; Consultant Cardiac Anaesthetist Dr Peter Wallace; Consultant Cardiologist Dr Petros Nihoyoan- noupolus; and Professor of Paediatric Dentistry, Graham Roberts. Their opinions and advice are truly valued.

I greatly appreciate the generosity of several friends and clinical colleagues who have provided illustrations for the book. These include Consultant Cardiologists Dr David Roberts, Victoria Hospital, Blackpool, UK; Dr Chris Bellamy, Glan Clywd Hospital, Wales, UK; Dr Brad Munt and Dr Robert Moss, St Paul’s Hospital, Vancou- ver, BC, Canada; Dr Nick Newall, Arrowe Park Hospital, Wirral, UK; Dr Peter Schofield, Papworth Hospital, Cam- bridgeshire, UK; Dr Syamkumar Divakaramenon, Med- ical College Hospital, Calicut, Kerala, India; Dr Bogdan Marcu, Hospital of Saint Raphael-Yale University, New Haven, CT, USA; Dr Lindsay Morrison, Dr Serge Osula, and Dr Richard Charles, The Cardiothoracic Centre, Liver- pool, UK; Specialist registrars in Cardiology, Dr Malcolm Burgess and Dr. Elved Roberts, The Cardiothoracic Centre, Liverpool, UK; Consultant Cardiothoracic Surgeons Mr Niraj Mediratta, Mr Walid Dihmis, Mr John Chalmers, Mr Mark Pullan, Mr Aung Oo, and Mr Abbas Rashid, The Cardiothoracic Centre, Liverpool, UK; Professor John Pepper, Royal Brompton Hospital, London, UK; Specialist

registrars in Cardiothoracic Surgery Dr Joanna Chikwe and Dr J. Barnard, Royal Brompton Hospital, London, UK; Consultant Cardiothoracic Anaesthetists Dr Nigel Scawn and Dr Mike Desmond, The Cardiothoracic Centre, Liverpool, UK; Consultant in Infectious Diseases Dr Nick Beeching, Royal Liverpool University Hospital, Liverpool, UK; Consultant Pathologists Dr Hani Zakhour, Arrowe Park Hospital, Wirral, UK, Dr John Gosney, Royal Liverpool University Hospital, Liverpool, UK, and Dr Mary Sheppard, Royal Brompton Hospital, London, UK;

Consultant Microbiologists Professor Martin Altwegg, University of Zurich, Switzerland, Dr Lisa Grech, Royal Hallamshire Hospital, Sheffield, UK, Dr John Cunniffe, Arrowe Park Hospital, Wirral, UK, and Dr Mike Rothburn, Aintree Hospital, Liverpool, UK; Consultant Radiologists, Dr Hilary Fewins and Dr John Holemans, The Cardiotho- racic Centre, Liverpool, UK; Consultant Neuroradiologist Dr Sacha Niven, Walton Centre for Neurology, Liverpool, UK. Consultant Dental Surgeon Mr Phil Hardy, Liver- pool University Dental School, Liverpool, UK; Consultant Dermatologist Dr Graham Sharpe, Royal Liverpool Uni- versity Hospital, Liverpool, UK; Consultant Opthalmolo- gist, Mr Simon Harding, St Paul’s Eye Hospital, Liverpool, UK; Echocardiographers Janet Beukers, Jackie Rolt, Sandra Belchambers, and Amanda Christopher, The Cardiotho- racic Centre, Liverpool, UK; and Medical photographers, Mr Phil Rooney, Aintree Hospital, Liverpool, UK and Ms Jackie Hyland, Alder Hey Hospital, Liverpool, UK.

I am also grateful to several other international col- leagues for their generosity in allowing me to use their won- derful illustrations. These include Dr Charlie Goldberg,

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xii Acknowledgments

University of California San Diego, USA; Dr Josh Fierer, Dr Frederick Chen; Dr Hubert Lepidi, Consultant Patholo- gist, Universit´e de la Mediterran´ee, Marseille, France; Pro- fessor Didier Raoult, Marseille School of Medicine and Director of Clinical Microbiology Laboratories, University Hospitals of Marseille, France; Professor Tomas Freiberger, Centre of Cardiovascular Surgery and Transplantation, Brno, Czech Republic; Dr John E. Moore and Dr B. Cherie Moore, Clinical Scientists, Northern Ireland Public Health

Laboratory, Department of Bacteriology, Belfast City Hos- pital, Northern Ireland.

Finally, I appreciate the personal efforts and tech-

nical expertise of all at Springer, and in particular

Mr Grant Weston, the commissioning editor, Hannah

Wilson, Mr Weston’s editorial assistant, and Ms Lesley

Poliner, Senior Production Editor, for their conscien-

tious help in coordinating much of the work involved in

production.

CONTENTS

Chapter 1 Incidence and Pathogenesis . . . . 1

Chapter 2 Clinical Features . . . . 11

Chapter 3 Investigations . . . . 45

Chapter 4 Diagnostic Criteria . . . . 71

Chapter 5 Treatment: Prophylaxis . . . . 77

Chapter 6 Treatment: Antimicrobial Therapy . . . . 93

Chapter 7 Cardiac Surgery in Infective Endocarditis . . . . 121

Chapter 8 Prognosis . . . . 137

Appendix 1 Abbreviations . . . . 139

Index . . . . 141

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