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IVDU, murmur & respiratory symptoms, fever (IE Microbiology What…
IVDU, murmur & respiratory symptoms, fever
What is your PDx and DDx?
PDx
infective endocarditis → aortic valve vegetations & pulmonary septic emboli
PE: acute* haemoptysis, pleuritic chest pain
Source septic emboli: mycotic vegetations tricuspid valve - left sternal border murmur (TR)
Fever (IE)
DDx
Cardiovascular
VSD (tricuspid area murmur)
Pulmonary a. stenosis, flow murmur (LSE's pulmonic area)
CCF
Dilated cardiomyopathy
Respiratory
Embolic
clot emboli from DVT
Infective
TB
pneumonia (viral, bacterial, fungal)
lung abscess
Aspergillosis?
Vascular
AVM
Neoplastic
lung cancer (primary or secondary)
lymphoma
Autoimmune
vasculitis
Wegner's granulomatosis
Goodpasture's syndrome
RA
SLE
Infiltrative
Sarcoidosis
Non-cardiorespiratory
Coagulopathy (organic or iatrogenic drug-induced)
What organisms commonly cause IE?
Normal person
Strep viridans
Staph epidermidis
Immunocompromised
HACEK group:
IE Microbiology
What organisms commonly cause IE?
Native valve
Community-onset
strep viridans / bovis (colorectal Ca)
staph aureus
enterococcus
Healthcare-associated
staph aureus / epidermidis
enterococcus
IVDU
staph aureus
(venepuncture sites, skin flora, needle-sharing)
gram negative e.g. pseudomonas
candida
diptheroids
(polymicrobial)
Prosthetic valve
Early / pacemaker or defibrillator
staph aureus / epidermidis
Late
staph aureus / epidermidis
step viridans
enterococcus
Culture negative
Bartonella, Brucella
Coxiella burnetti
Whipplei (Tropheryma)
Overall
Strep viridans - 60% (oral cavity normal flora)
Staph aureus - 20% (normal skin flora)
Staph epidermidis (normal skin flora)
HACEK group (oropharyngeal)
Haemophilus
Aggregatibacter
Cardiobacterium
Eikenella
Kingella
Fungi: candida, aspergillus