case study 4 bacterial endocarditis

8/3/2019 Case Study 4 Bacterial Endocarditis

http://slidepdf.com/reader/full/case-study-4-bacterial-endocarditis 1/13

f¾fnf°nf¾

¾ff¯f¯¯ff�°nf¯¯°�n°n¾f¾¾��¯

n°fnf°nf¾@¯¾n°½¾¾ff½nnn¾f¾°�n°�

¯ff¯°¾f�f°½nnn¾¯f°¾°�n°�fnf°�¾f

¾½ff° f° nnf�f¯ f fn ¾°¾¾ ¯f fn °¾��n°n n°n

ff�f°¾f°¯fff°f�¯°@f¾f�nf°¯°n¾

�@9-f½�¯f°°nf¾½fn°¾¾-$If¾f¾f�¾f

f¾f°f¾f�¾��f°fnf°f,¾f¾f¾�n°n©°½f°

- f�°�¯ �ff¾°f¯ �°nf¾

-$I f° °f �f °n¾f ¾ f¾ ° ̄°�f° n°� n°¾f° ¾ f¾f

n¾��f�©°½f°f°ffn¾��f¯¾¾°½n¾¾

°f¾f¾�f¾¾¾f°f¾f°f�¾¯¯f¾f°@9-f¯$f°

°½°n°¯°°¾In°°�¾¯nf°¾f�¾¯

¯�9f¯½°¯�9¯9%¾f©¾fnn°�ff¾¾

¯½¯�9f°½¯I9½°�-$I¯¾¾°If$%¾½°

f°$%¾°�J°f¾¾¾¾�°f�f$I¾¾n¯¯

f° f �f $I f¾n¯̄ + ½°� f ¯f °½½f nf°¾¾ nf °�¾°f°¾¾�f¯°¾�D;°°¾¾¯fff°¯½½nf

°¾°�f¯¾�¾f°n¾

¯¯¾ff° ,f°°�$�°°

nnf�f¯

° nnf�f ̄ ¾ f ¾ f ¾¾ ¾° f¾

nff¯°� ½n� f @½n ¾¯n

¯ f f° f ½f° f ¯f� f° °¾ °

ff° ½¾ °nnf�f ̄ f¾ n¾

¾ff°�f°¾ff¾f°

¾n¾�f

f�°¾¾$¯nfn°°¾

°n f¯¯°

�n°n

fnf°nf¾

¾n½°$¯f°°��f�°¾¾¯nf½¯

J° ¯¯° ¾¾¯ � ¾ f f°

¯¾f°ffn¾n¾¾nff¯¯°

�n°n@¾¾fn¯½¾ff¾¾¯

¾¾½n¾¾°¾°°�°�f°¯f°°�

½$$n¯$fn¾$f¯¯°

�n°n¯

310.9;003/4.,7/988,3310.94341903341900,798.,2-078.,0/9003/4.,7/:247900,798;,;08

1019:3970,90/03/4.,7/98.,3.,:804907.425.,94388:.,8,-44/.4902-482,3770:,70,79-0,9

,7792,;,;0/,2,047/0897:.943,3/3920.43089;00,791,:70



-f¾ff°¯°�

°f�f%n°n

-f¾f¾¾©nf°¾n¯¯°¾nf¾°¾f°

f ½n¾ ̄°�I ̄°� ¾ f ½¾nf ° f

¾¾°f½�n�©n°�°¾°fn°°¾

°�f�f¾°�¯¾¯fnf¯ 9�¾¾ nf¾ ° °f �°n° ¾¾°

fnn¯f° � f¾ ½n¾ ° n

f°¯f¾f°f°¯f

9¾nf�°°�¾f°n°nf½¾°f°

° ½f nn¯¾¾ ¯f ½°¾° ¯°f

f$½¾¾° °nf ½¾°f° f¾

��°f�ff°¾°°��¯¯°

¾¯½¯¾ f �°f �f� °f¾f f°f

½¾°¾¯°ff¾¾f°n¾

,nf°¾¯

¯½°%-f¾n

½%°f½¾°

,½%½¾¾@½O

9°n°

D¾¾@- ¯fn° ½nnf¾-ff°

f¾½° °f¾n°°� ½�° f°¾f °f

f� ¾�°f¾ f°f ½fn n¯f$¾ n

½° n 9 ½�n¯f n -¾ ,°

n¾°f�°n°�¾¾I¯fnf¾

D¾¾ @- ¾f °¾f f°�°f n° nfn¯ nf°°

n f¾ n°f f¾nf ¾¯ ¯¾n ½½f

¯f½f½f°¾�¾°�-¾f$�f¯f¾

D¾¾-$I f°¾n ½¯nf°n° f°¾f° f°¯n °f n¯½°° ¾°¾ ¾°¾¾ ¯

n9nnf¾°ffnnfff°f½f¯f°¾;@°f

½°�f°f¯f¾-I9¾¯°

Jf°°� ° fn ¾½ f½ f¾ ¯f ¾°°� �

f°�°f nf° ¾ D¾¾ @- f°�°f , n° f

f°�nn½n

°f f¯f $ fnnff ¾°¾¾ °¾¯°f

