PAINE #PANCE Pearl – Infectious Disease



Question

 

To weave a common theme this week between this post and Wednesday’s eponym:

  1. What are the HACEK bugs?
  2. What disease are they associate with?
  3. Why are they important?


Answer

 

The HACEK pathogens is an acronym for the fastidious, gram-negative bacteria that are implicated in 5-10% of infective endocarditis cases. The bugs are:

  • Haemophilus species
  • Aggregatibacter species
  • Cardiobacterium species
  • Eikenella species
  • Kingella species

 

These pathogens are normal oropharyngeal flora, but can take up to 14 days to grow in the laboratory and are often referred to as
culture-negative” endocarditis cases.  It is important to discuss with your lab if you are worried about HACEK pathogens so they can plate the blood cultures on the appropriate agar plates and keep past the typical 3-5 days if there is no growth.

 


References

  1. Sharara SL, Tayyar R, Kanafani ZA, Kanj SS. HACEK endocarditis: a review. Expert review of anti-infective therapy. 2016; 14(6):539-45. [pubmed]
  2. Chambers ST, Murdoch D, Morris A, et al. HACEK infective endocarditis: characteristics and outcomes from a large, multi-national cohort. PloS one. 2013; 8(5):e63181. [pubmed]
  3. Yew HS, Chambers ST, Roberts SA, et al. Association between HACEK bacteraemia and endocarditis. Journal of medical microbiology. 2014; 63(Pt 6):892-5. [pubmed]
  4. Wassef N, Rizkalla E, Shaukat N, Sluka M. HACEK-induced endocarditis. BMJ case reports. 2013; 2013:. [pubmed]

Ep-PAINE-nym



Duke Criteria

 

Other Known Aliasesnone

 

Definitionradiographic, laboratory, pathologic, and clinical criteria to help establish the diagnosis of infective endocarditis and (similar to the Jones Criteria) there are major and minor subtypes:

  • Major
    • Two positive blood cultures (drawn 12 hours apart) with typical endocarditis pathogen
      • Viridans-group streptococci
      • Streptococcus bovis
      • HACEK group
      • Staphylococcus aureus
      • Community-acquired enterococci
      • Coxiella burnetii
    • Evidence of endocardial involvement with positive echocardiogram showing:
      • oscillating intracardiac mass
      • Abscess
      • partial dehiscence of prosthetic valve or new valvular regurgitation
  • Minor
    • known cardiac lesion or IVDU
    • Fever > 38°C
    • Evidence of septic emboli
    • Immunologic phenomenon: glomerulonephritis, Osler’s nodes, Janeway lesions, conjunctival hemorrhage
    • Positive blood culture  or laboratory evidence of organisms not described above

 

Clinical Significancea diagnosis of infective endocarditis is made with 1 major and 1 minor, or 3 minor criteria

 

History – Named after the Duke Endocarditis Service, which established these criteria with their seminal paper entitled “New Criteria for the diagnosis of infective endocarditis” in 1994.  The group sought to improve upon the older von Reyn criteria and increase the specificity, so as to not miss cases and have potentially catastrophic cardiac complications later.  These criteria were further validated several times throughout the 1990s and modified in 2000, which is the current set we use today.

 


References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  5. Up To Date. www.uptodate.com
  6. Durack DT, Lukes AS, Bright DK. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Duke Endocarditis Service. Am J Med. 1994; 96(3):200-9. [pubmed]
  7. Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clinical infectious diseases : an official publication of the Infectious Diseases Society of America. 2000; 30(4):633-8. [pubmed]

Ep-PAINE-nym



Jones Criteria

 

Other Known Aliasesdiagnostic criteria for acute rheumatic fever

 

Definitionclinical criteria to help diagnose acute rheumatic fever.  There are divided into major and minor criteria as follows:

  • Major
    • Polyarthritis
    • Carditis
    • Subcutaneous nodules
    • Erythema marginatum
    • Sydenham’s chorea
  • Minor
    • Fever
    • Arthralgia
    • Elevated ESR or CRP
    • Leukocytosis
    • 1st degree heart block

Clinical Significancea diagnosis of acute rheumatic fever is either two major or one major and two minor criteria

 

History – Named after T. Duckett Jones (1899-1954), an American cardiologist who received his medical doctorate from the University of Virginia in 1923.  With a keen interest in rheumatic fever and heart disease, he practiced at Massachusetts General Hospital and House of Good Samaritan in Boston for over 20 years.  He became the medical director of the Helen Way Whitney Foundation to pursue his passion for public health, which led to one of the first tweleve appointments to the National Advisory Heart Council in 1948.  He published his seminal paper entitled “The Diagnosis of Rheumatic Fever” in JAMA in 1944 which described these findings.  Dr. Jones unfortunately died as a result of malignant hypertension in 1954 at the age of 55.

