A 12-year old child, a known case of rheumaric hea disease, presents with low grade fever of 1 month duration. She has pallor, splenomegaly, clubbing and microscopic hematuria. The most impoant diagnostic test, you would like to do is
Correct Answer: Blood cutlure
Description: Ref: R Alagappan - Manual of Practical Medicine 4th Edition.pg no:162 Lab Diagnosis Blood Culture a. At least 3 blood culture samples and maximum of six blood culture samples to be taken. b. Each sample to be collected from different venipuncture sites and after 30 minutes to 1 hour gap (to demonstrate continuous bacteraemia). c. At least 10 ml of blood to be obtained for culture and diluted 10 fold in culture medium (l00 ml of culture medium). d. Culture to be done for both aerobic and anaerobic organisms. e. Yield of positive culture increased by observing them over 3 weeks and making periodic subcultures. f. Presumptive antibiotics to be staed immediately after obtaining culture samples. Negative Blood Culture in Infective Endocarditis 1. Infection with fastidious organisms (H. parainfluenzae, Brucella) 2. Anaerobic infection 3. Candida, Aspergillus, Histoplasma, Coxiella burnetii, Chlamydia psittaci endocarditis 4. Inadequate quantity of blood sample for culture or inadequate amount of culture media 5. Prior antibiotic therapy 6. Right sided endocarditis. 2D Echo * The smallest size of vegetation that can be picked up by echo is 2 mm. * Transoesophageal echocardiography is more sensitive in detecting vegetations in the aoic valve (90%) and mitral valve (100%) than transthoracic echocardiography.
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