Infective endocarditis

Question 1

Native valve endocarditis with previously normal valve

• presentation
• organisms

Answer 1

Presentation: acute bacterial endocarditis

S aureus most common

• affects left-side valves
• IVDU have right valve disease

Austrian syndrome:

• Strep pneumonia
• meningitis
• pneumonia
• infective endocarditis
• alcoholics

Question 2

Native valve endocarditis with abnormal valve

• presentation
• organisms

Answer 2

Presentation: Subacute bacterial endocarditis due to formation of vegetations

Streptococci most common - esp viridans

HACEK organisms

S bovis associated with colorectal CA

Question 3

Prosthetic valve endocarditis

Organisms

• within 2 months
• within 1st year
• late infection

Answer 3

2 months: S aureus, S epidermidis (most common), gram negative bacilli

1st year: S epidermidis and S aureus

Late: causes are similar to SBE

Question 4

Blood culture negative endocarditis

Answer 4

1. prior abx
2. Noninfectious endocarditis
   
   1. Libman Sacks
   2. nonbacterial thrombotic (marantic)
   3. carcinoid heart syndrome
3. Coxiella burnetii
4. Bartonella
5. Chlamydia
6. Legionella
7. Tropheryma Whipplei
8. HACEK orgs

Question 5

Laboratory approach to infective endocarditis

Answer 5

Blood cultures:

3 sets of blood cultures drawn at separate times (1-8 hours apart)

Each should be paired

>20-30 ml