Infective endocarditis Ix: Bloods  CRP/ESR, FBC, U+Es… Blood cultures CXR *ECHO  TTE (transthoracic) or TOE (transoesophageal)* Serological testing (unusual organism suspected: coxiella burnetti) The Peer Teaching Society is not liable for false or misleading information…

Infective endocarditis What is the diagnostic criteria for IE? What is required for diagnosis? Duke’s criteria Definite IE diagnosis: either 2 major criteria + 1 minor criteria OR 1 major + 3 minors OR 5 minors Possible IE diagnosis: 1 major + 1 minor OR 3 minors The Peer Teaching Society is not liable for false or misleading information…

Infective endocarditis BE FEVEER (Duke’s criteria): Major: Blood cultures +ve >12 hours apart Evidence of endocardial involvement (ECHO) Minor: Fever ECHO Evidence from microbiology (+ve blood cultures not meeting major criteria) Evidence from immunology (Roth spots, osler’s nodes, glomerulonephritis) Risk groups (prosthetic valve, IVDU, valvular disease…) The Peer Teaching Society is not liable for false or misleading information…

Infective endocarditis Rx: Strep: IV benzylpenicillin + gentamycin Staph: IV flucloxacillin + gentamycin Also: supportive care and consider surgery (valve replacemnt); treat complications (e.g. embolisation) The Peer Teaching Society is not liable for false or misleading information…

(CAP) Pneumonia What? Causes? Atypical causes: Inflammation of parenchyma of the lung Two types: CAP (community) + HAP (hospital) Causes? Commonest: S. pneumoniae Others: staph aureus (secondary to influenza), viruses… Atypical causes: Chlamydia psittaci Mycoplasma pneumoniae Legionella pneumophila (SUMMER HOLIDAYS) Chlamydia pneumoniae Coxiella burnetti The Peer Teaching Society is not liable for false or misleading information…

CAP Pneumonia Ix: Clinical features: Sx: fever, productive cough, pleuritic chest pain, SOB, systemic features (hypotension)… Signs: abnormal vital signs (^RR…), unilateral signs of consolidation (dull percussion, reduced air entry on auscultation, crackles ± wheeze) Ix: Bloods (inc. CRP, ?ABG [resp failure]) CXR: opacity/consolidation of affected lobe Sputum sample + blood cultures Legionella: urinary Ag (if indicated by Hx) The Peer Teaching Society is not liable for false or misleading information…

CAP Pneumonia Give a complication of pneumonia? How do you assess severity of CAP? Why are they important? CURB 65: Confusion, urea (>7mmol/L), RR (>30/min), BP (<90mmHg), ≧65 Mild: 0-1 (outpatient) Moderate: 2 (hospital admission) Severe: 3+ (hospital admission + ?ICU) Rx: O2, analgesia (pleuritic pain), IV fluids Mild: PO amoxicillin Moderate: PO amoxicillin + clarithromycin Severe: IV co-amoxiclav + clarithromycin Give a complication of pneumonia? Empyema Lung abscess Assess severity and therefore need for hospitalisation + also guides treatment Clarithromycin = first line for legionairres; amoxicillin = first line for strep pneumoniae The Peer Teaching Society is not liable for false or misleading information…

CAP Pneumonia A 62 yo male presents to A&E with SOB and a productive cough, he is unsure where he is and who brought him in. O/E you find that he is pyrexial, has a blood pressure of 89/64 mmHg, RR = 34. His bloods show a raised WCC + neutrophil count, raised CRP and urea of 7.3mmol/L. What is his CURB 65 score? Severe: 4/6 Where would he be managed? Hospital (consider ICU) How would you treat him? (give routes where applicable) IV fluids, analgesia, oxygen Antibiotics: IV clarithromycin + co-amoxiclav This is what we got?

HAP Pneumonia What? Causes: Defined as 1new onset cough w/ purelent sputum, 2acquired 2 days or more after admission, 3CXR showing consolidation Causes: CAP organisms Also: staph aureus (+ MRSA), klebsiella pneumoniae, pseudomonas aeruginosa What antibiotic might you use if someone has a pneumonia causes by MRSA? Why? Vancomycin – it is broad spectrum