fnff°n¾½f¾¯

D¾¾ fn ̄f °nf¾ ½nf¾ ¾½ fn °�°¾

¯°°�¾ °¾½¾ ¾°$¾° ¾n °�n°¾ n°

fnn n nf ¾°¾¾½n¯¯¾ �f ̄ %+ %°

¾f½nnn¾½nnn-¯°°�¾¾½¾n¾ff°

f°f¾ %° fn¾ °f f� f�n °¾

°¾f°½¾ff¾¾

@f¯°$ °°°$

f½n½n¾

9f°f °° %9- ¾ �°� f ½¾° °f°¾



@9- ½f¾¾°� ¾f ½n¾¾ � f°� f° �¾° @ ½¾°

n¾ °°f �̄ f¾ f n°f° °°¾ ¾n f¾ ¾f¾

�n¾ f¯° fn¾ ½¾ f° ff¯°¾ ¾ nf f

½f°f°°%@9-f°°f¯%@-°

°�¾�°¾

D¾

%49,5,703907,3:97943%!8574;/0/0390

,8974390893,97,.983431:3.943,-0.,:8041,339077:5943398.4393:947-0.,:8098,-84759;0.,5,.9

825,70/(9,8-003:80/147.42,94805,90398,94:03907,100/38:8:,570107,-0,3/0885743094

.425.,9438!,703907,3:9794383/.,90/94570;03990,/;07800110.98412,3:9794335,903984,70:3,-094

4-9,3,/06:,903:970398-47,4703907,74:908(

,�

%057010770/2094/41/0;073!89,20/.,

31:8435:2589070-,413:9703984:943-09003

2,3/8574;/0/%05:2531:808,82,,24:399427.4393:4:8347/079400590;034503

00/38.0/:08;,7-:9430.42243702037,258:5903:979434;074304:70;08411907,90147,104:78

,3/9037,2589/434;07,13,4:7347/079482:,90,3472,209,-4.7085438070802-320,920%884:/

-0/4304;07944:787,9079,33907299039/:7390/,

743.!850714720/974:,.0397,397,;034:8.,90907:8:,974:908:-.,;,347 ::,7;039

90954190.,90907,9908:50747;03,.,;,94:90390739079,97:234907.4224357,.9.0894:80,

!30.473,908390,72,3/0903/8944304190.0397,;0388:.,8908:-.,;,399095390

8:50747;03,.,;,331,3988420920890:2-.,;038:80/

,990754070/,2-:,94731:8435:258.,3-0:80/9

.743.!5,90398&8:,905:25,3/,82,2 -,413:970399400590;034503,70.,770/3,82,

-,,74:3/90,8947439084:/07:95,9039%! 57,.9.08,7089-0370130/-:9,;0-003:80/1470,78

!,90398.,370.0;0902,4794190731:84380908005,3/38905,733907.,9090780390,70/430

9482:,90,24703472,10890411905:259950350/,47!,703907,*3:97943



ff¾¾

¯

,989

%0,8.09,-4.!,30!8,1706:03947/070/ 5,3041908989,9;084:7/4.94725479,3931472,943

,-4:990.:7703989,9:8414:7/308-44/8:,7,3/00.97490,3/,./-,80-,,3.0-3472,708:98,3/

0850.,.42-3,943841,-3472,708:98.,33/.,90, 574-029,9300/894-0,//70880/%0!8,74:541

850.1.908989,9,;0-003,5574;0/3,20/,3/,8830/,!%.4/0,:77039!74.0/:7,%0723443:2-07,8,

