Failed Thrombolysis in Massive PE — EECC MCQ

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HardPulmonary Vascular DiseaseFailed Thrombolysis in Massive PEEECC

A patient with prosthetic-valve endocarditis has repeatedly negative routine blood cultures. He has fever, splenomegaly, hepatitis and close occupational exposure to sheep at lambing. Which microbiological test is most important?

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Correct answer: D — Coxiella burnetii phase I IgG serology

The best answer is “Coxiella burnetii phase I IgG serology”. Coxiella burnetii is a classic cause of blood-culture-negative endocarditis, particularly with ruminant exposure, hepatitis and prosthetic material; high phase I IgG supports chronic Q-fever endocarditis. “A single throat swab for streptococcal culture” is less appropriate because a throat swab does not investigate this chronic intracellular pathogen “Urinary pneumococcal antigen testing” is less appropriate because pneumococcal antigen does not fit the exposure or culture-negative syndrome “Serum cryptococcal antigen alone” is less appropriate because cryptococcal testing is not the targeted investigation for this epidemiology “A stool culture for Campylobacter species” is less appropriate because Campylobacter stool culture does not address prosthetic-valve infection

Reference: 2023 ESC Guidelines for infective endocarditis. https://academic.oup.com/eurheartj/article/44/39/3948/7243107