Pearls from 10/5/21 Medicine LEADS

The October 05, 2021, session of Duke Medicine LEADS was presented by Joshua Parsons, MD; Ryan Anderson, MD; Vanessa Blumer, MD; Cary Ward, MD,PhD; and Arthur Baker, MD on "A Challenging Case of Endocarditis— Multi-Disciplinary Approach is an Achievable Chimera."

Here are pearls and takeaways from the session:

  1. Culture negative endocarditis accounts for 20% of infective endocarditis and should be considered based on patient risk factors and exposures, including timing of administration of antibiotics. Consideration should be given to optimal collection of blood cultures which may need special growth requirements and longer duration to detect culture growth. Additional serologic testing for culture-negative etiologies, should be pursued.
  2. Karius testing is a non-invasive peripheral blood test that can detect over 1000 pathogens using microbial cell-free DNA, but does not have clear evidence-based indications for use at this time.
  3. Mycobacterium chimaera (M. chimaera) is a non-tuberculous mycobacterium, most commonly associated with disseminated infection in immunocompromised hosts. M. chimaera has been related to exposure to heater-cooler units used during cardiopulmonary bypass and can be an infectious trigger for secondary hemophagocytic lymphohistiocytosis (HLH) .
  4. H-score can used to to assist in the diagnosis of HLH early in disease course. H-score takes into consideration immunosupression, temperature, laboratory values, bone marrow findings and organomegaly. Ferritin levels can help guide decision for cessation of outpatient HLH treatment, but patients may be at risk for subsequent secondary HLH triggered by unique antigens. 

Watch the recorded session

Duke Medicine Learning, Education, and Discussion Series (LEADS) takes place each Tuesday at 12 p.m. Learn more and see schedule of upcoming sessions.