SIGNS OF INFECTIVE ENDOCARDITISInfective endocarditis is a condition characterized by microbial infection of the endothelial surface of the heart, most commthe heart.

The diagnosis of endocarditis can be difficult but may be made by satisfying certain well- described criteria, including the presence of positive bloodcultures for typical causative microorganisms and evidence of endocardial involvement seen on echocardiography.

The physical signs of endocarditis are numerous and include heart murmurs, which are encountered frequently, and the peripheral signs of endocarditis,which are much less common. When uncertainty exists, the peripheral signs may be useful to support the diagnosis of endocardi

OTHER SIGNS

ROTH’S SPOTSRoth’s spots are named after Moritz Roth, who described white- centered haemorrhages on the funduscopicexaminations of patients with sepsis.PathogenesisThe currently accepted explanation involves anoxia that causes a sudden increase in venous pressure, whichresults in capillary rupture in the inner retinal layers. This rupture results in extravasation of blood and formationof a fibrin-platelet plug.

OSLER’S NODESOsler’s nodes are named after Sir William Osler, who described painful, erythematous nodules on the pads of thefingers and toes in patients with endocarditis.PathogenesisThese nodules are the result of septic micro emboli originating from an endocardial valvular lesion. Another theoryholds that the nodes are caused by an immunologically-mediated vasculitis caused by circulating immune complexdeposition in the skin.

JANEWAY LESIONSJaneway lesions are named after Edward G. Janeway, who described “numerous small haemorrhages with slightnodular character in the palms of the hand and soles of the feet . . . in malignant endocarditis.”PathogenesisThese lesions are necrotic micro abscesses with an inflammatory infiltrate that involves the dermis but not theepidermis. Some believe that the lesions are the result of septic micro emboli that originate from theendocardium.

SPLINTER HAEMORRHAGESSplinter haemorrhages were originally described as “minute petechiae at the side of the bed of a fingernail.”They are caused by engorgement of capillaries under the nail.Potential mechanisms include digital vasospasm, embolic events, and local factors that promote capillaryengorgement.

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A. PURPURIC RASHB. SEPTIC EMBOLI WITH HAEMORRHAGE

AND INFARCTIONC. MICROSCOPIC HEMATURIAD. CUTANEOUS PURPURA FULMINANSE. SUBCONJUCTIVAL HAEMORRHAGE

ENDOCARDITISInfective endocarditis is a condition characterized by microbial infection of the endothelial surface of the heart, most commonly involving the valves of

described criteria, including the presence of positive bloodcultures for typical causative microorganisms and evidence of endocardial involvement seen on echocardiography.

murmurs, which are encountered frequently, and the peripheral signs of endocarditis,which are much less common. When uncertainty exists, the peripheral signs may be useful to support the diagnosis of endocarditis.

DR.SANTOSH MAHALINGAM

centered haemorrhages on the funduscopic

accepted explanation involves anoxia that causes a sudden increase in venous pressure, whichresults in capillary rupture in the inner retinal layers. This rupture results in extravasation of blood and formation

Osler’s nodes are named after Sir William Osler, who described painful, erythematous nodules on the pads of the

endocardial valvular lesion. Another theorymediated vasculitis caused by circulating immune complex

Janeway lesions are named after Edward G. Janeway, who described “numerous small haemorrhages with slight

abscesses with an inflammatory infiltrate that involves the dermis but not the

riginally described as “minute petechiae at the side of the bed of a fingernail.”

Potential mechanisms include digital vasospasm, embolic events, and local factors that promote capillary

C.

PURPURIC RASHSEPTIC EMBOLI WITH HAEMORRHAGEAND INFARCTIONMICROSCOPIC HEMATURIACUTANEOUS PURPURA FULMINANSSUBCONJUCTIVAL HAEMORRHAGE