Prosthetic aortic valve endocarditis without evidence of vegetation
Introduction
The modified Duke criteria for the diagnosis of infective endocarditis (IE) include three major and five minor criteria. One of the major criteria is evidence of structural findings on echocardiography such as an oscillating intracardiac mass, abscess or partial dehiscence of a prosthetic valve (1-2). Less common echocardiographic findings of IE include pseudoaneurysm, fistula, or valve perforation. The American Heart Association (AHA) Valvular Heart Disease Guideline and AHA Scientific Statement list new valvular regurgitation as a major criterion (3). Valvular vegetation remains the pathologic hallmark of infective endocarditis. M-mode echocardiography, transthoracic …show more content…
He also had a history of complete heart block requiring implantation of a permanent pacemaker 4 years prior. He was admitted to the Cardiology service with a presumptive diagnosis of viral upper respiratory tract infection and to rule out infective endocarditis. Physical examination on admission revealed no focal cardiac, respiratory or abdominal findings. The patient was found to have clear lungs, with normal heart sounds and no murmur. Neurological examination revealed no focal deficits. There were no splinter hemorrhages, janeway lesions or osler nodes. Electrocardiogram demonstrated an AV paced rhythm with a rate of 96 beats per minute (bpm). Laboratory examination revealed mild leucocytosis, anemia and thrombocytopenia, in addition to mild troponinemia. A chest radiograph revealed no focal consolidation or pleural effusions. A Computed Tomography (CT) scan of the chest demonstrated clear lungs with no main pulmonary artery thrombus. A CT scan of the head revealed no acute intra-cranial haemorrhage or …show more content…
The most common causative organism of inefctive endocarditis is Staphylococcus aureus (15, 17), and typically causes aggressive infection leasing to poor outcome and complications such as local valvular destruction, diffuse septic emboli and persistent bacteremia (17). Risk factors for endocarditis include injection drug use, prosthetic heart valves, structural heart defects, and comorbidities, such as diabetes (16, 18, 19).
The Duke criteria, established in 1994 and revised in 2000, are a collection of major and minor criteria used to establish a diagnosis of infective endocarditis. Our patient met the Modified Duke criteria for infective endocarditis, despite the absence of vegetation. This included the presence of one major (two separate blood cultures over 12 hours apart growing MRSA) and three minor (predisposing condition, fever and vascular
Introduction
The modified Duke criteria for the diagnosis of infective endocarditis (IE) include three major and five minor criteria. One of the major criteria is evidence of structural findings on echocardiography such as an oscillating intracardiac mass, abscess or partial dehiscence of a prosthetic valve (1-2). Less common echocardiographic findings of IE include pseudoaneurysm, fistula, or valve perforation. The American Heart Association (AHA) Valvular Heart Disease Guideline and AHA Scientific Statement list new valvular regurgitation as a major criterion (3). Valvular vegetation remains the pathologic hallmark of infective endocarditis. M-mode echocardiography, transthoracic …show more content…
He also had a history of complete heart block requiring implantation of a permanent pacemaker 4 years prior. He was admitted to the Cardiology service with a presumptive diagnosis of viral upper respiratory tract infection and to rule out infective endocarditis. Physical examination on admission revealed no focal cardiac, respiratory or abdominal findings. The patient was found to have clear lungs, with normal heart sounds and no murmur. Neurological examination revealed no focal deficits. There were no splinter hemorrhages, janeway lesions or osler nodes. Electrocardiogram demonstrated an AV paced rhythm with a rate of 96 beats per minute (bpm). Laboratory examination revealed mild leucocytosis, anemia and thrombocytopenia, in addition to mild troponinemia. A chest radiograph revealed no focal consolidation or pleural effusions. A Computed Tomography (CT) scan of the chest demonstrated clear lungs with no main pulmonary artery thrombus. A CT scan of the head revealed no acute intra-cranial haemorrhage or …show more content…
The most common causative organism of inefctive endocarditis is Staphylococcus aureus (15, 17), and typically causes aggressive infection leasing to poor outcome and complications such as local valvular destruction, diffuse septic emboli and persistent bacteremia (17). Risk factors for endocarditis include injection drug use, prosthetic heart valves, structural heart defects, and comorbidities, such as diabetes (16, 18, 19).
The Duke criteria, established in 1994 and revised in 2000, are a collection of major and minor criteria used to establish a diagnosis of infective endocarditis. Our patient met the Modified Duke criteria for infective endocarditis, despite the absence of vegetation. This included the presence of one major (two separate blood cultures over 12 hours apart growing MRSA) and three minor (predisposing condition, fever and vascular