Infective endocarditis (IE) is a microbial infection, implanted on a heart valve or on the mural endocardium after bacteremia or fungemia. It is characterized by fever, valvular destruction, and peripheral embolization. Acute IE is most commonly caused by Staphylococcus aureus, occurs on normal valves, is rapidly destructive, produces metastatic foci, and is fatal in < 6 weeks unless treated. Subacute EI is usually caused by Streptococcus viridans, occurs on damaged valves, does not produce metastatic foci, and takes >6 weeks (up to one year) to be fatal.
Characteristic lesions of IE are vegetations on valves or elsewhere on endocardium. Usually arises secondary to colonization by microbes of sterile vegetations composed of platelets/fibrin. Sterile vegetations represent nonbacterial thrombotic endocarditis; these form over areas of trauma to endothelium (intracardiac foreign bodies), in areas of turbulence (deformed valves), over scars, or in setting of wasting disease (e.g., malignancy with marantic endocarditis). Vegetations of IE then result from deposition of platelets/fibrin over bacteria, which forms a "protective site" into which phagocytic cells penetrate poorly. Clinical features result from vegetations and immune reaction to infection. With fungal IE, vegetations may be large, occluding valve orifice and forming large peripheral emboli. S. aureus can cause rapid valve destruction; healing forms scar, with resulting valvular stenosis or regurgitation. Abscesses may form in myocardium. Other complications include conduction abnormalities, fistulas, or rupture of chordae, papillary muscle, or ventricular septum. Vegetations can embolize to heart, brain, kidney, spleen, liver, extremities, lung, with resultant infarcts and abscesses. Circulating immune complexes may result in glomerulonephritis, arthritis, or various mucocutaneous manifestations of vasculitis.
* Night sweats (may be severe)
* Weight loss
* Muscle aches and pains
* Heart murmur
* Red, painless skin spots on the palms and soles (Janeway lesions).
* Nail abnormalities (splinter hemorrhages under the nails)
* Joint pain
* Abnormal urine color
* Red, painful nodes (Osler's nodes) in the pads of the fingers and toes
Joke and Humors
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