Endocarditis

Question 1

Endocarditis Clinical features

Answer 1

Fever
New murmur or change in a murmur
Complications of endocarditis

Question 2

Complications of endocarditis

Answer 2

Splinter hemorrhages
Janeway lesions (flat and painless)
Osler nodes (raised and painful)
Roth spots in the eyes
Brain (mycotic aneurysm)
Kidney (hematuria, glomerulonephritis)
Conjunctival petechiae
Splenomegaly
Septic emboli to the lungs

Question 3

Endocarditis Diagnostic Tests

Answer 3

Blood culture (95%–99% sensitive)
Transthoracic echocardiogram (60% sensitive but 95%–100% specific)
Transesophageal echocardiogram (95% sensitive and specific)

Question 4

while Establishing a Diagnosis of Culture Negative Endocarditis
The diagnosis is based on:

Answer 4

1. -Oscillating vegetation on echocardiography
2. • Three minor criteria:
     - Fever >100.3 F (38 C)
     - Risk such as injection drug use or prosthetic valve
     - Signs of embolic phenomena

Question 5

Endocarditis The best initial empiric therapy is

Answer 5

vancomycin and gentamicin

Question 6

When culture results are available, treat as

Answer 6

in the table “Treatment of

Endocarditis.”

Question 7

Viridans streptococci Tx

Answer 7

Ceftriaxone for 4 weeks

Question 8

Staphylococcus aureus (sensitive)

Answer 8

Oxacillin, nafcillin, or cefazolin

for 6 weeks

Question 9

Fungal etiology, tx

Answer 9

Amphotericin and valve

replacement

Question 10

Staphylococcus epidermidis or resistant

Staphylococcus

Answer 10

Vancomycin or daptomycin for 6

weeks

Question 11

Enterococci

Answer 11

Ampicillin and gentamicin

Question 12

Colon pathology is associated with

Answer 12

Streptococcus bovis and

Clostridium septicum.

Question 13

Treatment of Resistant Organisms

Answer 13

Add an aminoglycoside and extend the duration of treatment

tipo genta, amika, tobra, spiro…

Question 14

When Is Surgery the Answer for endocarditis?

Answer 14

• CHF from ruptured valve or chordae tendineae**
• Prosthetic valves
• Fungal endocarditis
• Abscess
• AV block
• Recurrent emboli while on antibiotics

Question 15

what to do with prosthetic valve endocarditis + Staphylococcus?

Answer 15

Add rifampin

Question 16

Treatment of Culture-Negative Endocarditis

Answer 16

ceftriaxone

Question 17

HACEK meaning

Answer 17

Haemophilus aphrophilus
Haemophilus parainfluenzae
Actinobacillus
Cardiobacterium
Eikenella
Kingella

Question 18

Prophylaxis for Endocarditis. When, in a nutshell?

Answer 18

1 Significant cardiac defect
+
2 Risk of bacteremia

Question 19

what do you mean with Significant cardiac defect

Answer 19

• Prosthetic valve
• Previous endocarditis
• Cardiac transplant recipient with valvulopathy
• Unrepaired cyanotic heart disease

Question 20

what do you mean with Risk of bacteremia

Answer 20

• Dental work with blood

- Respiratory tract surgery that produces bacteremia

Question 21

wich ATB for Endocarditis Prophylaxis

Answer 21

amoxicillin

if penicillin allergic, then clindamycin, azithromycin, or clarithromycin

Question 22

__________ are the most
common causes of culture-negative
endocarditis. THO

Answer 22

Coxiella and Bartonella