Patient Encounter Part 1

A 56-year-old man with a history of diabetes and coronary artery disease presents to the emergency department with complaints of weakness, fever, and chills. On interviewing the patient, you determine that he went to the dentist about 3 weeks ago and since that time has lost about 2.3 kg (5 lb). His current weight is 63.6 kg (140 lb). The patient reports that the symptoms began about 1 to 2 weeks ago. He denies any use of alcohol or illicit drugs but admits to smoking about half a pack of cigarettes per day.

What information would make you suspect infective endocarditis (IE)?

Does he have any risk factors for IE?

What additional information would you like to know before deciding on an empirical treatment for this patient?

Table 74-1 Etiologic Organisms of IE

Percent ah CAlrl

PVE < In (I.CA1 ed Jn Mtxil hi Aft e i IUDU (Rlghl-

Ntfln-Wtlwt IE Vil»» Surgery) and LoJt-Sidcd)

Table 74-1 Etiologic Organisms of IE

Percent ah CAlrl

PVE < In (I.CA1 ed Jn Mtxil hi Aft e i IUDU (Rlghl-

Ntfln-Wtlwt IE Vil»» Surgery) and LoJt-Sidcd)

Commir nily

Health care

OrganUifl

Acquired

Aswlltid

Le» Than 2

2-1 i

Than 12

Total

Slrcp toe ooci '

32

e

1

31

12

Enléroioctï

3-

16

fi

12

11

SrqjrfiytooMCiSiJirrfuj

35

■tib

H

Î2

19

57

CNS

a

IS

13

11

11

HAjC.EK group

Ë

Guam iwgativi.' b&illi

3

S

13

3

7

1 ungl KitDthria ipftj-

i

$

12

1

A

Polymicrobia I'miscella^eous

|

1

3

6

S

7

CuHuc'TH.'gitivr

5

S

S

6

S

i

(.Wi, îteptylDWCdt fi potÇfltKÇvMvi " (Mrrtiri.luci^, arxi HflpiififipMiij), fcttnobacNhji actinomycetenKomilans, Card'*obac<erkjm homimi, fi'fceneffo cofiodem, and KingeVa Hngae.

:lncludpi vindans group ureptocooci; i hrrfi ol her rongroup A. groupoble sKeptooacci: and nutritionally vanant sheplooocci.

(.Wi, îteptylDWCdt fi potÇfltKÇvMvi " (Mrrtiri.luci^, arxi HflpiififipMiij), fcttnobacNhji actinomycetenKomilans, Card'*obac<erkjm homimi, fi'fceneffo cofiodem, and KingeVa Hngae.

:lncludpi vindans group ureptocooci; i hrrfi ol her rongroup A. groupoble sKeptooacci: and nutritionally vanant sheplooocci.

' Melhfcxtn i«lstance Is common among 1heso S. autem strains.

f/rodifieci frsm Karchimer Ntf. Infective endocarditis. IH Fauci AS, ISraunwald F, liaspef IX, Hauss 5t,Longci Dl., iarreson JC Loscalicr JLeris. Harrêooi hir* hnrnil Mtdidnt i ?ih ttf. n™ vork; mî&îw MilL ïfloe:i.hj(j. 1 ie.

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