Tag Archives: Infectious Disease

Endocarditis – 7/17/17

Risk Factors for developing Endocarditis

  • Dental procedure that penetrates the gums
  • Prior endocarditis
  • Prosthetic valves
  • IVDU
  • Immunosuppression

Common Organisms

  • Staph
  • Strep
  • Enterococcus
  • HACEK

Symptoms/Signs

  • Fever (most common)
  • Murmur
  • Splinter hemorrhages
  • Janeway lesions (non-tender erythematous macules on palms and soles)
  • Osler nodes (tender, subcutaneous nodules, on pads of fingers and toes)
  • Roth spots (exudative edematous hemorrhages in the retina)

Indications for surgical repair

  • New heart failure
  • Perivalvular abscess/extension
  • Conduction abnormalities
  • Persistent bacteremia
  • Prosthetic valves
  • Septic emboli
  • Large vegetation > 10-15 mm
  • Resistant organisms

 

 

 

AM Report 7/10/17 – Falciparum Malaria

  • Most dangerous form of malaria – highest number of deaths
  • Transmitted by the female Anopheles mosquito (females feed on blood, males feed on nectar)
  • Most commonly seen along in Southeast Asia, Latin America, and Africa
  • Two phases – liver and RBC phase
  • Symptoms:
    • Temperature paroxysms (alternating fevers and chills)
    • Headache
    • Diarrhea
    • Jaundice
  • Considered severe infection if evidence of end organ damage (Falciparum is sticky and can cause ischemia and infarcts as the RBCs get more viscous!)
    • Cerebral malaria – ischemia/infarcts in the brain
    • ARDS
    • Nephropathy
    • Hypotension
  • Physical exam findings:
    • Hepatomegaly (from the parasite replicating in the liver)
    • Splenomegaly (from the spleen taking up the damaged RBCs)
    • Pallor
    • Jaundice and scleral icterus
  • Diagnosis:
    • Thick and thin smears
      • Thick smears give a look at the RBCs in an overall sense to figure out if a parasite is present – are there parasites? If yes, look at thin smear.
      • Thin smears give a closer look at the TYPE of parasite – what type of parasite is it?
    • Rapid detection test – blood test which looks at enzymes on the various parasites to determine the type – only available at certain hospitals
  • Treatment:
    • Start immediately!
    • Determined based on the type of plasmodium, whether the malaria is severe or not, and whether the organisms are from an area with high resistance
    • Use 2-3 medications for treatment – consult ID immediately once you have a suspicion!
  • Prophylaxis
    • Given to anyone going to an endemic area – start a few weeks before travel, continue during travel, and continue for some time after returning depending on the medication
    • Wear long sleeves and pants
    • Use DEET