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Questions and Answers
What laboratory findings are associated with inflammatory responses in infectious endocarditis (IE)?
Which imaging modality is noted for its lower invasiveness and cost when monitoring for valvular vegetations?
Which statement regarding the pathology of cutaneous manifestations of infectious endocarditis (IE) is true?
What is the significance of detecting vegetations larger than 10 mm in patients with infectious endocarditis?
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How are bacteria identified in cases where cultures cannot be obtained prior to surgery?
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Study Notes
Laboratory Testing
- Bacterial cultures are performed to detect bacteremia and guide antibiotic therapy.
- If unable to culture, removed valves can be cultured.
- Polymerase chain reaction sequencing and immunostaining techniques can help identify the organism.
- Erythrocyte sedimentation rate, C-reactive protein, antineutrophilic cytoplasmic antibody (ANCA), and rheumatoid factor elevation are laboratory findings.
- Anemia and red cell casts/pyuria on urinalysis are also indicative.
Pathology
- Histologic findings of cutaneous manifestations of IE are nonspecific.
- Clinical pathologic correlation of systemic symptoms and skin lesions with findings of extravasated red blood cells, fibrinoid degeneration of vasculature, karyorrhexis, and Gram-positive/negative organisms in microemboli on pathology are suggestive of IE.
Imaging
- An EKG baseline is necessary to monitor for changes in conduction that may indicate worsening disease.
- Echocardiography allows visualization of the valves and provides information about myocardial involvement.
- Transthoracic echocardiography is less invasive and less expensive than transesophageal echocardiography.
- When these imaging modalities are used in combination, valvular vegetations can be detected in the majority of cases.
- Other potential imaging studies include high-resolution cardiac CT and 18F-fluorodeoxyglucose positron emission tomography CT.
- Vegetations larger than 10 mm are associated with a greater embolic risk.
- Emboli to the CNS leads to stroke, brain abscess, and meningitis and can be identified with MRI.
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Description
This quiz covers critical aspects of infective endocarditis, including laboratory testing, pathology, and imaging techniques used for diagnosis. It delves into various diagnostic methods like bacterial cultures, EKG monitoring, and echocardiography, alongside relevant laboratory findings. Test your knowledge on the key identifiers and clinical correlations of this condition.