5,30-0/.,70$3.0902,4794138:7,3.0.425,308,84:8090803,208,3/!%.4/083907.,2574.0883

9874:534190898,8-0.42089,3/,7/0/974:4:990

&390/$9,908

%0!3.:/08

O n¾

O fn¯

493.70,80/,3//0.70,80/0;08.,3-0831.,39

0.974908

O ¯O 9f¾¾¯

O %nf°nf°f

O

%0.43.0397,94384184/:2,3/549,88:2,7099

70:,90/-90-4/,8890-,,3.0-090039014:7240.:080.97490,3/,./-,802-,,3.08.,3-0 57080399,/0;,70941,.:90,3/.743.308808

47/0,3/90898,707,7047/070/-90280;08

/30%0898

O D-%f°�°

O f°°

&,3/.70,9330,70,890574/:.9819070/4:94190 -44/-90/3083.70,80/.43.0397,9438390-44/

2,3/.,90,902547,747.743./0.70,803/30



1:3.9430334947/070/,85,794190!90,7089

:8:,47/070/940907

038947/070/

%0!84190347/070/3904859,020703.7442

80993-0.,:8098.425430398;0/4.947825479,3931472,943,-4:990.:7703989,9:8414:7/30800.97490,3/,./-,80-,,3.0-44/8:,7,3/.,.:2

0;08$31.,39.,308390809089708:98.,33/.,90,.:90574-0288:.,8/301,:7038:384.47

/,-09..42,70857,947/897088470,79792.,308

%090892,-047/070/034:8004:7/4.947147,74:9300,90,2

995,-90898433047:3/0789,3/3,3,908-259,-,3.0

9f½¾�

°nf¯¯°�n°n

039022:30889029390-4/89,798,99,.3-44/;0880870/-44/.08

.4330.9;0988:089003/4.7308890290/089;088902307;08,3/2:8.043989390-4/9801289,390294-0,970,99490-4/98.43/94388,/94089%0

82594284198/847/07;,7174250784394507843,898/11.:9948,9,93903899022:308890289,79,99,.3

0398/847/07809839022:30889028-:8,99,.39843.08,3/4190309890

4907,721:1,.94785,88974::38.,90/%81:79070,03890-4/,8934,894/0,92,32470/80,808,3/,20398,80:09498.42-3,94341970,98,/847/07

41983,9:70.,380;070/0-9,90,33/;/:,,3/.,:80,4941/,2,04;0790.4:78041920

%0.,:8084198/847/07.,3349-0343,..:7,90,3/,88:.9070,70,;,70941.,:808

.20/.,0507988,0,/9490438094198/847/0798349,/80,8039801,3/207045038:590-4/949078412,34907,721:/80,808070,7084204190

.,:8089,90507988,2,0,/9498/847/07

O 070/9,7470309.8

O !703,3.

O .088;04/30O 309,3/897088

O 3;7432039,9438O 9073,;7:808

O 0,033419022:3088902/:0940.088;08:-89,3.0,-:80



O ,.418005007.80,3/,574507/09½$$n¯$fn¾$f¯¯°

�n°n¯

fnf°nf¾

,9.,:808310.9;003/4.,7/98

%0310.9439,90,/89403/4.,7/98.,3-0.,:80/--,.907,1:3474907

2.7447,38289,9039074:7-44/8970,24:2,,;00,7/909072-,.907,03/4.,7/988:-,.:90-,.907,03/4.,7/9847$%08090728,70:80/14703/4.,7/98

.,:80/43--,.907,:8:,74:589705,3/349-49072.7447,3828

472,2.7447,3828;0434:78334:724:934:739089308,3/34:7:73,797,.9-:934934:7-44/$420920840;072.7447,3828.,3039074:7

-44/8970,21470,250/:73,8:7.,47/039,574.0/:70

472489504502.7447,3828390-44/8970,2/43495480,574-02:91430414:7

0,79;,;08-0.4208/,2,0/4:7-4/803/822:30.085,90098,3/1-73,.49932,907,940,90;,;0%80,3574.088.,30,/9403/4.,7/981,32.7447,3828

34:7-44/8970,2-0.42097,550/:3/0790,078419080.08%097,553412.7447,38280,/89490/0;045203941.:25841988:093900,79,3/4390

