IE and VASC ID

Infective Endocarditis (-itis: inflammation)  Communication is the key  incidence: 10-20 K (15 % are in prosthetic valve) Mortality: 20 % Pathogen 1. Gm Positive (80%) Pathogenesis: 3 Hit Hypothesis Anatomy: Skin exam: Can be missed for vasculitis  Nomenclature: Duke 1: 2D criteria included Modified Duke : TEE included Note: If TEE misses, CTA can be done Changing in imaging is more important than one time imaging finding. Hence, follow up is needed.  Diagnosis: 3 sets of blood culture before antibiotics can identify organism in 85 % of the case Culture negative:  Tryponemal Whippeli Bartoneall henscele  P ace > 10 day of blood culture  Histology:  Fungal serology   PCR sequencing: sent to Uni of Washington.  Everyone gets Head CT  CT chest (if device, or  CT abd  Splenic abscess vs infarct Managed differently Surgical staging is different  References:  IE Abx Regimen NEJM 2013 Infective Endocarditis NEJM 2013 Infections of Cardiovascular Implantable Electronic Devices NEJM AHA/Others Guidelines: Prevention of Infective Endocarditis Circulation 2007 Infective Endocarditis  Circulation. 2007;116:1736-1754.  Circulation. 2007;116:1736-1754.   Circulation. 2007;116:1736-1754.   Device Infection  Circulation. 2010;121:458-477.  Circulation. 2010;121:458-477.  Circulation. 2010;121:458-477.