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Table 2 Further investigations available by the third day of admission

From: Group B streptococcus tricuspid endocarditis presenting with arthralgia in a postpartum woman: a case report

Microbiology

Haematology

Mid Stream Urine

No organisms

Blood film

Toxic granulation of neutrophils. No schistocytes seen

High vaginal swab

No growth

Dilute Russell Viper venom test (<1.2)

1.99

cervical chlamydia screen

Negative

Fibrinogen (2-6 grams/Litre)

9.1

Syphilis antibodies

Negative

D-dimer (<0.5 microgram Fibrinogen Equivalent Units/ml)

18.22

Antistrepsolysin O titres

Negative

C3 (0.75-1.75 grams/Litre)

1.36

Parvovirus IgM

Negative

C4 (0.14-0.54 grams/Litre)

0.07

Mycoplasma antibodies

1:320 milli-International

Bone marrow aspirate

Reactive and fibrotic changes only. No malignant cells

(<1:320 mIU/ml)

Units per millilitre

Blood cultures x 3

No growth

Ferritin (10-300 nanograms/millilitre)

738

Methicillin Resistant Staphylococcus Aureus nose and groin swabs

Negative

Direct Coombs test

Negative for anti IgG Weakly positive for anti C3b/d

Human Immunodeficiency Virus 1+2

Negative

 

Herpes Simplex Virus Polymerase Chain Reaction 1+2

Negative

Immunology

Biochemistry

Anti Nuclear Antibody

Negative

Total protein (60-80 grams/Litre)

46

Anti Neutrophil Cytoplasmic Antibody

Negative

CK (<167 International Units/Litre)

316

Anti double-stranded deoxyribonucleic acid (DNA)

Negative

Urine albumin/Creatinine ratio (<2.26 milligrams/millimole)

4.87

Rheumatoid factor (<20 International Units/millilitre)

<11 International Units/millilitre

LDH (<225 International Units/Litre)

314

IgG

10.3

 

(5.3-16.5 grams/Litre)

IgA

2.26

Radiology

(0.8-4 grams/Litre)

IgM

3.08

Computed Tomography head

Normal

(0.5-2.5 grams/Litre)

Urine Bence Jones protein

Negative

Ultrasound abdomen

Normal

Cardiolipin IgG

2.3

Computed Tomography abdomen

Distended uterus, in keeping with post-partum changes; otherwise normal.

(<10 anti-IgG phospholipid units/millilitre)

   
  1. Although a diagnosis was still lacking, results at this time pointed more toward severe sepsis than any other of our differentials.