01-02-2008, 04:44 PM
Infectious Disease Medicine:Question 8
A 54-year-old man is evaluated because of fatigue, backache, and intermittent fever of 3 months duration. He has no history of cardiac disease or drug allergies.
On physical examination, there are three splinter hemorrhages under his fingernails but no other abnormalities of his skin. Ophthalmologic examination reveals a right conjunctival hemorrhage. Funduscopic examination is normal. The lungs are clear. Cardiac examination discloses a soft diastolic murmur of aortic insufficiency, which is a new finding. There is no splenomegaly. Neurologic examination is normal. Four sets of blood cultures grow a microorganism of the viridans streptococci group, which is sensitive to penicillin. A transthoracic echocardiogram shows a thickened bicuspid aortic valve with evidence of mild aortic insufficiency. A transesophageal echocardiogram confirms these findings and also shows an oscillating mass on the aortic valve. Which of the following intravenous agents is the most appropriate initial antibiotic therapy for this patient?
A. Vancomycin for 4 weeks
B. Penicillin G for 4 weeks
C. Penicillin G plus gentamicin, both for 4 weeks
D. Penicillin G plus gentamicin, both for 6 weeks
E. Ceftriaxone for 8 weeks
A 54-year-old man is evaluated because of fatigue, backache, and intermittent fever of 3 months duration. He has no history of cardiac disease or drug allergies.
On physical examination, there are three splinter hemorrhages under his fingernails but no other abnormalities of his skin. Ophthalmologic examination reveals a right conjunctival hemorrhage. Funduscopic examination is normal. The lungs are clear. Cardiac examination discloses a soft diastolic murmur of aortic insufficiency, which is a new finding. There is no splenomegaly. Neurologic examination is normal. Four sets of blood cultures grow a microorganism of the viridans streptococci group, which is sensitive to penicillin. A transthoracic echocardiogram shows a thickened bicuspid aortic valve with evidence of mild aortic insufficiency. A transesophageal echocardiogram confirms these findings and also shows an oscillating mass on the aortic valve. Which of the following intravenous agents is the most appropriate initial antibiotic therapy for this patient?
A. Vancomycin for 4 weeks
B. Penicillin G for 4 weeks
C. Penicillin G plus gentamicin, both for 4 weeks
D. Penicillin G plus gentamicin, both for 6 weeks
E. Ceftriaxone for 8 weeks