First page PDF preview

 


References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  5. Up To Date. www.uptodate.com
  6. White PD.  T. Duckett Jones, 1899-1954.  Circulation.  1955.
  7. Shulman ST. T. Duckett Jones and his criteria for the diagnosis of acute rheumatic fever. Pediatric annals. 1999; 28(1):9-12. [pubmed]
  8. Jones TD.  The Diagnosis of Rheumatic Fever.  JAMA. 1944;126(8):481-484 [article]

PAINE #PANCE Pearl – Pulmonary



Question

 

57yo man is referred to your practice due to an incidental 1.1cm single pulmonary nodule found on computed tomography.  He is a never smoker and denies any known family history of lung cancer.  He has no pulmonary medical history and reports no pulmonary symptoms.

 

Image result for single pulmonary nodule ct

 

What is the next step in the management of this patient?



Answer

 

  1. The first step in the management of this patient should be investigate if there are any previous studies to compare.  This will allow us to be able to assess if any growth has taken place.  For this patient, there are no previous studies to compare.
  2. The next step would be assess malignancy risk since it is larger than 8mm.  Up to Date uses the Brock University Cancer Equation, which I happen to like as well, though there are several out there and all use clinical, historical, and radiographical criteria.
  3. Our patient has a predicted malignancy risk of 3.54% and using the below algorithm, this patient needs a follow-up CT scan in 3 months to evaluate growth.



References

  1. Gould MK, Donington J, Lynch WR, et al. Evaluation of individuals with pulmonary nodules: when is it lung cancer? Diagnosis and management of lung cancer, 3rd ed: American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2013; 143(5 Suppl):e93S-e120S. [pubmed]
  2. Callister ME, Baldwin DR, Akram AR, et al. British Thoracic Society guidelines for the investigation and management of pulmonary nodules. Thorax. 2015; 70 Suppl 2:ii1-ii54. [pubmed]
  3. McWilliams A, Tammemagi MC, Mayo JR, et al. Probability of cancer in pulmonary nodules detected on first screening CT. The New England journal of medicine. 2013; 369(10):910-9. [pubmed]
  4. Up-To-Date.  Diagnostic Evaluation of the Incidental Pulmonary Nodule.  2018.

Ep-PAINE-nym



Westermark’s Sign

 

Other Known Aliasesnone

 

Definitionfocal peripheral hyperlucency resulting from collapsed vessels distal to a pulmonary thromboembolism.

 

 

Clinical SignificanceOccurs as a result of oligemia of perfusion to the lung parenchyma and can be seen in up to 10% of patients with acute PTE.  Similar to Hampton’s Hump, it has a low sensitivity, but a high specificity

 

History – Named after Nils Johan Hugo Westermark (1892-1980), a Swedish radiologist who first described this finding in his 1938 paper entitled ” On the roentgen diagnosis of lung embolism”.  He was also an accomplished sailor and won a silver medal in the 1912 Olympics.

 

 


References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  5. Up To Date. www.uptodate.com
  6. Krishnan AS, Barrett T. Images in clinical medicine. Westermark sign in pulmonary embolism. NEJM. 2012; 366(11):e16. [pubmed]
  7. Radiopaedia.  Westermark Sign. https://radiopaedia.org/articles/westermark-sign-1
  8. Westermark N. On the roentgen diagnosis of lung embolism. Acta Radiol 1938;19:357‑72.

PAINE #PANCE Pearl – Pulmonary



 

57yo man is referred to your practice due to an incidental 1.1cm single pulmonary nodule found on computed tomography.  He is a never smoker and denies any known family history of lung cancer.  He has no pulmonary medical history and reports no pulmonary symptoms.

 

Image result for single pulmonary nodule ct

 

What is the next step in the management of this patient?