Download - Infective Endocarditis 56
![Page 1: Infective Endocarditis 56](https://reader034.vdokumen.com/reader034/viewer/2022050805/563dbbff550346aa9ab05a16/html5/thumbnails/1.jpg)
INFECTIVE ENDOCARDITIS
Riyani Wikaningrum
Bag. Mikrobiologi
Fak. Kedokteran Univ. Yarsi
![Page 2: Infective Endocarditis 56](https://reader034.vdokumen.com/reader034/viewer/2022050805/563dbbff550346aa9ab05a16/html5/thumbnails/2.jpg)
ANATOMI
![Page 3: Infective Endocarditis 56](https://reader034.vdokumen.com/reader034/viewer/2022050805/563dbbff550346aa9ab05a16/html5/thumbnails/3.jpg)
PENDAHULUAN
• Keadaan infeksi yang jarang tapi berat.• Ditandai dengan kolonisasi atau invasi
katup jantung dan endokardium oleh agen mikroba.
• Terbentuk “vegetasi” yang terdiri atas fibrin, platelet dan mikroorganisme lepas ke sirkulasi memberikan gejala dan tanda berupa demam, gejala sistemik non-spesifik, bising jantung dan emboli.
![Page 4: Infective Endocarditis 56](https://reader034.vdokumen.com/reader034/viewer/2022050805/563dbbff550346aa9ab05a16/html5/thumbnails/4.jpg)
![Page 5: Infective Endocarditis 56](https://reader034.vdokumen.com/reader034/viewer/2022050805/563dbbff550346aa9ab05a16/html5/thumbnails/5.jpg)
Gambaran Histopatologi
![Page 6: Infective Endocarditis 56](https://reader034.vdokumen.com/reader034/viewer/2022050805/563dbbff550346aa9ab05a16/html5/thumbnails/6.jpg)
Tipe Infective endocarditis
• Akut– Paling sering disebabkan oleh S. aureus– Jarang terjadi, menyerang katup normal
maupun abnormal
• Subakut– Paling sering disebabkan oleh S. viridans– Lebih sering terjadi Sub-acute bacterial
endocarditis (SBE)– Menyerang katup abnormal
![Page 7: Infective Endocarditis 56](https://reader034.vdokumen.com/reader034/viewer/2022050805/563dbbff550346aa9ab05a16/html5/thumbnails/7.jpg)
Tipe Infective endocarditis (cont)
• Prostetik– Terjadi sesudah operasi penggantian katup– Bisa terjadi awal (< 60 hari sesudah operasi)
atau lambat (> 60 hari sesudah operasi)
• Right sided endocarditis– Terjadi akut, pada pemakai obat iv dan
penderita penurunan kekebalan– 5% kasus endokarditis– Katup tricuspidal
![Page 8: Infective Endocarditis 56](https://reader034.vdokumen.com/reader034/viewer/2022050805/563dbbff550346aa9ab05a16/html5/thumbnails/8.jpg)
Faktor resiko
• Kelainan kongenital jantung• Abnormalitas vaskuler• Penyalah gunaan obat iv• Aborsi• Operasi penggantian katup• Kateterisasi urin dan jantung• Prosedur diagnostik dan operasi invasif:
– Gigi; Saluran nafas atas; traktus urinarius; traktus digestivus bawah
![Page 9: Infective Endocarditis 56](https://reader034.vdokumen.com/reader034/viewer/2022050805/563dbbff550346aa9ab05a16/html5/thumbnails/9.jpg)
![Page 10: Infective Endocarditis 56](https://reader034.vdokumen.com/reader034/viewer/2022050805/563dbbff550346aa9ab05a16/html5/thumbnails/10.jpg)
Organisme penyebab
• Gol. Streptokokus viridans:– S. sanguis; S. mitis; S. mutans; S. milleri
• Gol. Enterokokus:– Enterococcus faecalis, E. faecium
• Gol. Stafilokokus:– S. aureus; S. epidermidis
• Fungi:– Candida; Aspergillus; Histoplasma; T.
