Infectious endocarditis: interdisciplinarity or dual responsibility?
© Lăzureanu et al; licensee BioMed Central Ltd. 2014
Published: 15 October 2014
Infectious endocarditis remains – due to its clinical polymorphism – a disease that is sometimes late diagnosed.
We present a man, 56 years, admitted in our department for tuberculous (TB) meningoencephalitis (history of pulmonary tuberculosis, symptoms: fever, dizziness, sleepy, difficulty in speaking and walking; in the CSF proteins=62.1 mg/dL, 17 lymphocytes/cmm, chest X-ray: nodular opacity in the upper left lobe, reticulo-nodular image bilaterally, pneumologist consult: pulmonary tuberculosis, secondary infiltrative nodular upper left lobe) with favorable evolution under treatment with: meropenem 2 g Q8h + category II 7/7 TB drugs. After 7 days from admission the blood culture tested positive for Streptococcus gallolyticus (BACTEC). The second cardiac examination revealed during transthoracic echography a 1.8 cm vegetation on the aortic valve. We switched to vancomycin 1g Q12h plus tuberculostatics. Cardiac surgery consult recommends 4 weeks of treatment with vancomycin and then probably surgical intervention.
The laboratory has a very important role in the diagnosis of infectious diseases. A close contact with cardiologists has to be established in order to have carefully investigated patients.
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