Blood culture negative endocarditis

@npowah and @SAIRABT walked us through a case of 50F who p/w flank pain ➡️ found to have renal, splenic, and brain emboli on imaging ➡️final dx: marantic endocarditis


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:

https://www.nejm.org/doi/full/10.1056/NEJMcp2000400

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:

https://pubmed.ncbi.nlm.nih.gov/32376608/

There is no specific way to differentiate infective vs non-infective endocarditis, but here are some clues that may suggest one over the other

https://pubmed.ncbi.nlm.nih.gov/32376608/

Looking back, @A_Spallonii and @DocWoc71 discussed 2 Fusarium cases in different hosts during our September #IDFellowCase

A great summary infographic when thinking about the combination of skin+eye infections

There were two #IDWeek2020 cases of Acanthamoeba infection in the @PIDSociety Fellow Day (@hannawardellMD) and the @IDSAInfo Adult Fellows Day (@AxellHouse)!

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

https://cmr.asm.org/content/27/1/68

Check out other graphics from the initial #IDFellowCase at this thread:
https://twitter.com/ID_fellows/status/1300819786574770181

Originally tweeted by Infectious Diseases Fellows Network (@ID_fellows) on 21 October, 2020.

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