Infective Endocarditis

N C Joshi
Infective Endocarditis - Clinical Features
The classic tetrad of the clinical features of endocarditis is:
- Features of infection
- Features of heart disease
- Features of embolism
- Features of immunological disease

Fever (96-100 %) with rigors, sweats, lassitude, arthralgia, myalgia are features of infection. Splenomegaly is present in 60% of the patients and anemia in 100% of patients.

Majority will reveal signs of pre-existing valvar or shunt lesions (85%). The sudden occurrence of an aortic insufficiency or mitral insufficiency arises because of destruction of valve leaflets by the infected vegetations.

Finger clubbing may develop in acyanotic lesions or may already be present in cyanotic heart disease. Hepatomegaly and other signs of heart failure may be present.

Any child with unexpected embolism should be suspected as having endocarditis. The brain, kidneys, liver, spleen and bones are particular sites for emboli.

Many classic signs of endocarditis, which were previously thought to embolic, are now known to represent immunological phenomenon. The mechanism of these features is thought to be antigen-antibody complement complexes being deposited in tissues. These features are:
- Splinter hemorrhages, which are linear subungual hemorrhages present on finger and toes.
- Petechial lesions with pale centre, found in conjunctiva oral mucosa, dorsum of hands and the trunk.
- Osler's nodes: Uncommon in children. They are painful, small, red or purple raised lesions found on the pulp of the terminal phalanges of the fingers.
- Janeway lesions: They are flat, non-tender erythematous lesions on the thenar or hypothenar eminences.
- Roth's spots are while centered hemorrhages on the retina.
- A diffuse glomerulonephritis leading to microscopic hematuria with changes identical to proliferative glomerulonephritis.

Infective Endocarditis Infective Endocarditis 01/02/2002
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