Infective Endocarditis Fall 2012

Had some dental work done one week ago and did not

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had some dental work done one week ago and did not take any antibiotics prior to or after this procedure. He denies illicit drug use. Vitals are BP 110/70, HR 98, RR 14, T 100.2F, Wt 80 kg. Pertinent labs include SCr 0.8 mg/dl, WBC 9,000/mm3, Hgb 11.2 g/dl, Hct 33%, Plt 173,000/mm3. Blood cultures are immediately drawn. A stat TEE is performed which reveals a large vegetation on the mitral valve.
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Case 1 What risk factors does this patient have for IE? What signs/symptoms does this patient have that are consistent with IE? What is/are the most likely organisms causing this patient’s IE?
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Case 2 A 24 yo male presents to the ED complaining of fever, chills, N/V, and anorexia. He has no significant PMH. He is homeless and an IVDA (heroin) for the past year but claims to have quit 1 week ago. On physical exam, he has (+) Janeway lesions, (-) Osler nodes, and (+) splinter hemorrhages under his fingernail beds. His vitals are BP 115/80, HR 115, RR 12, T 102.1F, Wt 73 kg. He has a faint systolic ejection murmur. Pertinent labs include SCr 0.7 mg/dl, WBC 15,000/mm3, Hgb 13 g/dl, Hct 39%, Plt 110,000/mm3. A TEE reveals a vegetation on the tricuspid valve. Blood cultures are growing Gram-positive cocci in clusters.
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Case 2 What risk factors does this patient have for IE? What signs/symptoms does this patient have that are consistent with IE? Would he be considered to have left- or right-sided IE? What is/are the most likely organisms causing this patient’s IE?
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Case 3 A 68 yo male presents to the ED complaining of fever and N/V worsening over the past few days. His PMH is significant for HTN, HL, CHF, prostate cancer, mitral valve replacement (2006) due to previous IE. He states his symptoms started about 1 week after after he had his prostate removed via transurethral resection (TURP), which was 3 weeks ago. On physical exam, he has (-) Janeway lesions, (+) Osler nodes, and (+) splinter hemorrhages under his fingernail beds. His vitals are BP 138/88, HR 110, RR 18, T 100.8F, Wt 84 kg. Pertinent labs include SCr 1.2 mg/dl, WBC 14,000/mm3, Hgb 12 g/dl, Hct 34%, Plt 94,000/mm3. A TEE reveals a vegetation on the prosthetic mitral valve. Blood cultures are growing Gram-positive organisms in pairs and chains.
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Case 3 What risk factors does this patient have for IE? What is/are the most likely organisms causing this patient’s IE?
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