glabrata
![Page 11: Infective Endocarditis 56](https://reader034.vdokumen.com/reader034/viewer/2022050805/563dbbff550346aa9ab05a16/html5/thumbnails/11.jpg)
Organisme penyebab
• Lain-lain:– Coxiella burnetti– Legionella sp.– Chlamydia psittaci– Bartonella henselae; B. quintana– HACEK group (Haemophilus sp.,
Actinobacillus actinomycetecomitans, Cardiobacterium hominis, Eikenella corrodens dan Kingella kingae)
![Page 12: Infective Endocarditis 56](https://reader034.vdokumen.com/reader034/viewer/2022050805/563dbbff550346aa9ab05a16/html5/thumbnails/12.jpg)
Sumber infeksi
• Karies dentis• Kateterisasi uris• Penyalahgunaan obat iv• Kateter vena• Gangguan kolon• Dekubitus• Operasi dan perawatan gigi• Septisemia
![Page 13: Infective Endocarditis 56](https://reader034.vdokumen.com/reader034/viewer/2022050805/563dbbff550346aa9ab05a16/html5/thumbnails/13.jpg)
Gejala
• Demam
• Malaise, anorexia dan BB turun
• Gejala gagal jantung
• Gejala emboli
• Gangguan kesadaran
![Page 14: Infective Endocarditis 56](https://reader034.vdokumen.com/reader034/viewer/2022050805/563dbbff550346aa9ab05a16/html5/thumbnails/14.jpg)
Tanda-tanda
• Pyrexia• Bising jantung• Tanda-tanda emboli• Tanda-tanda gagal jantung• Osler’s Nodes, splinter haemorrhages, lesi
Janeway• Anemia, LED meningkat, AL umunya normal• Splenomegali• Clubbing fingers
![Page 15: Infective Endocarditis 56](https://reader034.vdokumen.com/reader034/viewer/2022050805/563dbbff550346aa9ab05a16/html5/thumbnails/15.jpg)
Splinter hemorrhage
Conjunctival petechiae
Osler’s nodes
Janeway’s lesion
![Page 16: Infective Endocarditis 56](https://reader034.vdokumen.com/reader034/viewer/2022050805/563dbbff550346aa9ab05a16/html5/thumbnails/16.jpg)
Splinter hemorrhage
Osler’s Node
![Page 17: Infective Endocarditis 56](https://reader034.vdokumen.com/reader034/viewer/2022050805/563dbbff550346aa9ab05a16/html5/thumbnails/17.jpg)
Pemeriksaan
• Kultur darah:– Standar baku– Apabila hasil negatif, kemungkinan:
• Pemeriksaan sesudah pemberian antibiotik• Mikroorganisme penyebab gol yang sukar tumbuh dengan
cara kultur biasa
• Serologi utk patogen penyebab• Imunoglobulin; total komplemen dan komplemen C3• Echocardiografi• Pemeriksaan urin, darah• Foto thorax, ECG
![Page 18: Infective Endocarditis 56](https://reader034.vdokumen.com/reader034/viewer/2022050805/563dbbff550346aa9ab05a16/html5/thumbnails/18.jpg)
Manajemen
• Manajemen pasien sakit akut
• Pemberian antibiotik– Blind therapy kombinasi penisilin dan
gentamisin atau vancomisin dan gentamisin– Berdasarkan hasil kultur dan tes sensitivitas
mikroba thd antibiotik
• Operasi
![Page 19: Infective Endocarditis 56](https://reader034.vdokumen.com/reader034/viewer/2022050805/563dbbff550346aa9ab05a16/html5/thumbnails/19.jpg)
Sumber Bacaan
• Bahan kuliah Riyani Wikaningrum:– Infective Endocarditis– Chlamydia– Rickettsiae
• Brooks GF et al. (2004) Jawetz, Melnick, & Adelberg’s Medical Microbiology. 21st ed.
• Prendergast BD (2004) Diagnostic criteria and problems in infective endocarditis, Heart; 90: 611-613