Micro 6: PUO + infective endocarditis Flashcards
Define PUO
Temp >38.3 >3 weeks despite >1 week Ix in Hospital or 3 days in hospital or 3 OP visits (latter number of 3 days is a newer definition)
differentials for PUO
Non infectious inflammatory disease (PMR, still’s disease, sarcoid)
infection
malignancy
investigations used to diagnose EBV in <12 and >12
<12 –> EBV viral serology
>12 years –> FBC + mono spot for heterophile antibodies
in a patient with CD4 count of <200, which 3 infections are they particularly susceptible to?
Cryptococcus
PCP
Disseminated mycobacterium avium complex
What is needed for the diagnosis of infective endocarditis
2 major criteria (Duke’s)
1 major 3 minor
5 minor
what are the major criteria to diagnose infective endocarditis?
2 separate +ve blood cultures with microorganisms typical for IE
Echocardiographic evidence of endocardial involvement
“minor criteria” for diagnosing IE? (name 4, don’t bother with the +ve BC and echo findings which don’t satisfy the major criteria)
Predisposing heart condition or IVDU
Temp >38C
VASCULAR phenomena: Janeway lesions, arterial emnboli
Immunological phenomena: Osler’s nodes, Roth spots, Rf
Microbiological evidence: +ve blood culture but not meeting the major criterion
investigation of giant cell arteritis
temporal artery biopsy = gold standard
GCA symptoms
jaw claudication, scalp tenderness, headache, visual disturbances, >50, ESR >45
ferritin often very high in…
Adult onset Still’s disease (salmon pink rash, fever, joint pain)
WCC in typhoid and malarai
NORMAL
main pathogens causing ACUTE infective endocarditis
Strep pyogenes, Staph aureus (IVDU), CoNS (prosthetic valves) = HIGH VIRULENCE
Causes of SUBACUTE infective endocarditis
Staph epidermidis, Strep viridian’s (low virulence)
Strep viridian’s often seen after ?
dental procedures
symptoms of subacute bacterial endocarditis
V gradual damage with longterm PUO Clubbing Roth spots Oslers nodes janewya lesions etc MICROSCOPIC HAEMATURIA!!!
