A patient with known cardiac valve disease presents to ED with fever and shortness of breath worsening over the past 2 weeks. On examination, you note poor dental hygiene, and the patient informs you he underwent a tooth extraction about 3 weeks ago. You suspect infective endocarditis. Which of the following is the most likely causative pathogen:
There are two main risk factors for infective endocarditis:
Structurally weakened and damaged endocardium is susceptible to colonisation with an infective organism, especially if a thrombus has already been deposited. This process of infection and deposition of thrombus continues, forming the characteristic vegetation lesion. As the disease progresses, the valve is destroyed and regurgitation or obstruction develops. Thrombi from the vegetation can embolise to distant sites. In addition, infective organisms can enter the circulation and form immune complexes.
Infection | Treatment |
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Initial 'blind' therapy for native-valve endocarditis |
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Initial 'blind' therapy for prosthetic-valve endocarditis |
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Native-valve endocarditis caused by Staphylococci spp. |
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Prosthetic-valve endocarditis caused by Staphylococci spp. |
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Endocarditis caused by Streptococcus spp. |
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Endocarditis caused by Enterococci spp. |
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Endocarditis caused by HACEK microorganisms: |
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Patients at risk of endocarditis should be:
Antibacterial prophylaxis and chlorhexidine mouthwash are not recommended for the prevention of endocarditis in patients undergoing dental procedures.
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Biochemistry | Normal Value |
---|---|
Sodium | 135 – 145 mmol/l |
Potassium | 3.0 – 4.5 mmol/l |
Urea | 2.5 – 7.5 mmol/l |
Glucose | 3.5 – 5.0 mmol/l |
Creatinine | 35 – 135 μmol/l |
Alanine Aminotransferase (ALT) | 5 – 35 U/l |
Gamma-glutamyl Transferase (GGT) | < 65 U/l |
Alkaline Phosphatase (ALP) | 30 – 135 U/l |
Aspartate Aminotransferase (AST) | < 40 U/l |
Total Protein | 60 – 80 g/l |
Albumin | 35 – 50 g/l |
Globulin | 2.4 – 3.5 g/dl |
Amylase | < 70 U/l |
Total Bilirubin | 3 – 17 μmol/l |
Calcium | 2.1 – 2.5 mmol/l |
Chloride | 95 – 105 mmol/l |
Phosphate | 0.8 – 1.4 mmol/l |
Haematology | Normal Value |
---|---|
Haemoglobin | 11.5 – 16.6 g/dl |
White Blood Cells | 4.0 – 11.0 x 109/l |
Platelets | 150 – 450 x 109/l |
MCV | 80 – 96 fl |
MCHC | 32 – 36 g/dl |
Neutrophils | 2.0 – 7.5 x 109/l |
Lymphocytes | 1.5 – 4.0 x 109/l |
Monocytes | 0.3 – 1.0 x 109/l |
Eosinophils | 0.1 – 0.5 x 109/l |
Basophils | < 0.2 x 109/l |
Reticulocytes | < 2% |
Haematocrit | 0.35 – 0.49 |
Red Cell Distribution Width | 11 – 15% |
Blood Gases | Normal Value |
---|---|
pH | 7.35 – 7.45 |
pO2 | 11 – 14 kPa |
pCO2 | 4.5 – 6.0 kPa |
Base Excess | -2 – +2 mmol/l |
Bicarbonate | 24 – 30 mmol/l |
Lactate | < 2 mmol/l |