Infective endocarditis Flashcards
What tests would you arrange for IE?
TOE, blood cultures, urine dip
What are the two most likely organisms to cause IE?
staph aureus and strep viridens
Name three causes of PUO (pyrexia of unknown origin)
malaria, lymphoma, TB, colonic cancer, abscess
Define PUO
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.
List three risk factors for IE
Prosthetic valves Rheumatic fever IVDU Immunocompromised Dental work
List two gram positive causes of IE
s. viridans
s. aureus
List two gram negative causes of IE
Haemophilus
Chlamydia
Kingella
Which murmur/valvular abnormality is most commonly associated with IE?
MR
List five clinical features of IE
Fever Splenomegaly Clubbing Murmur Anaemia Immune complex deposition- vasculitis, GN
Which diagnostic scoring tool is used in IE?
Duke criteria
What are the two major components of Duke’s criteria?
Positive culture of typical organism and endocardium involvement (seen on echo) or NEW valve regurg
List two of the minor criteria for Duke’s criteria
1 Fever 2 Emboli- janeway's lesions, splinters 3 Predisposition: IVDU, cardiac lesion 4 Immune phenomenon: GN 5 Positve culture not meeting major criteria
Combinations of which major/minor criteria lead to diagnosis?
2 major
1 major + 3 minor
All 5 minor
Describe four investigations for IE
- Bloods- cultures, CRP, FBC
- Urine
- ECG
- Echo
Describe the blood results of a typical IE case
Normochromic normocytic anaemia
Incr CRP
Positive IgG RF (if immune phenomenon has occured)
Positive cultures
What is the empirical treatment for IE?
fluclox + gent IV
What is the treatment for strep infection?
benpen + gent IV
Treatment for staph?
fluclox + rifampicin IV
In which valve is the most common site of endocarditis?
mitral valve
How can endocarditis be classified?
- native valve endocarditis NVE 2. Endocarditis in IVDUs (intravenous drug users) 3. Prosthetic valve endocarditis (PVE)
Which species most commonly causes NVE?
strep- s.viridans
Which most commonly causes IVDU?
s.aureus
And PVE?
staph
Which valves are affected in IVDU endocarditis?
tricuspid valve (50%)more common rather than aortic or mitral
What are the two clinical syndromes of infective endocarditis?
- Acute endocarditis 2. Subacute
