A quick graphic on Duke’s criteria
Although we often think of the atypical pathogens, pre-treatment with antibiotics is a major consideration for culture negative infective endocarditis
Although etiology will vary with geography/epi risk factors, some important considerations for BCNIE are below
Remember to expect HACEK organisms and nutritionally variant Strep to be identified even though they were previously listed under culture negative
A little more on thinking through strategy for BCNIE work-up.
AHA/IDSA Guidelines: https://www.idsociety.org/practice-guideline/endocarditis-management/
ESC Guidelines: https://academic.oup.com/eurheartj/article/36/44/3075/2293384
NEJM 2020 reference for chart below:
Switching gears to non-infectious:
Non-bacterial/marantic endocarditis can occur in any cancer, although pulmonary and pancreatic adenocarcinoma appear most common
NBTE results in sterile, friable vegetations which frequently embolize. In addition, there is less valvular destruction or valvular failure in these cases
A great review from this year on non-infective endocarditis:
There is no specific way to differentiate infective vs non-infective endocarditis, but here are some clues that may suggest one over the other
A great summary infographic when thinking about the combination of skin+eye infections
A little fun fact/trivia about fusarium in nature > Fusarium wilt!
The classic banana or canoe shaped conidia pictured below!
An important learning point is that Fusarium sporulates in vivo and can grow in blood cultures, unlike other hyaline molds
Some information on Fusarium in pts with hematologic malignancy
Thinking about Fusarium in the eye and difference between keratitis vs endophthalmitis
Closing with some info on treatment for Fusarium
Check out other graphics from the initial #IDFellowCase at this thread: