2. 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)
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3. 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
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4. 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…)
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5. Infective endocarditis
Rx:
Strep: IV benzylpenicillin + gentamycin
Staph: IV flucloxacillin + gentamycin
Also: supportive care and consider surgery (valve replacemnt); treat complications (e.g. embolisation)
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6. (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
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7. 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)
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8. 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
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9. 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?

10. 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