Differentiating NBTE from Infective Endocarditis No pathognomonic signs/symptoms or echo features that are specific to NBTE, and diagnosis can only be confirmed with demonstration of platelet thrombi on histologic exam. So high index of clinical suspicion is required for diagnosis! Features of Non-Bacterial Thrombotic Endocarditis (NBTE): • Predisposing conditions: Autoimmune (SLE/APLS), Malignancy, Hypercoagulable states • Clinical features: Fever -, Systemic embolism +++, Heart failure -(rare), Valve dysfunction + • Blood cultures/serology: Serial negative blood cultures • Echocardiographic features: Frequent false-negative results: vegetation may have already embolised, Vegetations often small (<1 cm), broad based and irregular in shape, Predilection for left-sided heart valves • MRI brain for cerebral emboli: Multiple, small disseminated infarcts Features of Infective Endocarditis: • Predisposing conditions: Underlying valve pathology, History of intravenous drug use, Central lines/indwelling catheters • Clinical features: Fever +, Systemic embolism +, Heart failure ++, Valve dysfunction +++ • Blood cultures/serology: + (Negative blood cultures in up to 30% of cases) • Echocardiographic features: Mobile mass of variable location, Valve destruction/dysfunction common, Aortic root abscess often seen • MRI brain for cerebral emboli: Usually single territory large infarct - Infectious Diseases Fellows Network @ID_fellows #NonInfective #Endocarditis #comparison #infective #NBTE #Marantic #diagnosis #table
