Endocarditis/UTI/Skin Infections

Question 1

Complications of endocarditis

Answer 1

Valve destruction
Paravalvular abscess
Mycotic aneurysm
Embolic phenomenon (e.g. renal impairment, septic arthritis, neurological sequelae)

Question 2

What are vegetations?

Answer 2

Clumps of material that “grow” from infected valves; contain bacteria, small blood clots and other debris

Question 3

At-risk groups for endocarditis

Answer 3

Pre-existing valvular abnormality

IVDU

Question 4

What is the most common cause of splinter haemorrhages?

Answer 4

Trauma (splinter haemorrhages more significant if occurring closer to the base of the nail)

Question 5

Metastatic foci of endocarditis

Answer 5

Mycotic aneurysm
Stroke
Roth spots
Skin manifestations (petechiae, red nodules, purpura)
Spleen infarction or abscess
Splinter haemorrhages
Kidney infarction, haematuria
Infected embolus or infected thrombus
Seeding of vertebra (osteomyelitis?)

Question 6

Ix for endocarditis

Answer 6

3 blood cultures (3 different times, 3 different sites)

Question 7

Sources of infection

Answer 7

Mouth: dental disease or procedures
IVDU
Prolonged indwelling vascular catheters
Underlying genitourinary disease or procedures
Native and prosthetic valve endocarditis
Soft tissue infections

Question 8

Staph or enterococcus in urine

Answer 8

Staph or enterococcus bacteraemia until proven otherwise

Question 9

Most common causative organisms for endocarditis

Answer 9

Strep viridans
Staph aureus (growing in incidence)

Question 10

Major Dukes criteria

Answer 10

Positive blood cultures (2 separate for usual pathogens; at least 2 for less common)
Evidence on echocardiogram (intracardiac or valve lesion, prosthetic regurgitant flow, abscess, partial dehiscence of prosthetic valve, new valvular regurgitant flow)

Question 11

Minor Dukes criteria

Answer 11

Predisposing conditions
Fever
Emboli or vascular signs
??

Question 12

ECG evidence of endocarditis sequelae

Answer 12

Paravalvular abscess can precipitate 2nd degree heart block (indication for urgent consideration of surgery)

Question 13

Role of hospital in home in endocarditis

Answer 13

Not straight-forward; 6 weeks minimum Abx, risk of sequelae including septic emboli so keep in hospital to be risk-averse

Question 14

Indications for surgical intervention in endocarditis

Answer 14

HF
Valve ring abscess
Large vegetations
Failed medical therapy
DIfficult organisms (e.g. Pseudomonas, fungi)