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Thursday, March 1, 2012

Osler’s Node of Infective Endocarditis

Posted by Dr Prahallad Panda on 8:12 PM Comments

Infective endocarditis, earlier termed as sub-acute bacterial endocarditis is an infection of valvular endothelium, the inner lining of heart valve; mostly was seen in damaged valves following Rheumatic Valvular Disease

English: Vegetation on tricuspid valve by echo...
Image via Wikipedia, Vegetations seen in ECHO
Here, the vegetations of bacterial colonies are seen on the endothelium, consequent upon entry of microbes through some route; commonly through dental procedures, artificial valve placement, Intravenous catheter placement and other procedures giving rise to bacterimia.
Though, not seen frequently now-a-days after use of rampant antibiotics for various diseases, some cases do occur.
The onset is with fever, chill, malaise, nausea, vomiting and dyspnoea; skin lesions like Osler’s node, Janeway lesion and Roth’s spots. It’s presentation also depends on the virulence of the organism.
Osler’s node and janeway lesions are hallmark of the disease.
osler's node
Osler’s nodes are small, painful nodules that appear on the palms of the hands and soles of the feet as well as the distal phalanges. They are between 2 mm and 15 mm in diameter, occasionally have a blanched center, are usually multiple, and transiently appear and resolve at different times over a period of days.
The Duke Criteria used to diagnose endocarditis may be fulfilled by the finding of 2 major criteria, 1 major and 3 minor, or 5 minor criteria. The major criteria include 2 positive blood cultures or evidence of endocardial involvement on echocardiography.
Minor criteria include predisposing factors, fever, vascular phenomena, immunologic phenomena, other microbiologic evidence (not meeting major criteria), and other echocardiographic findings (not meeting major criteria).
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