A 29 years old presented in emergency department with high grade fever with rigor and chills and acute confusional state
A 29 years old presented in emergency department with high grade fever with rigor and chills and acute confusional state. Examination was notifiable for a GCS of 13/15. Temperature of 102 o F, heart rate of 130 beats per minute with regular pulse, respiratory rate of 28 per minute, diaphoresis, Grade 2/6 diastolic murmur at left lower sternal border heard on leaning forward and bibasilar crackles. ECG showed sinus tachycardia and chest x-ray showed vascular congestion and right sided alveolar infiltrates. Baseline labs were significant for TLC of 18000 (86% neutrophils), elevated CRP and creatinine of 0.6 mg/dl. Culture result as awaited: a) What is the most probable diagnosis? b) What is Osler’s Triad? c) What empirical antibiotic will you use? d) What is sensitivity and specificity of trans-esophageal echocardiography in this case and what are the possible expected findings? e) When will you consider surgical intervention? Answers: a. Infectiv...