Patient usually come recurrent history of fever, tired, night sweat, athralgia, weight loss. May or may not have history of rheumatic history. Sign: splinter heamorrhage, janeway lesion, osler node, roth spot (heamorrhage, pale at the centre), splenomegally.
duke's criteria: ( 2 majors, 1 mojar and 3 minors or 5 minors)
Major Criteria:
a) positive blood culture (3/4 consequtive blood culture, typical organism
b) positive echo finding (new murmur, vegetation
Minor Criteria:
1) risk factor: IVDU, prosthetic valve, rhematic fever.
2) fever 38'C
3) evidence of vasculitis lesion: (splinter heamorage, optic??,JL)
4) blood culture that not meet criteria
5) echo finding that not meet criteria
Investigation:
FBC, renal function, blood culture, ESR, urine (microscopic heamaturia), echo, ECG, TB workup (if suspected),
complication:
a) emboli
b) CF, heart block.
management:
abx (4-6w)
strep : penicillin G and iv gentamicin. staphy (cloxacillin or vancomycin), culture negative of native valve: (penicillin G and Iv gentamiccin)
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