Crash Course: Endocarditis, GI, UTI, SSI Flashcards by Georgia Leggett

Define infective endocarditis

Infection, typically bacterial, of the endocardium

How well did you know this?

Not at all

Perfectly

How is infective endocarditis classified by onset?

Subacute: classic indolent presentation

Acute: rapid onset, present septic

Prosthetic: high-risk 1-2m following valve replacement

How well did you know this?

Not at all

Perfectly

How is infective endocarditis classified by valve affected?

L more common than R

Prosthetic valves are higher risk

TRICUSPID (R) affected in IVDU

How well did you know this?

Not at all

Perfectly

What are the 3 classical signs of infective endocarditis?

Pyrexia of unknown origin
Constitutional Sx
New regurgitant murmur

How well did you know this?

Not at all

Perfectly

What embolic phenomena manifest in infective endocarditis?

JANEWAY lesions: painless

SPLINTER HAEMORRHAGES

Septic emboli to brain, spleen, kidney- splenomegaly, haematuria

How well did you know this?

Not at all

Perfectly

What immune phenomena occur in infective endocarditis?

ROTH spots
OSLER nodes: PAINFUL
Glomerulonephritis

How well did you know this?

Not at all

Perfectly

What is the most common organism causing infective endocarditis in the UK vs the developing world?

UK: Staphylococcus aureus

DW: Streptococcus viridans

How well did you know this?

Not at all

Perfectly

Which organism causing infective endocarditis is associated with recent prosthetic valve surgery?

Staphylococcus epidermidis

How well did you know this?

Not at all

Perfectly

Which organism causing infective endocarditis is associated with colon tumours? Thus what investigations should be performed?

Streptococcus bovis
If culture +ve for S Bovis do colonoscopy

How well did you know this?

Not at all

Perfectly

Which organisms causing infective endocarditis are culture negative?

HACEK organisms

Haemophilus
Aggregatibacter
Cardiobacterium
Eikenella
Kingella

How well did you know this?

Not at all

Perfectly

Which organism causing infective endocarditis is associated with exotic birds?

Chlamydia psittaci

How well did you know this?

Not at all

Perfectly

Which organism causing infective endocarditis is associated with farm animals?

Coxiella burnetti

How well did you know this?

Not at all

Perfectly

Which organism causing infective endocarditis is associated with unpasteurised dairy?

Brucella spp.

How well did you know this?

Not at all

Perfectly

What is the criteria used for diagnosing Infective endocarditis?

Duke criteria
2 Major
or
1 major + 3 minor
or
5 minor

How well did you know this?

Not at all

Perfectly

What are the major criteria for diagnosing infective endocarditis?

BC’s +ve for infective endocarditis (at least 2 cultures, with typical organism)

Evidence of endocardial involvement on USS: new regurgitation + vegetation

How well did you know this?

Not at all

Perfectly

What antibiotic regimen is used for infective endocarditis?

Initial ‘blind’: Amoxicillin + Gentamicin

S. aureus: Flucloxacillin + Vancomycin + Rifampicin

S. viridans: Benzylpenicillin

How well did you know this?

Not at all

Perfectly

Give 4 indications for surgery in infective endocarditis

Continuing to worsen on Abx

Acute heart failure

Aortic root abscess: IE in aorta + developed abscess, suggested by PR prolongation

Prosthetic valve disease

How well did you know this?

Not at all

Perfectly

What is non-infective endocarditis?

Endocardial vegetations without infection:

Mucin-producing adenocarcinomas (esp. Pancreatic adenocarcinomas)

SLE/ APLS = Libman-Sacks endocarditis

How well did you know this?

Not at all

Perfectly

How can GI infection presentations be broadly split?

Infections limited to secretory GI Sx

Infections causing inflammation in the GI tract – dysentery

Infections causing systemic Sx

How well did you know this?

Not at all

Perfectly

Give 4 causes of secretory GI disease. What is each associated with?

Bacillus cereus: Reheated RICE

Staphylococcus aureus: BBQ, short incubation as Sx caused by preformed toxin

Escherichia coli: Traveller’s diarrhoea

Vibrio cholera: Ricewater stool, comma- shaped bacterium

How well did you know this?

Not at all

Perfectly

What is dysentery?

Bloody stool

How well did you know this?

Not at all

Perfectly

Which organisms are associated with dysentery?

CHESS
Campylobacter jejuni: BBQs, longer incubation
Haemorrhagic E.coli
Entamoeba histolytica (Amoeba)
Salmonella enteritides: poultry, eggs
Shigella spp

How well did you know this?

Not at all

Perfectly

Other than CHESS organisms, what can cause dysentery?

Yersinia enterocolitica
Non bloody or more often bloody diarrhoea

Often causes terminal ileitis + adenitis- can resemble appendicitis (RLQ pain)

How well did you know this?

