Infective endocarditis

Question 1

What tests would you arrange for IE?

Answer 1

TOE, blood cultures, urine dip

Question 2

What are the two most likely organisms to cause IE?

Answer 2

staph aureus and strep viridens

Question 3

Name three causes of PUO (pyrexia of unknown origin)

Answer 3

malaria, lymphoma, TB, colonic cancer, abscess

Question 4

Define PUO

Answer 4

it was described as a persistent fever above 38.3°C (100°F) that evades diagnosis for at least 3 weeks, including 1 week of investigation in hospital.

Question 5

List three risk factors for IE

Answer 5

Prosthetic valves
Rheumatic fever
IVDU
Immunocompromised
Dental work

Question 6

List two gram positive causes of IE

Answer 6

s. viridans

s. aureus

Question 7

List two gram negative causes of IE

Answer 7

Haemophilus
Chlamydia
Kingella

Question 8

Which murmur/valvular abnormality is most commonly associated with IE?

Answer 8

MR

Question 9

List five clinical features of IE

Answer 9

Fever
Splenomegaly
Clubbing
Murmur
Anaemia
Immune complex deposition- vasculitis, GN

Question 10

Which diagnostic scoring tool is used in IE?

Answer 10

Duke criteria

Question 11

What are the two major components of Duke’s criteria?

Answer 11

Positive culture of typical organism and endocardium involvement (seen on echo) or NEW valve regurg

Question 12

List two of the minor criteria for Duke’s criteria

Answer 12

1 Fever
2 Emboli- janeway's lesions, splinters
3 Predisposition: IVDU, cardiac lesion
4 Immune phenomenon: GN
5 Positve culture not meeting major criteria

Question 13

Combinations of which major/minor criteria lead to diagnosis?

Answer 13

 2 major
 1 major + 3 minor
 All 5 minor

Question 14

Describe four investigations for IE

Answer 14

1. Bloods- cultures, CRP, FBC
2. Urine
3. ECG
4. Echo

Question 15

Describe the blood results of a typical IE case

Answer 15

Normochromic normocytic anaemia
Incr CRP
Positive IgG RF (if immune phenomenon has occured)
Positive cultures

Question 16

What is the empirical treatment for IE?

Answer 16

fluclox + gent IV

Question 17

What is the treatment for strep infection?

Answer 17

benpen + gent IV

Question 18

Treatment for staph?

Answer 18

fluclox + rifampicin IV

Question 19

In which valve is the most common site of endocarditis?

Answer 19

mitral valve

Question 20

How can endocarditis be classified?

Answer 20

1. native valve endocarditis NVE 2. Endocarditis in IVDUs (intravenous drug users) 3. Prosthetic valve endocarditis (PVE)

Question 21

Which species most commonly causes NVE?

Answer 21

strep- s.viridans

Question 22

Which most commonly causes IVDU?

Answer 22

s.aureus

Question 23

And PVE?

Answer 23

staph

Question 24

Which valves are affected in IVDU endocarditis?

Answer 24

tricuspid valve (50%)more common rather than aortic or mitral

Question 25

What are the two clinical syndromes of infective endocarditis?

Answer 25

1. Acute endocarditis 2. Subacute