Infective endocarditis diagnosis

Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis Diagnosis, antimicrobial therapy, and management of complications a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association endorsed by the Infectious Diseases Society of America. Circulation 2005 111(23) 394M34. 

Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis Diagnosis, antimicrobial therapy, and management of complications. American Heart Association scientific statement. Circulation 2005 111 e394—433. 

B. Modified Duke Criteria for the Diagnosis of Infective Endocarditis ... 

Firm alternate diagnosis explaining evidence of infective endocarditis, or... 

When presented with a patient with infective endocarditis, it is imperative to have an accurate diagnosis and treat appropriately. Mortality can be significant depending on the organism and the patient s comorbidities. However, outcomes can be improved through diligent care and monitoring. 

Bayer AS, Bolger AF, Taubert KA, et al. Diagnosis and management of infective endocarditis and its complications. Circulation 1998 98 2936-2948. 

Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis Utilization of specific echocardiographic... 

Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis 2000 30 633-638. 

Sachdev M, Peterson GE, Jollis JG. Imaging techniques for diagnosis of infective endocarditis. Cardiol Clin 2003 21 185-195. 

Suggested Alternatives for Differential Diagnosis Influenza, infectious mononucleosis, hepatitis, leptospirosis, infective endocarditis, malaria, tuberculosis, typhoid fever, cryptococcosis, histoplasmosis, ankylosing spondylitis and undifferentiated spondyloarthropathy, collagen vascular disease, chronic fatigue syndrome, malignancy, and osteomyelitis. 

Suggested Alternatives for Differential Diagnosis Brucellosis, chlamydial pneumonias, infective endocarditis, legionnaires disease, mycoplasma infections, pneumonia, Cox-iella burnetii infection, Francisella tularensis infection, Q fever, tuberculosis, tularemia, typhoid fever, and all atypical pneumonia. 

An electrocardiogram, chest radiograph, and echocardiogram are commonly performed. Echocardiography to determine the presence of valvular vegetations plays a key role in the diagnosis of infective endocarditis it should be performed in all suspected cases. 

Thrombotic thrombocytopenic purpura is a rare acute or subacute disease in adults, rather similar to the hemolytic uremic syndrome in children, in which there is systemic malaise, fever, skin purpura, renal failure, hematuria and proteinuria. Hemorrhagic infarcts caused by platelet microthrombi occur in many organs in the brain they may cause stroke-like episodes (Matijevic and Wu 2006) although more commonly there is global encephalopathy. The blood film shows thrombocytopenia, hemolytic anemia and fragmented red cells. The differential diagnosis includes infective endocarditis, idiopathic thrombocytopenia, heparin-induced thrombocytopenia with thrombosis, systemic lupus erythematosus, non-bacterial thrombotic endocarditis and disseminated intravascular coagulation. 

TABLE 1 09—3. Diagnosis of Infective Endocarditis According to the Modified Duke Criteria... 

Culture negative endocarditis—Describes a patient in whom a clinical diagnosis of infective endocarditis is likely, but blood cultures do not yield a pathogen. 

Gratz S, Raddatz D, Hagenah G, Behr TM, Behe M, Becker W (2000) " Tc-labelled antigranulocyte monoclonal antibody FAB fragments versus echocardiography in the diagnosis of subacute infective endocarditis. Int J Cardiol 75 75-84... 

Arnett EN, Roberts WC. Valve ring abscess in active infective endocarditis. Frequency, location, and clues to chnical diagnosis from the study of 95 necropsy patients. Circulation 1976 54 140-145. 

There are a number of nonspecific laboratory tests that are useful to support the diagnosis of infection. The inflammatory process initiated by an infection sets up a complex of host responses. Activation of complements, such as C3a and C5a, initiates inflammation and sets off a cascade of changes and the subsequent release of mediators, all of which can be measured and monitored. Serum complement concentrations, particularly C3, usually are consumed as part of the host defense mechanism and subsequently are reduced during the early stages of an acute infectious process. Acute-phase reactants, such as the erythrocyte sedimentation rate (ESR) and the C-reactive protein concentration, are elevated in the presence of an inflammatory process but do not confirm the presence of infection because they are often elevated in noninfectious conditions, such as collagen-vascular diseases and arthritis. Large elevations in ESR are associated with infections such as endocarditis, osteomyelitis, and intraabdominal infections. ... 

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