Bacillus cereus causing infective endocarditis (IE) in a native valve is an extremely rare event, but it is reported mostly in intravenous drug abusers and other risk factors as immunosuppression, malignancy, and valvular heart disease including prosthetic heart valves. We report a case of B.cereus native mitral valve infective endocarditis in a 58-year-old Sri Lankan male who is not a drug abuser who presented with painless hematuria with reduced urine output. During hospital stay, he developed frequent episodes of brief focal seizures. He had undergone multiple investigations that revealed splenic abscesses, cerebral vasculitis, and glomerular nephritis with positive rheumatoid factor, cytoplasmic antineutrophil cytoplasmic antibody (C-ANCA), and cryoglobulin. The appropriate antibiotic was the prime therapeutic intervention which carried an excellent prognosis. This case highlights an unusual organism in the blood culture that caused IE warranting thorough physical examination and investigations.

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Aims: Conventional clinical and laboratory parameters for the management of dengue haemorrhagic fever (DHF) were validated using ultrasound scan (USS) as the gold standard. Methods: Clinically suspected 184 patients with platelet count <100,000 were enrolled in the study. Results: USS evidence of leaking was observed in 48% of the sample. When Hct rises >10% and >20% were used as a predictor of leaking, sensitivity and specificity of 30%, 82% (PPV 60%, NPV 56%) and 11%, 94% (PPV 63% and NPV 54%) were observed. Liver tenderness and gall bladder wall oedema (wall thickness>6mm) had sensitivity of 28%, 91% and specificity of 83% and 94% as predictors of leaking. Haematocrit rise > 10% during any stage of critical phase associated with 94% sensitivity and 37% specificity (PPV 46%, NPV 92%) in prediction of complications. Conclusions: Rising HCT, liver tenderness and clinical detection were found to be weak predictors of onset of leaking. HCT rise was a strong predictor of complications during the leaking phase. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

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