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Infective Endocarditis
Organisms
Presentation
History
Risk Factors
- prosthetic valves
(account for 1/3 of cases)
- IV drug use
- right-sided (tricuspid)
- young male
- no known heart disease
- short history
- complicated by pulmonary infarction
Sub-acute
- gradual onset
- previous dental / surgical procedures
- sweats
- chills / rigors (rarely)
- general malaise
- anorexia
- weight loss
- aching joints
- symptoms of CVA
- Past medical history
- pre-existing valve disease
Examination
General
CVS
Abdomen
Urinalysis
- miscroscopic haematuria and proteinuria
Investigations
- blood cultures 6x
- echocardiography
- FBC
- mild normochromic, normcytic anaemia
- ESR elevated
- U&E
Diagnosis
Dukes Criteria
Diagnosis Requires 2 major, 1 major and 3 minor or 5 minor
- Major
- positive blood culture
- typical organism in 2 blood cultures
- persistently positive blood cultures (>12 hours apart, 3 or
majority of 4)
- endocardium involvement
- positive echocardiogram
- vegetation
- abscess
- dehiscence of prosthetic valve
- new valvular regurgitation
- Minor
- Predisposition
- cardiac lesion
- IV drug use
- Fever >38ºC
- Vascular / Immunological phenomena
- Positive blood cultures not meeting major criteria
- Positive echocardiogram not meeting major criteria
Culture Negative Endocarditis
- antibiotics given before cultures
- HACHET group of organisms
- Non-infective causes
- Fungi
Treatment
- Underlying infection
- IV antibiotics
- bactericidal according to cultures
- Surgery
- extensive valve damage
- prosthetic valve infection
- severe heart failure
Complications
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