Not at all

Perfectly

Give 3 features of GI infection presentation due to Entamoeba histolytica

Dysentery
Chronic diarrhoea
Liver abscess

How well did you know this?

Not at all

Perfectly

What is seen on histology in Entamoeba histolytica infection?

Flask shaped ulcers Anchovy paste in abscess

What is used to treat Entamoeba histolytica?

Metronidazole

Give 2 features of GI infection presentation due to Giardia lamblia

Chronic diarrhoea Malabsorption

What is seen on histology in Giardia lamblia infection?

Pear shaped trophozoites

What is used to treat Giardia lamblia?

Metronidazole

Which 2 organisms are associated with diarrhoeal illness in patients with HIV?

Cryptosporidium Microsporidium spp

What causes Clostridium difficile?

Cephalosporins Clindamycin Ciprofloxacin

What investigations can be used to diagnose C difficile?

Stool C. difficile toxin Visualise pseudomembrane

What is the treatment for first C. difficile infection? What is the treatment for first recurrence?

1st: Vancomycin PO !st recurrence: Fidaxomicin PO

What is the treatment for further recurrence of C. difficile infection?

Consider faecal microbiota transplant

What is fulminant C difficile infection? What is the treatment for fulminant C. difficile infection?

In shock/ toxic megacolon Vancomycin PO + IV metronidazole

Describe the appearance of C difficile on histology

Wet cornflake Pseudomembranous colitis

In which scenarios is a UTI considered to be complicated?

Urinary tract abnormality Pregnant Immunocompromise Instrumentation

How is UTI classified on severity?

Lower UTI/ cystitis: only affects bladder, classic Sx only Pyelonephritis: infection ascends to kidney, fever, rigors, flank pain, systemically unwell Pyonephrosis: pyelonephritis with obstruction, not producing urine. Hydroureter + enlarged kidney on USS

What is seen on urine dipstick in UTI?

Leukocytes ± nitrites ± haematuria Nitrites specific for coliform UTIs If -ve for nitrites, could still have a UTI, but probably not E coli

What is diagnostic of UTI on MC+S?

>10^4 colony-forming units/ml any organism >10^3 colony-forming units/ml E. coli or Staph. saprophyticus

When is renal tract imaging performed in UTI?

if concern for complicated UTI

What could contaminate MC+S in potential UTI?

Epithelial squamous cells Mixed growth Organisms that don’t make sense e.g. S aureus

What are fried egg cells on MC+S? What are they indicative of?

Epithelial cells Indicative of contamination

Why should you avoid urine dipsticks for diagnosing UTI in >65s?

Less reliable Majority have bacteruria without infection/ Sx Abx not indicated, may cause harm e.g. C diff risk

What is the most common cause of UTIs?

Escherichia coli

Which patient group is Staphylococcus saprophyticus associated with?

Young healthy women

What is Proteus mirabilis associated with on MC+S?

Struvite stones- affinity for calculi

What is Klebsiella aerogenes associated with on MC+S?

Catheterisation-adheres to plastic

Give 5 causes of sterile pyuria

TB Sexually Transmitted Disease Calculi Catheterisation Bladder neoplasm

What is the treatment for lower UTI?

Nitrofurantoin, Trimethoprim, Cephalexin Uncomplicated: 3d Complicated or Male: 7d

What is treatment for pyelonephritis?

Admit IV Co-amoxiclav + Gentamicin

What is treatment for asymptomatic bacteriuria?

Do not treat unless pregnant

What must be checked before prescribing Trimethoprim for UTI?

Check if on Methotrexate (folate antagonist) Do not give Trimethoprim if already on folate antagonist

What antibiotics can be used to treat UTI in pregnancy?

1st + 2nd Trim: Nitrofurantoin, Amoxicillin, Cephalexin 3rd Trim: Amoxicillin, (Trimethoprim) or Cephalexin

Why should Trimethoprim be avoided in the first trimester?

Teratogenic risk as it's a folate antagonist

Why should nitrofurantoin be avoided at term?

Risk of neonatal haemolysis.

From most to least common give 4 causes of surgical site infection

Staphylococcus aureus Escherichia coli Streptococcus spp. Pseudomonas

From most to least common give 3 causes of Osteomyelitis

Staphylococcus aureus Streptococcus spp. Escherichia coli

What organism is the most common cause of osteomyelitis and septic arthritis in sickle cell patients?

Salmonella

From most to least common give 3 causes of Septic arthritis

Staphylococcus aureus Streptococcus spp. Escherichia coli

From most to least common give 3 causes of prosthetic joint infection

Staphylococcus epidermidis (in first 2 months post-op) Staphylococcus aureus Streptococcus spp. Escherichia coli

Crash Course: Endocarditis, GI, UTI, SSI Flashcards

(61 cards)