Fungal Biology Reviews Discussion Paper
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Primary Diagnosis: endocarditis
- Describe the pathophysiology of the primary diagnosis in your own words. What are the patient’s risk factors for this diagnosis?
| Pathophysiology of Primary Diagnosis | |
The pathophysiology of endocarditis involves the invasion of the endocardium by infectious agents, such as bacteria or fungi, leading to the formation of vegetations (clumps of microorganisms, blood cells, and fibrin) on the heart valves or other endocardial surfaces (Del Giudice et al., 2021). The process typically begins with damage to the endocardium, creating a site for microbes to adhere to. This damage can result from conditions like congenital heart defects, heart valve abnormalities, or prior heart surgery. The microbes in the bloodstream can then adhere to these damaged areas and multiply, forming vegetation. As the vegetation grows, it can damage the heart valves, leading to regurgitation or obstruction of blood flow. Additionally, small vegetation fragments can break off, travel through the bloodstream, and lodge in other organs, causing further complications. Fungal Biology Reviews Discussion Paper
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| Causes | Risk Factors (genetic/ethnic/physical) |
| An infection typically causes endocarditis, often bacterial, though other microorganisms, such as fungi, can also be responsible (Negi & Ahmad, 2018). | Genetic Factors
Congenital Heart Defects: Individuals born with structural heart abnormalities, such as congenital heart defects, may have an increased risk of endocarditis. Ethnic Factors Race and Ethnicity: Some studies suggest that certain racial and ethnic groups may have a higher predisposition to endocarditis. Fungal Biology Reviews Discussion Paper Physical Factors Cardiac Valve Abnormalities: Any condition that affects the heart valves, such as rheumatic heart disease, mitral valve prolapse, or aortic stenosis, can increase the risk of endocarditis. Prosthetic Heart Valves: Individuals with prosthetic heart valves are at an increased risk of endocarditis. Previous Episodes of Endocarditis: Individuals who have had endocarditis in the past are at a higher risk of experiencing a recurrence. Intravenous (IV) Drug Use: People who use intravenous drugs, especially those involving shared needles or unsterile practices, have an elevated risk of endocarditis. |
- What are the patient’s signs and symptoms for this diagnosis? How does the diagnosis impact other body systems and what are the possible complications? Fungal Biology Reviews Discussion Paper
| Signs and Symptoms – Common presentation | How does the diagnosis impact each body system? Complications? |
| (i)Fever: Persistent fever is a hallmark of endocarditis. The fever may be low-grade or high and may come and go.
(ii)Fatigue: Patients often experience fatigue and weakness, which may be attributed to the systemic effects of the infection. (iii)Heart Murmur: The infection can cause damage to heart valves, leading to the development of a heart murmur. This can be detected by a healthcare professional using a stethoscope. Fungal Biology Reviews Discussion Paper (iv)Joint and Muscle Pain: Endocarditis can cause generalized body aches, joint pain, and muscle discomfort. (v)Shortness of Breath: As the infection progresses, it can lead to heart failure, causing symptoms such as shortness of breath, especially with exertion. (vi)Cough: Endocarditis can result in fluid accumulation in the lungs, leading to a persistent cough. (vii)Paleness: Pallor or paleness of the skin may be observed due to the underlying infection and potential anemia. (viii)Night Sweats: Some individuals may experience night sweats, particularly during fever episodes.
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Cardiovascular System
Valve Damage: Endocarditis often damages heart valves, affecting their structure and function. Heart Failure: Severe cases of endocarditis can contribute to heart failure, a condition where the heart is unable to meet the body’s demand for blood and oxygen. Respiratory System Pulmonary Embolism: Pieces of infected material (emboli) from the heart valves can break off and travel to the lungs, causing pulmonary embolism. Hematological System Anemia: Chronic infection and inflammation can lead to anemia, reduced red blood cells, or hemoglobin in the blood. Gastrointestinal System Splenic Infarcts: Septic emboli can affect the spleen, causing infarcts which can lead to abdominal pain and other gastrointestinal symptoms Fungal Biology Reviews Discussion Paper |
- What are other potential diagnosis that present in a similar way to this diagnosis (differentials)?
| Rheumatoid Arthritis: This chronic inflammatory disorder may cause joint pain and fatigue, overlapping with some symptoms of endocarditis (Jubber & Moorthy, 2021).
