Endocarditis

Question 1

Endocarditis in IVDU

Answer 1

Staph aureus, most common, acute presentation -> tricuspid valve

Question 2

Endocarditis in low-resource countries after seeing the dentist

Answer 2

Streptococcus viridans

Question 3

Acute endocarditis post-rheumatic fever

Answer 3

Streptococcus pyogenes (Group A strep)

Question 4

Endocarditis within 2mo of valvular surgery

Answer 4

Staphylococcus epidermis, subacute

Question 5

Endocarditis hospital acquired

Answer 5

Enteroccocus Faecium

Question 6

Endocarditis and around farm animals

Answer 6

Coxiella burnetti

Question 7

Endocarditis and exposure to unpasteurised dairy

Answer 7

Brucella

Question 8

Criteria for infective endocarditis?

Answer 8

Modified duke criteria

Question 9

Definite diagnosis requirements for Infective endocarditis?

Answer 9

2 major criteria OR 1 major, 3 minor OR 5 minor

Question 10

Possible diagnosis requirements for Infective endocarditis?

Answer 10

one major, one minor OR 3 minor

Question 11

Major criteria of Modified Duke Criteria

Answer 11

1. Blood cultures positive for IE
2. Evidence of endocardial involvement
   (BE TIMER)

Question 12

Minor criteria of Modified Duke Criteria

Answer 12

1. Temp>38C
2. Immunologic phenomena - glomerulonephritis, painful nodes (Osler’s), Roth’s spots (retinal haemorrhages with small clear centres), positive RF
3. Microbiologic evidence not meeting major criteria
4. Embolic phenomena - emboli, intracranial/conjunctival haemorrhage, painless skin lesions (janeway lesions)
5. Risk factor - IVDU, predisposing heart condition

(BE TIMER)

Question 13

Management of Infective endocarditis (acute, subacute, prosthetic)

Answer 13

Broad Abx until culture (4-6wk course)
Acute - flucloxacillin
Subacute - gentamicin + benzylpenicillin
Prosthetic - gentamicin + vancomycin + rifampicin

Surgical debridement if required