blank1

Staphylococcal Endovascular Infection II

Infectious Endocarditis cont'd
Presenting symptoms/history	Laboratory/Diagnostic Information	Physical Examination	Endocarditis: Organ System Involvement

Endocarditis: Pulmonary Manifestations
Pleuritic chest pain; cough	Chest x-ray	Pleural Rub; crackles	Septic pulmonary emboli (right-sided endocarditis

Table of contents

Endocarditis: Renal Manifestations
Reduced urine output; Discolored urine (Brown, indicative of bleeding); flank pain	increased BUN (blood urea nitrogen); increased creatinine Pyuria right (pus in the urine) Hematuria (blood in the urine) Renal sonogram	Flank tenderness	Renal pathologies perinephric abscess Intrarenal abscess Renal artery emboli Immune-complex glomerulonephritis

Table of contents

Presenting symptoms/history

Laboratory/Diagnostic Information

Physical Examination

Endocarditis: Organ System Involvement

Endocarditis: CNS Manifestations
Headaches Back pain Focal weakness	Head CT scan Spinal MRI (magnetic resonance imaging) Cerebral arteriogram Increased erythrocyte sedimentation rate	Papilledema Focal neurologic exam positive Babinski's sign hyperreflexia weakness Focal vertebral spinal tenderness	Epidural abscess Vertebral osteomyelitis Mycotic aneurysm (+/-hemorrhage) Cerebral emboli

*Positive Babinski's sign (Big toe fanning upon stroking the plantar aspect of the foot): The presence of a Babinski reflex in patients > two years old indicates damage in the corticospinal; Babinski's reflex may occur on one side or on both sides; abnormal Babinski's reflex may be temporary.

Other causes include: generalized tonic-clonic seizures, amyotrophic lateral sclerosis, brain tumor, head injury, familial periodic paralysis, meningitis, pernicious anemia, hepatic encephalopathy, poliomyelitis, rabies, spinal cord injury, spinal cord tumor, stroke, syringomyelia, tuberculosis (spinal)

Table of contents

Endocarditis: Gastrointestinal Manifestations
Abdominal Pain	Abdominal sonogram, CT scan	Focal abdominal tenderness Hepatomegaly Splenomegaly	Splenic abscess Intestinal artery embolism (ischemic bowel) Hepatic abscess

Table of contents

Presenting symptoms/history

Laboratory/Diagnostic Information

Physical Examination

Endocarditis: Organ System Involvement

Endocarditis: Skin/Miscellaneous
Rashes Focal lesions (painful) Visual abnormalities	Skin Biopsies (rashes)	Janeway lesions (hemorrhagic, painless macules on palms and soles); Splinter hemorrhages (nail beds) Petechiae Osler's nodes (painful modules) Roth spots (funduscopic examinations)	Septic emboli Immune complex vasculitis

Fever
Chills
Malaise
Night sweats
symptoms may be acute/chronic/subacute

Positive blood cultures
Increased white blood cell count
Increased erythrocyte sedimentation rate
Increased rheumatoid factor

"Ill- appearing"
Fever
Tachycardia
Hypotension
Cardiac murmurs

Systemic
- Persistent bacteremia

Table of contents

Primary Reference: "Staphylococcal Infections", Deresiewicz, R.L., and Parsonnet, J., in Harrison's Principles of Internal Medicines, (Fauci, A., et al., eds) 14th edition, McGraw-Hill, 1998.
Primary Reference:"Infective Endocarditis", Zurawski, C.A. and Rimland, D., in Medicine for the Practicing Physician, Hurst, J.W., Fourth edition, Appleton & Lange, Stamford, Connecticut, pp 322-325,1996.
"Compiling the Identifying Features of Bacterial Endocarditis" Harris, G.D. and Steimle, J., Postgraduate Medicine, volume 107, No. 1, in January 2000
"Infectious Diseases", Bloch, K. C. in Pathophysiology of Disease, An Introduction to Clinical Medicine, (McPhee, S. J., Lingappa, V.R., Ganong, W.F., and Lange, J.D., eds), 3rd edition, Lange Medical Books, McGraw-Hill, pp. 59-61, 2000.