0,798;,;08%080.:258,70.,0/;009,9438

'009,9438,70/,3074:8-0.,:8090.,3-70,411,3/0390790-44/8970,2%8574.0888.,0/02-4,94319002-4:890.:259,9-70,84118,70034:9.,3-4.,

-44/;0880%8-4.,0.,3849014414037.-44/945,798414:7-4/

48,978147/0;0453310.9;003/4.,7/98

4:,7024700940903/4.,7/9814:,70,/,;049070,79574-028474:,;0

0,79;,;0/,2,03/4.,7/9882470.422433504504/079,3,3/203,70,110.90/2470419039,34203

4:778147/0;045303/4.,7/9883.70,80/1

O ff¾f¾

O fffff½fn

O ffn°�°ff�n%ff�nf°

O f¯fn�¯fnf¾f¾f¾fnn¾nfff¾

O f½½nnf¯½f%°f�n°ff¾

O ff°°f°¾�¾

°nff¾f°¾ n°nf¾¾f°¾¾n¾¾f¯�°�°f

�°��¯ff¾�°¯½f°¾�¯½f¾f°°�¾f¾ff¾



¾¯½¯¾°fn¾f°¾f@nn¯�°f°n¾�¾f¾

-°°�n¾°nf¾%¯f°fn¾¾°¯°¾¾¯n½¾¯f¾¾¯fn�

nfn°¾°¯nn¾n¾

O @ff°°nffn�f¯¯¾�n¾f�°¾n¾�°�nf°n°

f¾nf°

½°¯�f¾½fnf�°°f�ff°nnf¾¾½n¯n¯¾¯¾f�

½f�°¯°n¾�°�nf°n%f½½¯f�nf¾¾nf½¯°f°nf°

�°�¾f°¾%¾°¾½f¯¾f°¾¾��%f°f¾°¾f¾°

n°©°nf¾°�f,n¯¾¯¾nf°¾½°�f°fff°nf½

f�¯¾¯¾f¾nf°nf¾nf�n¾@�¾ff¾°n¾¾fn°¾

°�n¾°nf¾°°�½f°¾½°n°�f�f½½nn¾

,9,70908259428

f°f¯½¯¾@¯¾¯½f°n°nf¾¯½¯¾�°nf¾f

�

n¾

½f�nfff¾nf°�°°�¾

¯n¯¾¯¾

°f�°°�

¾½°¯�f

14:,;0,.:9003/4.,7/9820,3390310.943,8,55030/70.0394:2,1000

4:,;0901:9,10;073980,982:8.0,.08,3/5,38,3//0.70,80/0307

14:,;0.743.03/4.,7/98.2,,89147243984:2,10010;078,3/.0/ -0;07970/48009,3/,;04395,33980,9847908259428410,791,:70

90782594282,3.:/070/8549843905,28414:7,3/8,3/908408414:71009.,0/,30,084384770/5,31:847084390958414:713078,3/9408.,0/8078

34/08

9f�°¾ �nf ¾½nnnf°¾f½nnn¯f°¯¾�° ½f�°¾nf¾°�

°nf¾°°nf¾nnn¾°f�nfff¾f°f�¯¾¾°�¾n

½¾¾�¾f�¾�f°¾¯¾�°nf¾f½nnn¾½¯¾

f½nnn¾f¾f¯°�f°¾n¯f½f�°¾°n°f¾f�¯¾f

fnf¾½n¯n¯½fff�°nf¾°°fff¾

@¯¾�°nf¾�°�fn¾°°nf¾¾½f°nf½½nf

n¯ff°°�°nf°¯¾fn½f�°¾� �½

%f¯½¾¾½n¾ n°fn¾¾½n¾ffn¯¾½n¾ °f¾½n¾f° °�f



¾½n¾f¾f¾nff°nf¾½f�°¾f�°ff°%;�

f¯ff°f°f%fnf¯ff¾½n¾nnf°°f�°¾¾�nf

48310.9;003/4.,7/98/,3480/

489/4.94788:850.9310.9;003/4.,7/9814:909024:78259428,3/14:,;0,894741.43039,0,79/80,8070:2,9.10;0747;,;0/80,804.94782,,844414782,/,7308:3/074:713073,89,944044/8539078.,0/853907

