IE

Hope everyone had a good weekend

Today we started off the week talking about a blue team patient who was admitted last week with a high suspicion of endocarditis. We discussed how although our patients are often IVDU, most commonly IE occurs in older patients who are not drug users.

We reviewed the DUKE's CRITERIA: since to make a diagnosis you need 2 major criteria, or 1 major and 2 minor, or 5 minor. 


Major Criteria:

1. Positive blood cultures for endocarditis.

• high risk microorganisms on 2 blood cultures (separated by time) (Strep, Staph, Enterococcus, HACEK etc). THese should be persistent (i.e. over a 12 hour period) and positive for typical IE organisms

• Single positive blood culture for Coxiella burnetii 

2. Evidence of endocardial involvment

• Echocardiographic evidence

• A NEW regurgitant murmer.

Minor Criteria:

1. Fever >38 degrees C

1. High risk- e.g. cardiac lesion or IV drug use.

1. Vascular phenomena: arterial emboli, septic pulmonary infarcts, mycotic aneurysm, intracranial hemorrhage, conjunctival hemorrhages, Janeway lesions.

1. Immunologic phenomena: glomerulonephritis, Osler's nodes, Roth spots, positive rheumatoid factor.

1. Microbiologic evidence: positive blood culture not meeting major criterion 

Remember: Dukes is for LEFT sided lesions and right sides lesions do not have the same presentation in terms of vascular phenomena or easily heard murmur.



Here is a link the american heart association recommendations 

Happy monday.