8 Dec - Endocarditis

This AM - patient with a bioprosthetic valve in the aortic position presented with a few weeks of "flu like illness" and neck pain and muscle spasms.  Imaging of the neck was unremarkable but abdominal imaging revealed splenomegaly and probable splenic infarcts.  This constellation of findings is very worrisome for prosthetic valve endocarditis.  Cultures were noted to be positive for GPCs later in the day.

Prosthetic valve endocarditis is a challenging disease to treat, and difficult to cure without surgery.  PCN susceptible strains of streptococci respond better and may be treated without gentamicin with good cure rates,  Staphylococcal endocarditis requires the addition of gentamicin and rifampin and is more likely to require surgery. 

Culture negative endocarditis is a special case.  Most commonly, prior outpatient antibiotics are the culprit.  Always check blood cultures in patients who are at risk for endocarditis when they present with undifferentiated febrile illness.  This table helps narrow the choices in patients with culture negative endocarditis based on thier comorbid illness or other risk factors.