Deep Vein Thrombosis (DVT) or Pulmonary Embolism (PE): These conditions can cause shortness of breath, chest pain, and, in the case of PE, symptoms similar to endocarditis due to emboli reaching the lungs. Systemic Lupus Erythematosus (SLE): An autoimmune disease like SLE can present various symptoms, including joint pain, fatigue, and fever. Fungal Biology Reviews Discussion Paper |
- What diagnostic tests or labs would you order to rule out the differentials for this patient or confirm the primary diagnosis?
| Blood Cultures
Purpose: To identify the causative microorganism responsible for the infection. How It’s Done: Blood samples are taken from different sites and incubated to allow for the growth of bacteria or fungi. Complete Blood Count (CBC) Purpose: To assess for anemia, leukocytosis (elevated white blood cell count), and thrombocytopenia (low platelet count). How It’s Done: A blood sample is analyzed to measure the number of red and white blood cells and platelets. Erythrocyte Sedimentation Rate (ESR) and C-reactive protein (CRP) Purpose: These tests measure the degree of inflammation in the body. How It’s Done: Blood samples are analyzed to assess the rate at which red blood cells settle (ESR) and the level of CRP. Fungal Biology Reviews Discussion Paper Serological Tests Purpose: To detect specific antibodies that may indicate an underlying infection. How It’s Done: Tests may include anti-streptolysin O (ASO) titer, anti-DNAase B, and other serological markers.
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- What treatment options would you consider? Include possible referrals and medications.
| Antimicrobial Therapy
Empirical Antibiotics: Initially, broad-spectrum antibiotics are often prescribed before the causative microorganism is identified. Common choices may include vancomycin in combination with a beta-lactam antibiotic (e.g., ceftriaxone). Culture-Directed Therapy: Antibiotic therapy is adjusted accordingly once blood cultures identify the specific microorganism and its susceptibility. Fungal Biology Reviews Discussion Paper Surgical Intervention Valve Replacement or Repair: In cases of severe valve damage or persistent infection despite antibiotic therapy, surgical intervention to repair or replace affected heart valves may be necessary. Drainage of Abscesses: Surgical drainage may be required to remove abscesses or infected tissue. Referrals Cardiologist: A cardiologist is often involved in managing endocarditis, especially in assessing cardiac complications and the need for surgical intervention. Infectious Disease Specialist: Collaboration with an infectious disease specialist is common for guidance on antimicrobial therapy and managing complex cases. Surgeon: Referral to a cardiac surgeon may be necessary for valve replacement or repair. Medications Antibiotics: Depending on the identified microorganism and its susceptibility, various antibiotics may be used, such as vancomycin, ceftriaxone, gentamicin, and others. Analgesics: Pain management with medications like acetaminophen or nonsteroidal anti-inflammatory drugs (NSAIDs) may be recommended. Antipyretics: To manage fever, medications like acetaminophen may be used. Fungal Biology Reviews Discussion Paper |
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References
Del Giudice, C., Vaia, E., Liccardo, D., Marzano, F., Valletta, A., Spagnuolo, G., … & Rengo, G. (2021). Infective endocarditis: a focus on oral microbiota. Microorganisms, 9(6), 1218. https://doi.org/10.3390/microorganisms9061218
Jubber, A., & Moorthy, A. (2021). Reactive arthritis: a clinical review. Journal of the Royal College of Physicians of Edinburgh, 51(3), 288-297. https://doi.org/10.4997/jrcpe.2021.319
Negi, N., & Ahmad, A. (2018). Current updates on fungal endocarditis. Fungal Biology Reviews, 32(1), 1-9. https://doi.org/10.1016/j.fbr.2017.11.001
Concept Map Template
Primary Diagnosis: ___________________________________________________________
- Describe the pathophysiology of the primary diagnosis in your own words. What are the patient’s risk factors for this diagnosis? Fungal Biology Reviews Discussion Paper
| Pathophysiology of Primary Diagnosis | |
| Causes | Risk Factors (genetic/ethnic/physical) |
- What are the patient’s signs and symptoms for this diagnosis? How does the diagnosis impact other body systems and what are the possible complications?
| Signs and Symptoms – Common presentation | How does the diagnosis impact each body system? Complications? |
- What are other potential diagnosis that present in a similar way to this diagnosis (differentials)?
- What diagnostic tests or labs would you order to rule out the differentials for this patient or confirm the primary diagnosis?
- What treatment options would you consider? Include possible referrals and medications. Fungal Biology Reviews Discussion Paper
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