Mr. K.P. is a 71-year-old female, who presents to your office with a 3-day history of more than 103F with chills. The patient reports, “I don’t feel well, and I think that I may have the flu.” He also complains of “some painful bumps on my fingers and toes that came on last night.” He denies IVDA. When asked about recent medical or dental procedures, he responds: “I had an infected tooth removed about 2 weeks ago.” He does not recall receiving any antibiotics either prior to or after the procedure.
PMH:
Asthma since childhood
Rheumatic fever as a child x 2 with mitral valve replacement 2 years ago
HTN x 20 years
DM type 2, x 9 years
COPD x 4 years
H/O tobacco abuse
Alcoholic liver disease
Urinalysis: The urine was pale yellow, clear, and negative for proteinuria and hematuria. A urine toxicology screen was also negative.
ECG: Normal
Transthoracic ECHO: A 3-cm vegetation on the aortic valve was observed. No signs of ventricular hypertrophy or dilation were seen.
Blood Cultures: 3 of 3 sets (+) for Streptococcus viridans (collection times 1030 Tuesday, 1230 Tuesday, 1345 Tuesday)
Laboratory Blood Test Results
Na 135 meq/L
K 3.7 meq/L
Cl 100 meq/L
HCO3 22 meq/L
BUN 17 mg/dL
Cr 1.0 mg/dL
Glu, random 145 mg/dL
Hb 14.1 g/dL
Hct 40%
Plt 213,000/mm3
WBC 19,500/mm3
Neutros 80%
Bands 7%
Lymphs 12%
Monos 1%
Alb 4.0 g/dL
ESR 30 mm/hr
Ca 8.9 mg/dL
Questions
Which type of infective endocarditis is suggested by the patient’s clinical manifestations—acute or subacute? Explain your answer.
Which three of the illnesses in this patient’s medical history may be contributing to the onset of infective endocarditis and why are these diseases considered risk factors? Explain each of the factors.
What are the six diagnostic modified Duke University criteria that favor a diagnosis of infective endocarditis in this patient? Explain your answer.
Explain the pathophysiology of proteinuria and hematuria in a patient with infective endocarditis.
Identify four elevated laboratory test results that are consistent with a diagnosis of bacterial endocarditis. And explain the pathophysiology of the elevated values.
