Infective endocarditis

Question 1

What is meant by bacteraemia (used to be septicaemia)?

Answer 1

Viable bacteria in the bloodstream

Question 2

What should be done before blood cultures are taken?

Answer 2

The skin should be sterilised

Question 3

How long can some blood cultures take to give a positive result?

Answer 3

Up to 2 days

Question 4

When should broad spectrum antibiotics be started on a patient with suspected bacteraemia?

Answer 4

After blood cultures are taken but before a result

Question 5

What are some bacteria that can cause bacterial meningitis?

Answer 5

Streptococcus pneumoniae
Neisseria meningitidis
Haemophilus influenzae
Streptococcus agalactiae
Listeria monocytogenes

Question 6

What is the main bacteria that causes otitis media?

Answer 6

Streptococcus pneumoniae

Question 7

What are some bacteria that can cause eye infections?

Answer 7

Staphylococcus aureus
Neisseria gonorrhoaea
Chlamydia trachomatis

Question 8

What are some bacteria that can cause sinusitis?

Answer 8

Streptococcus pneumoniae
Haemophilus influenzae

Question 9

What are some bacteria that can cause upper respiratory tract infections?

Answer 9

Streptococcus pyogenes
Haemophilus influenzae

Question 10

What are some bacteria that can cause community acquired pneumonia?

Answer 10

Streptococcus pneumoniae
Haemophilus influenzae
Staphylococcus aureus

Question 11

What are some bacteria that can cause atypical pneumonia?

Answer 11

Mycoplasma pneumoniae
Chlamydia pneumoniae
Legionella pneumophila

Question 12

Which bacteria can cause tuberculosis?

Answer 12

Mycobacterium tuberculosis

Question 13

What are some bacteria that can cause skin infection?

Answer 13

Staphylococcus aureus
Streptococcus pyogenes
Pseudomonas aeruginosa

Question 14

What are some bacteria that can cause sexually transmitted diseases?

Answer 14

Chlamydia trachomatis
Neisseria gonnorhoaea
Treponema pallidum
Ureaplasma urealyticum
Haemophilus ducreyi

Question 15

What are some bacteria that can cause urinary tract infections?

Answer 15

Escherichia coli
Enterobacteriaceae sp
Staphylococcus saprophyticus
Pseudomonas aeruginosa

Question 16

What bacteria is the most common cause of gastritis?

Answer 16

Helicobacter pylori

Question 17

What are some bacteria that can cause food poisoning?

Answer 17

Campylobacter jejuni
Salmonella sp
Shigella sp
Clostridium sp
Staphylococcus aureus
Escherichia coli

Question 18

How many blood samples should be taken in suspected endocarditis?

Answer 18

At least 3 samples, as the more samples taken, the higher the detection sensitivity

Question 19

How can implantable devices lead to endocarditis?

Answer 19

Implantable devices can carry a biofilm on their surface which can infect leads and then the heart

Question 20

How long after removal of an infected ICED should blood tests be taken?

Answer 20

48 - 72 hours

Question 21

What are some pre-disposing factors for infective endocarditis?

Answer 21

Heart valve abnormality
Prosthetic heart valves
People who inject drugs
Intravascular lines

Question 22

What are some forms of heart valve abnormality that can predispose to infective endocarditis?

Answer 22

Calcification
Congenital
Rheumatic fever

Question 23

What are the 4 most common bacteria in infective endocarditis?

Answer 23

Staphylococcus aureus
Viridans group Streptococci
Enterococcus sp
Staphylococcus epidermidis

Question 24

What are some examples of bacteria that can cause infective endocarditis, but won’t grow on agar?

Answer 24

Bartonella
Coxiella burnetti (Q-fever)
Chlamydia
Legionella
Mycoplasm
Brucella

Question 25

What is required for testing if a bacteria won't grow on agar?

Answer 25

Serology testing

Question 26

What are the HACEK bacteria that grow very slow on agar?

Answer 26

H - Haemophilus sp A - Aggregatibacter sp C - Cardiobacterium sp E - Eikenella sp K - Kingella sp

Question 27

What are the major conditions in the duke criteria for infective endocarditis?

Answer 27

2 separate positive blood cultures with microorganisms typical for infective endocarditis: - Strep viridian's groups - Strep gallolyticus - HACEK groups - Staph aureus - Community acquired enterococci Echocardiographical evidence of endocardial involvement: - Vegetation - Abscess - Valvular lesions - New murmur

Question 28

What are the tests performed in blood culturing?

Answer 28

Gram staining Microscopy Coagulase testing MALDI-TOF

Question 29

What is shown on blood agar in a culture of staphylococcus aureus?

Answer 29

A gold aura

Question 30

What is the main acute presentation of infective endocarditis?

Answer 30

Overwhelming sepsis and cardiac failure

Question 31

What are some sub-acute presentations of infective carditis?

Answer 31

Slow onset Fever Malaise Weight loss Tiredness Breathlessness New or changing heart murmur Finger clubbing Splinter haemorrhage Splenomegaly Roth spots, Janeway lesions and Osler nodes Microscopic haematuria

Question 32

What is meant by a Roths spots?

Answer 32

White, central retinal haemorrhages

Question 33

What is meant by Janeway lesions?

Answer 33

Painless, flat red/blue spots on the palms and soles

Question 34

What is meant by Osler nodes

Answer 34

Painful, pea sized lesions on the fingers and toes

Question 35

How are people likely to contract infective endocarditis with Streptococcus viridans?

Answer 35

It is most commonly found in the mouth and so it can move into the blood stream via broken tissue in the gums, or in IV drug user as they can lick the needle

Question 36

What are some common skin infections that can contaminate the blood during surgery?

Answer 36

Staphylococcus aureus Staphylococcus epidermidis Corynebacterium sp Propionibacterium acnes

Question 37

In the Dukes criteria, what does the mnemonic BE TIMER stand for?

Answer 37

Blood cultures positive Echocardiogram Temperature Immunological (Osler's nodes, Roth spots) Microbiological evidence Emboli Risk factors (Heart condition or IV drug use)

Question 38

What is the main first site of infection in IV drug users?

Answer 38

Right sided endocarditis

Question 39

What is the treatment option for Coxiella burnetti?

Answer 39

Doxycycline and hydroxychloroquine for 18 months

Question 40

What is the main treatment option for Streptococcus viridans group endocarditis?

Answer 40

Amoxicillin and gentamicin IV

Question 41

What is the main treatment option for prosthetic valve endocarditis?

Answer 41

Vancomycin and gentamicin IV Then oral rifampicin after 3-5 days

Question 42

What is the main treatment option for endocarditis in IV drug users?

Answer 42

Flucloxicillin IV

Question 43

What is the main treatment option for staphylococcus aureus endocarditis?

Answer 43

Flucloxicillin IV

Question 44

What is the main treatment option for enterococcus sp endocarditis?

Answer 44

Vancomycin and gentamicin IV

Question 45

What is the main treatment option for staphylococcus epidermidis endocarditis?

Answer 45

Vancomycin and gentamicin IV and oral rifampicin

Question 46

How long are most anti-biotic courses for infective endocarditis?

Answer 46

4-6 weeks

Question 47

What are the main symptoms of myocarditis?

Answer 47

Fever Chest pain Shortness of breath Palpitations

Question 48

What are some clinical signs of myocarditis?

Answer 48

Arrhythmia Cardiac failure