Infective Endocarditis Case Study

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Introduction Infective endocarditis (IE) is a life-threatening infection of cardiac valves and endomyocardial lining of the heart. IE remains a major health problem, and is associated with significant morbidity, disability, and mortality. Infective endocarditis is clinically manifested with diverse clinical pictures and syndromic diagnoses including heart failure, stroke, and febrile illness. Therefore, clinicians should maintain a high index of suspicion of IE , carry out prompt and appropriate work up, and initiate a management plan in order to prevent death and serious complications associated with IE. Historically, IE diagnosis is largely dependent on a combination of clinical features, microbiological studies, and imaging techniques mainly…show more content…
It is one of the two major criteria proposed in modified Duke criteria to diagnose IE. It is not only helpful in establishing the diagnosis of IE , but it may identify complications , direct the management plan, and inform about the prognosis. Transthoracic echocardiography (TTE) is usually the first modality to be used in investigating IE ,however, when IE is strongly suspected in a patient with prosthetic valve or ICED transesophageal must be undertaken. The diagnostic yield of TTE is usually dependent on acoustic window, vegetation size and location, nature of the valve (native vs prosthetic ) , amount of valvular and paravalvualr calcifications, and operator and interpreter skills. Diagnostic accuracy of TTE for IE in the modern era of harmonic imaging is in the range of 44-89%. However, It worth mentions that TTE sensitivity decreases greatly based on the vegetation size where a vegetation less than 5 mm may only be seen in 0- 25% , and a vegetation size greater than 10 mm would be identified in 84-100 % of…show more content…
In this case , antimicrobial agents should be directed against the most likely pathogens based on epidemiological features including history of intravenous drug use, community vs hospital acquisition of infection, prosthetic vs native valve endocarditis , history indwelling intravascular catheter , source of infection entry (skin vs genitourinary vs gastrointestinal source ) . It is advisable to involve infectious disease specialist early in the course of endocarditis evaluation to aid in identify the best empiric
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