ABSTRACT

ABSTRACT

ABSTRACT

INTRODUCTION

ABSTRACT
Aorto-cavitary fistulae are rare complications of infective endocarditis. The diagnosis, in the absence of concomitant aortic valve disease, replacement of aortic valve with homograft or prosthetic valve, periannular abscess and negative blood culture, requires a high index of suspicion and has important prognostic and management significance. The sensitivity of the Modified Duke Criteria is challenged in this case report with a documented right sinus of valsalva fistula to the right ventricle seen on transthoracic echocardiography.

Patients with sickle cell disease are more susceptible to acute anaerobic osteomyelitis due to focal gut mucosal ischaemia, translocation of bacteria, and seeding in infarcted bone marrow. Modulation of the immune system is also present. The isolation of anaerobic organisms requires a high index of suspicion, correct specimen collection procedures and meticulous specimen handling. Bacteroides is the predominant organism isolated. Intra-osseous gas in the bone may be seen within four days and radiographs are therefore useful earlier than with aerobic osteomyelitis.