CIS Microbiology of Heart Disease--Hersh Flashcards
1
Q
subacute vs acute Infective Endocarditis?
A
ACUTE:
- rapid onset (less than 7 days), toxic-appearing, super sick!!
- no underlying heart disease
- R more than L (Tri>Bi>aorta>pulmonary)
- S aureus
- SOB, high fever, chills, pleuritic chest pain, back pain
SUBACUTE:
- underlying heart disease
- gradual onset
- L more than R
- S viridans, HACEK, enterococcus
- low grade fever, anorexia, fatigue, N/V
2
Q
IE- risk factors
A
- age older than 60; males
- IV drug use
- poor dentition
- predisposing conditions- valves!
3
Q
signs of IE
A
- roth spots
- janeway lesions (painless- pams, soles)
- osler nodes (painful- fingers)
- splinter hemorrhages
4
Q
workup for subacute IE?
A
-blood cultures x 3, TTE (transthoracic echocardiogram)
5
Q
staph epidermidis
A
-G+ cocci in clusters, catalase positive, coagulase negative
6
Q
what is empiric treatment?
A
-broad coverage! until you get cultures back
7
Q
best empiric treatment for IE?
A
vancomycin and ceftriaxone!!
8
Q
dental work- subacute IE- which organism?
A
-streptococcus viridans
9
Q
duke criteria- major?
A
- positive blood culture
- electrocardiograph changes consistent with valvular disease
- new murmur
10
Q
duke criteria- minor?
A
- prosthetic/abnormal vavle
- fever greater than 38 C
- immunologic phenomenon (GN, roth spots, osler nodes)
- vascular phenomenon (janeway lesions)
11
Q
duke criteria- diagnosis
A
- 2 major criteria
- 1 major with 3 minor
- 5 minor
12
Q
when to use antibiotic prophylaxis for IE?
A
- cardiac conditions with high risk of IE- dental procedures
- ampicillin!!
- if alleregic- cephalexin, clindamycin
13
Q
empiric treatment for IE?
A
-vancomycin + ceftriaxone
14
Q
enterococcus- where?
A
GI tract!
-grow on bile salts culture
15
Q
treatment for tb acute pericarditis
A
- isoniazid
- rifampin
- ethambutol
- pyrazinamide
