1) Does This Adult Patient With Suspected Bacteremia Require Blood Cultures?
A recent addition to the JAMA Rational Clinical Examination Series by several members of the Department of Medicine here at Mount Sinai has helped us to better answer the aforementioned age old question.
- The pretest probability of bacteremia varies considerably and is determined largely by the clinical context (including the presence or absence of an identifiable focus of infection).
- Blood cultures should not be ordered simply because isolated fever or leukocytosis is present in patients for whom the pretest probability of bacteremia is low.
- The SIRS criteria and Shapiro decision rule show promise in further defining low-risk patients but require prospective validation.
- The existing data do not allow generalization of these conclusions to immunocompromised patients or those under consideration for endocarditis.
2) HIV-associated Diarrhea
Today's discussion regarding HIV-associated diarrhea reminded me of a previous Rapid Fire Morning Report in which this exact diagnosis and its differential diagnosis was discussed. Clicking on this link will lead you to a previous post discussing this exact entity.
3) Heyde's Syndrome
Bleeding from angiodysplasia in the GI tract in patients with aortic stenosis has been called Heyde's syndrome. This is a well-known association, first reported by Dr. Edward Heyde in the NEJM in 1958, although the hypothesis of causality remains controversial.
The purported mechanism by which aortic stenosis may lead to the development of angiodysplasia is through the development of an acquired form of von Willebrand disease from mechanical disruption of von Willebrand multimers as they pass through a tight aortic valve, as well as from a vWF interaction with platelets that triggers platelet clearance.