02477,0847-:789-44/;088083907093,414:7008.,0/#49885498

9,890948.450,/4.947.,38903944:7.08914790/893.984:3/41,300,79

2:72:747,.,3039084:3/41,34/0,792:72:70,792:72:78,70.,:80/-9084:3/411,:90,79;,;08,3/-.079,3/010.9834:70,79

44/8,25081742/1107039,70,8414:7-4/.,390/4.947814:,;02.7447,38283

4:7-44/8970,2%08,2508,705,.0/43,98.,0/,.:9:700709047,382.,3

74849,99.,3-0,3,0/,3//03910/

.4.,7/47,5.,3-0:80/94800;,;0897:.9:70,3/1:3.9430,79,24943,3/

4;07,0,7980%88-1,790248970,-0,94/,3480310.9;003/4.,7/98

9072,390.36:088:.,897,380845,0,0.4.,7/47,5%.425:90/

94247,5%8.,333,3/2,309.70843,3.02,3#2,-0:80/147,2470.425090/,3488479413/4:914:,;04907.425.,9438

48310.9;003/4.,7/98970,90/

0/.308.,0/,39-49.8.902.7447,3828,709017893041970,92039147310.9;003/4.,7/981;009,9438,;0/,2,0/4:70,79;,;084:2,300/8:707

Jf¾¾�°�nf°n�¾fn½°¾°½¾½¾¾f°

fnnff"

nf¾nffn½°fn¾°¾¾

Jf¾¾�°�nf°n�f¯°f°°¾¾¯ff©°½f°f°½nf"

