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Infective Endocarditis — RACP Adult Medicine MCQ

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ModerateInfectious DiseasesInfective EndocarditisRACP Adult Medicine

A 45-year-old man presents with a 2-week history of fever, night sweats, malaise, and a new cardiac murmur. Blood cultures grow Streptococcus gallolyticus (bovis). Transoesophageal echocardiography confirms a vegetation on the mitral valve. What additional investigation is essential?

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Correct answer: E — Colonoscopy

S. gallolyticus (formerly S. bovis biotype I) bacteraemia and endocarditis have a strong association with colorectal neoplasia (adenomas and carcinomas). All patients with S. gallolyticus bacteraemia should undergo colonoscopy regardless of whether endocarditis is present. The association is with biotype I (S. gallolyticus) more than biotype II.

Reference: eTG – 2025 – Antibiotic Guidelines; ESC – 2023 – Infective Endocarditis Guidelines