Infective endocarditis

Question 1

causes of acute endocarditis

Answer 1

S. aureus (IV drug abuse)
S. pneumoniae
N. gonorrhea

Question 2

causes of subacute endocarditis

Answer 2

viridans streptococci (native valves)
enterococcus
Staph epidermidis (prosthetic valve)
S. bovis (GI insult)
fungi

Question 3

causes of marantic endocarditis

Answer 3

cancer (poor prognosis)
mets seed valves
emboli can cause cerebral infarct

Question 4

culture (-) endocarditis

Answer 4

Haemophilus parainfluenzae
Actinobacillus
cardiobacterium
eikenella
kignella
coxiella burnetii
brucella
bartonella

Question 5

SLE endocarditis

Answer 5

Libman-sacks endocarditis (autoantibody to valve)

Question 6

causative agent of acute bacterial endocarditis in patients with hx of IV drug abuse

Answer 6

Staph aureus

Question 7

causative agent of left-sided subacute bacterial endocarditis following a dental procedure in native valves

Answer 7

viridans streptococci

Question 8

most common infecting organism in prosthetic valve endocarditis

Answer 8

coagulase (-) staphylococcus

Question 9

assoc with coexisting GI malignancy

Answer 9

strep bovis

Question 10

long-term indwelling IV catheters, malignancy, AIDS, organ transplantation, IV drug abuse

Answer 10

candida and aspergillus species

Question 11

presentation of endocarditis

Answer 11

JR = NO FAME

Janeway lesions
Roth's spots
Nail-bed (splinter) hemorrhage
Osler's nodes
Fever
Anemia
Mumur
Emboli

Question 12

diagnosis of endocarditis

Answer 12

Duke’s criteria
Major:
-at least 2 separate (+) blood cultures for a typical organism, persistent bacteremia with any organism, or a single (+) culture of Coxiella brunetti……
-evidence of endocardial involvement (via transesophageal echocardiography or new murmur)

Minor:

• predisposing risk factors
• fever > or = 38.3C (100.9F)
• vascular phenomena: septic emboli, septic infarcts, mycotic aneurysm, janeway lesions
• immunologic phenomena: glomerulonephritis, osler’s nodes, roth spots
• microbiological evidence that does not meet major criteria

Question 13

CBC for endocarditis

Answer 13

• leukocytosis and left shift
• increased ESR
• increased CRP

Question 14

treatment:

Answer 14

early empiric IV antibiotic tx
-vancomycin is appropriate choice for most patient’s (tailer antibiotics once cause is known

sometimes valve replacement

antibiotic prophylaxis before dental work in patients with previous endocarditis or prosthetic valve