Infective Endocarditis: The Daily PANCE Blueprint

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Infective Endocarditis: The Daily PANCE Blueprint

A 32-year-old who injects drugs presents with fever, a new holosystolic murmur at the left sternal border that increases with inspiration, Osler nodes, and Janeway lesions; blood cultures grow gram-positive cocci in clusters. What is the most likely causative organism?

A. Viridans group streptococci
B. Enterococcus faecalis
C. Streptococcus gallolyticus (bovis)
D. Staphylococcus aureus
E. Coagulase-negative staphylococci

Answer and topic summary

The answer is D. Staphylococcus aureus.

In a person who injects drugs, endocarditis classically affects the tricuspid valve (right-sided – the murmur is louder with inspiration) and is most often Staphylococcus aureus, which also seeds septic pulmonary emboli; ‘gram-positive cocci in clusters’ confirms staph. Viridans group streptococci cause subacute disease on abnormal native valves after dental work; Streptococcus gallolyticus (bovis) links to colon cancer; enterococci follow GU or GI procedures; and coagulase-negative staphylococci favor prosthetic valves.

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Smarty PANCE Content Blueprint Review:

Covered under ⇒ PANCE Blueprint Cardiology ⇒ Traumatic, Infectious, and Inflammatory Heart Conditions ⇒ Acute and Subacute Bacterial Endocarditis

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