fever of unknown origin
3 weeks or longer with 1 week of unknown workup
fever
PGE2
its release stimulated by IL1, IL6, and TNFalpha
causes of FUO
infection, cancer, autoimmune/CT disease
duke criteria
for endocaritis
two major
or one major and 3 minor
or 5 minor
major - two positive blood cultures, echo evidence, new regurg murmur
minor - predisposing condition, fever, vascular emboli (janeway/osler/roth), immuno with agglutinating bodies
common bug for endocarditis
bartonella hensalae or quintana
Tx - doxycycline and gentamicin
acute endocarditis
virulent organisms
valvulr regurg, high fever, early emboli
native valve endocarditis
brushing teeth, IV device
staph
or strep viridans
or HACEK
IV drug users
staph to tricuspid valve
early prostethic valve infection
within 2 months
-coagulase + and - staph
late prosthetic valve infection
strep or staph
coag - and +
Dx of endocarditis
3 cultures one hour apart
use dukes criteria
-2 positive cultures
HACEK
takes a long time to culture
negative culture in suspected endocarditis
could be HACEK group
-eikenella, kingella**
complications of endocarditis
heart block CHF emboli mycotic aneurysms myocardial abscess
prosthetic aortic valve infection
coxiella burnetii
if owned cat
Tx for coxiella infection
doxycycline if acute
doxycycline + rifampin if chronic
strep endocarditis Tx
PCN G
enterococcal endocarditis Tx
PCN + gentamicin
staphaylococcus endocarditis
nafcillin or vanco
native valve treatment
vancomycin
prosthetic valve
rifampin - kills staph adhered to foreign material**
vancomycin
covers staph, strep, enterococcus
PCN G
strep
ampicillin and gentamicin
enterococcus
penicillin sensitive staph
nafcillin
nafcillin
for PCN sensitive staph
vancomycin
for MRSA or coag negative staph
inhibits cell wall synthesis in gram positives
gentamicin
30S ribosome
rifampin
DNA dependent RNA polymerase
poor dentition
strep mutans
strep bovis
GI neoplasm
enterococci
elderly with urinary problems
HACEK
prolonged incubation
late prosthetic valve
strep
IV drug users
staph
alcoholics and street people
bartonella
no growth
tropheryma
endocarditis prophylaxis
only high risk cardiac populations
-previous IE, prostethic valve, cyanotic heart disease
perforating procedures of teeth, lungs, skin
dental antibiotics
amoxicillin 2 grams 1 hour before procedure
syncope, diastolic rumble, weight loss, fever, sed rate elevation
atrial myxoma
atrial myxoma
carney complex of pigmented skin
cAMP activated protein kinase A