Infective endocarditis — formative SAQs

Question 1 (12 marks)

A nine-year-old girl with a history of repaired tetralogy of Fallot presents with two weeks of low-grade fever, fatigue and anorexia. On examination she has a new harsh diastolic murmur. Three sets of blood cultures drawn before antibiotics grow viridans streptococci. Echocardiography shows a vegetation on the aortic valve. ^[1]

a) List the two MAJOR criteria of the Modified Duke criteria and state how this case meets the definition of definite endocarditis. (4 marks) ^[3]

b) Outline the principles of targeted antibiotic therapy for this child, including the duration. (4 marks) ^[1]

c) Describe two clinical findings that would prompt urgent surgical referral during her admission. (4 marks) ^[1]