Endocarditis

Question 1

What are causes of endocarditis

Answer 1

Gram +ve = strep viridans, staph aureus in PWID

Grame -ve = HACEK

CoNS = prosthetic valves.

Question 2

Types

Answer 2

Acute - staph aureus likely, days - weeks

Subacute - strep viridans/enterococcus week -months

Question 3

Clinical features

Answer 3

1. Fever + new murmur
2. Embolic events: splinter haemorrhages, petechiae, strokes, if R sided e.g. PWID septic puimonary emboli can cause pleuritic chest pain
3. Late immune complex deposition: Osler nodes, vasculitis

Question 4

What is diagnosis

Answer 4

Duke criteria: 2 major, 1 major 3 minor, or 5 minor.

Major: +ve bloods in 2 cultures for typical organism
- positive echo e.g. new murmur

Minor:

• fever >38
• risk e.g. PWID, disease
• other cultures not typical
• immune
• embolic

Question 5

What is antibiotics used in endocarditis

Answer 5

Strep = benpen and gentamicin

Enterococcus = amoxicillin + gentamicin

Staph aureus = fluclox + gentamicin (if MRSA, use vancomycin)

CoNS = flucloxacillin + rifampicin +gentamicin

Use vancomycin if penicillin allergic.

Need to give for 4 weeks if native, 6 weeks if prosthetic.