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63 感染性心內膜炎之診斷標準中，下列那一項符合 Duke criteria 之 major criteria？
(A)血液培養二套皆為 E coli
(B)血液培養二套皆為 Acinetobacter spp.
(C)血液培養二套皆為 Klebsiella pneumoniae
(D)血液培養二套皆為 Streptococcus bovis
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統計： A(4), B(12), C(2), D(30), E(1) #1065301
統計： A(4), B(12), C(2), D(30), E(1) #1065301
詳解 (共 2 筆)
Chris
#4058943
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JuiYi Hsu
#6226154
這是一題既送分又充滿陷阱設計的題目 所有HACEK organisms 開頭的全都是陷阱
Streptococcus bovis放在(D)選項，是典型的
其他選項都是HACEK的開頭，但是都是陷阱
(A) 血液培養二套皆為 E coli→Eikenella corrodens腐蝕艾肯氏菌
(B) 血液培養二套皆為 Acinetobacter spp.→Aggregatibacter actinomycetemcomitans放線共生放線桿菌
(C) 血液培養二套皆為 Klebsiella pneumoniae→Kingella kingae金氏金氏菌
Major criteria
①兩套blood culture培養出典型引起感染性心內膜炎的細菌，其中包括HACEK Group的細菌
②心臟超音波檢查見到心臟瓣膜上有oscillating mass
Viridans streptococcus草綠色鏈球菌(口腔常在菌：蛀牙)
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但是其實這題題目是可以申覆成為送分的
因為沒有說是 typical的話
Terminology used for diagnostic criteria for infective endocarditisa (Modified Duke's Endocarditis Service)
Major criteria
l A positive blood culture for infective endocarditis as defined by the recovery of:
- A typical microorganism from two separate blood cultures in the absence of a primary focus (viridans streptoccoccibS. bovis, HACEK group, or community-acquired S. aureus or enterococci)
or
- A persistently positive blood culture defined as the recovery of a microorganism consistent with endocarditis from either blood cultures drawn more than 12 h apart or all three or a majority of four or more separate blood cultures with the first and last drawn at least 1 h apart.
or
- Single positive blood culture for Coxiella burnetii or phase I IgG antibody titer greater than 1:800
可以用第二點，只要持續長A persistently positive blood culture defined as the recovery of a microorganism consistent with endocarditis from either blood cultures drawn more than 12 h apart or all three or a majority of four or more separate blood cultures with the first and last drawn at least 1 h apart.相隔12小時以上長同一套，或者4套中有至少三套長同一套and第一套跟四套相隔1小時以上。
也還是符合major criteria
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