Infective endocarditisDownloads

A 27-year-old man who recently emigrated as a refugee from Somalia presents with fever, weight loss, fatigue, and exertional chest pain. He says his symptoms began 3 weeks ago and that his appetite has decreased and he has lost 3 kg (6.6 lb) in the last 3 weeks. He denies any history of cardiac disease. His past medical history is unremarkable. The patient admits that he has always lived in poor hygienic conditions in overcrowded quarters and in close contact with cats. His vital signs include: blood pressure 120/60 mm Hg, pulse 90/min, and temperature 38.0°C (100.4°F). Physical examination reveals generalized pallor. A cardiac examination reveals an early diastolic murmur loudest at the left third intercostal space. Abdominal examination reveals a tender and mildly enlarged spleen. Prominent axillary lymphadenopathy is noted. Laboratory investigations reveal a WBC count of 14,500/μL with 5% bands and 93% polymorphonuclear cells. An echocardiogram reveals a 5-mm vegetation on the aortic valve with moderate regurgitation. Three sets of blood cultures are taken over 24 hours followed by empiric antibiotic therapy with gentamicin and vancomycin. The blood cultures show no growth after 5 days. Following a week of empiric therapy, the patient continues to deteriorate. Which of the following would most likely confirm the diagnosis in this patient?

A 24-year-old male is brought into the emergency department complaining of chills, headaches, and malaise for several days. He also states that he experiences shortness of breath when climbing two flights of stairs in his home. He admits to occasionally using intravenous drugs during the previous year. On exam, his vital signs are temperature 39.2° C, heart rate 108/min, blood pressure 124/82 mm Hg, respiratory rate 20/min, and oxygen saturation 98% on room air. A holosystolic murmur is heard near the lower left sternal border. An echocardiogram confirms vegetations on the tricuspid valve. What is the most likely causative organism of this patient's condition?