½f½¾�nff¾¾�fn��¾¯½¯¾



f¯°f°°¾¾¯f°ff¯°f¯nnf°¾¯¾ff�¯�¯

fnf°f¾°¯nnn¾°f°¯¯°n¯½½¾°�¾¾

½$$©°f°¯f�°$©°f$$$

¯ff%�¯°½¾¯ff��¯f�°¯f¾�f¾nf

¾½°°°��¯ff¾¯°¯¯f°nf¾°�f¯¯f¯¯°�n

½n¾¾¾

n°½f°°�f¯¯f°�©°¯¯°n¯½½¾°�¾°¯

f¾f¯°f°�n¯$f½°¾©°

½f°¯+½f½¾�+�+©°+½f°+°+°nf¾nnn°�½

½nf¾½n̄ n¯¾¯¾ff�½f�°¯°n¾�°�nf°n°°nf¾%¾#¾

°¾©f°f¾°¾

¾¯°�ff¾�°¾f°¾¯½¯¾%$�¯f°

fn�"¾�¾¾¯¾�°°¾nf¾¾f°�¾�°¾f°¾¯½¯¾

#fn�n¯f°�fn��¾¾¯¾

°°f¯ff

¾½f½nn¾½f°

f¾°¾°f�½½ff°½f°

-�nf½f¾¾

½$$°¾°��n¯$°¾°�nf½f°$°¾°�°°°¾$°¾°�°°°¾�

°nf¾¯

@¯½f°f�°¾nnf�°�n¾°nf¾ff°¯f�f°nffn

¯¯¾½f°nf¾�fn¾�°½f½¾�nff¾¾�fn¾�°¾°°¾

nf¾¾



°¯fn°n°�n°¾�fnnf¾�f°¯f�n°n¾f¾¾°°°¾

f��n¾�n°n¾f¾¾°n¾@¾n°°¾nf¾f°¯�

nf°�¾°¾n¾@�¾½f°�n¾n¯¾¾½n°�

°n¾°°¯f¾¾°f°°¾¾fnf°°¾

¯f°n¾- f̄nn¾°�¯n¾f°¾¾¯f

°°¾°f°¯f�n°n¾f¾¾°nn°f¾f¾¾¾½°

n¾

½$$nfnf°nf$nf°°n°°°�f¾f¾½"¾f¾nf°°f°

nf¾¾n¾¯½¯f°¯f½¾¾�f¾�f°¾¯½¯¾f½½f

°¯°�$¯°½¾$$ ̄

ffn¯¯¾f¯¯¾fnf¾¾°��fff¾f°nf°�n¾

°f½$$f¾f�$$@½n¾$°$°nfn� ̄

°ff�f¯¾¾°#¾ff¾¾¾-f¯¯$%

¯¯$%¯¯$%D-¯�$%nf°°¯�$%

�n¾¯�$%�f¾°�J¾$n¯¯%n%,�

�$%,°�f¾ff°°°¯ff°�¾f°½f°f¾°

�fnf°¯fffn�ff¾¾f°¯f�¾½

°¯ff¾f°D-f°°�n¾¯fnf°¯�°

D-f°°f�f

f°°n°n°f�f

D-n°n°f�f

n¾n°n°f�fn°n°�n°



¯�°f°¯fnnf¾½°½n°¯n°n°f°¯¾¾

Jnfff%¾�n%¾nff¾¯�¯¾nf°¾¯¾nnff¾¯

nn"-f¯nnfff°¾f°�¯¾nnff¾¯nn¾°¾nf¾¾

f°°%¯�$nf¾�nffn¾f¾¾¾nf¾°f�f

�9f°f-°%9-¾¾n°ff¾¾°�n¾f°f°

"Jf¾�fn¾½n�f½�°�9-f°�f°f�½n

¾@¯°��n¾¾f�°¾f

9f°¾n°�9-°f¾�f�f�¾°f¾

½$$¯nf°$¾�$f¯f$9n¾$°°½n½�

J�n¾¯°°�¯½f°"

nf¾¾n°�@9-f°¾�n¾¾�

Jf¾�f¾¾�°�½n¾¾�f°f°f

¯°n¾½¯°"fnn¯½nf°�f¾¾¾ff¾

�¾¯½¯¾f½¯°�½½°�f½fnfn¯½nf°

fnfn°f¯°f°°�¾°�½fnf¯f°�n°

@D9

¾f¯ffff¾¾°f¾¾nf¯¾f¾�°�¯



°f�f¾°9-f°If°n¾@¯nff�°nf¾½¾°�nf¾

n°fn

n°f¾nf�½½ff°¾f°fn°�9

¾�¯½f°¾°¾°f¾¾¾¾°�¯fnf°¾

@D9

°ff¾f¾½½¾f°f°f�¾°fnf°�°n°f¾

nf�¾

°¾¾nf�@f°�½f°°fn°�f°nf¾

�f¾°�¾ff¾¾nf¾f°�f¯fn

nf°f¾f¾½½fffn°�½f°��f¯@¯nff�°nf¾

f½f°f°f°°%9-f¯f¾¾°°f°¾nf¾°n

f¯°¾¯°f¾f°½¾9-�¯f°¾n¯½nfnf°¾@9-f¯f¾nf�

�¯f°�9-�½f¯fnf¾f��%½°°�°nfff°�¯°¾

¾½¾½¾°�nf¾¾�fn¯f½f°@°�¾°n¾½ffnf¾¾¾

nf°°¾n¾¾°½¾¾°¾$f°¾¾

,909078

%0:8041.,909078320/.,57,.9.003,-080,81:/97,3810794/1107039,70,84190-4/38420.,808-:9:51:/2,300/947024;0/3490789:,9438,//31:/8830.088,7



%0.,90907895.,380790//70.93949083974:,40%00397,3.04190.,90907-0.4208,57208549147-,.907,2:95.,9434128.422:390841-,.907,9,9

,/07094,8:71,.0147243909:-01-,.907,749408:3.0.0/,3/:3970,90/-,.907,.,30390790-44/8970,2,3/.,:80574-028%0-,.907,.,30;032:95,3/-0.420,

4780574-02390-44/100/3438:,78390-44/5,82,..47/394788,2#,,/

,9903/07843,3.070390734:8943%0,85,903989.,9090789,9070709,30/-09003970,920398,/70,93.70,80/4//841,70.:77039147241-,.90702,

f ¯ ½$$¾°�n¯$fn$ffnf¾¾�fnf°

$fJI

°f½n¾@¯¾¯¯f°��°°¾�fnfJ°¾°¾°°

¯ f¾¾ nf¾ °¯f°n¯¯°°f ½n¾fnf nf°°f¾f¯f°

nf¾ ½¯¾ ¾½nf ° ¯¯°n¯½ ̄¾ J° �¾¾°� ¯f° ½½ nf°

f¯¾ �¾¾ f° f �¯¾�fn °° °n¯nfnf

fnn¯f¾°°fn�¾¾nf°½f°f¾f�fnf°

¾f¯°fff¾¾

f ¯ ½$$¾°�n¯$fn$ffnf¾¾�fnf°

$fnO

case study 4 bacterial endocarditis

Documents