Osler Nodes
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Osler Nodes
Osler's nodes are painful, red, raised lesions found on the hands and feet. They are associated with a number of conditions, including infective endocarditis, and are caused by immune complex deposition. Their presence is one definition of Osler's sign. __TOC__ Causes Osler's nodes result from the deposition of immune complexes. The resulting inflammation, inflammatory response leads to swelling, redness, and pain that characterize these lesions. The nodes are commonly indicative of subacute bacterial endocarditis. 10–25% of endocarditis patients will have Osler's nodes. Other signs of endocarditis include Roth's spots and Janeway lesions. The latter, which also occur on the palms and soles, can be differentiated from Osler's nodes because they are non-tender. Osler's nodes can also be seen in * Lupus erythematosus, Systemic lupus erythematosus * Marantic endocarditis * Disseminated gonococcus, gonococcal infection * Distal to infected arterial catheter Etymology Osler's nodes ...
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Infective Endocarditis
Infective endocarditis is an infection of the inner surface of the heart, usually the valves. Signs and symptoms may include fever, small areas of bleeding into the skin, heart murmur, feeling tired, and low red blood cell count. Complications may include backward blood flow in the heart, heart failure – the heart struggling to pump a sufficient amount of blood to meet the body's needs, abnormal electrical conduction in the heart, stroke, and kidney failure. The cause is typically a bacterial infection and less commonly a fungal infection. Risk factors include valvular heart disease, including rheumatic disease, congenital heart disease, artificial valves, hemodialysis, intravenous drug use, and electronic pacemakers. The bacteria most commonly involved are streptococci or staphylococci. Diagnosis is suspected based on symptoms and supported by blood cultures or ultrasound of the heart. There is also a noninfective form of endocarditis. The usefulness of antibiotic ...
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Immune Complex
An immune complex, sometimes called an antigen-antibody complex or antigen-bound antibody, is a molecule formed from the binding of multiple antigens to antibodies. The bound antigen and antibody act as a unitary object, effectively an antigen of its own with a specific epitope. After an antigen-antibody reaction, the immune complexes can be subject to any of a number of responses, including complement deposition, opsonization, phagocytosis, or processing by proteases. Red blood cells carrying CR1-receptors on their surface may bind C3b-coated immune complexes and transport them to phagocytes, mostly in liver and spleen, and return to the general circulation. The ratio of antigen to antibody determines size and shape of immune complex. This, in turn, determines the effect of the immune complex. Many innate immune cells have FcRs, which are membrane-bound receptors that bind the constant regions of antibodies. Most FcRs on innate immune cells have low affinity for a singular ant ...
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Inflammation
Inflammation (from la, wikt:en:inflammatio#Latin, inflammatio) is part of the complex biological response of body tissues to harmful stimuli, such as pathogens, damaged cells, or Irritation, irritants, and is a protective response involving immune cells, blood vessels, and molecular mediators. The function of inflammation is to eliminate the initial cause of cell injury, clear out necrotic cells and tissues damaged from the original insult and the inflammatory process, and initiate tissue repair. The five cardinal signs are heat, pain, redness, swelling, and Functio laesa, loss of function (Latin ''calor'', ''dolor'', ''rubor'', ''tumor'', and ''functio laesa''). Inflammation is a generic response, and therefore it is considered as a mechanism of innate immune system, innate immunity, as compared to adaptive immune system, adaptive immunity, which is specific for each pathogen. Too little inflammation could lead to progressive tissue destruction by the harmful stimulus (e.g. b ...
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Subacute Bacterial Endocarditis
Subacute bacterial endocarditis, abbreviated SBE, is a type of endocarditis (more specifically, infective endocarditis). Subacute bacterial endocarditis can be considered a form of type III hypersensitivity. Signs and symptoms Among the signs of subacute bacterial endocarditis are: * Malaise * Weakness * Excessive sweat * Fever Causes It is usually caused by a form of Viridans group streptococcus bacteria that normally live in the mouth ('' Streptococcus mutans, mitis, sanguis ''or ''milleri''). Other strains of streptococci can cause subacute endocarditis as well. These include streptococcus intermedius, which can cause acute or subacute infection (about 15% of cases pertaining to infective endocarditis). Enterococci from urinary tract infections and coagulase negative staphylococci can also be causative agents. Mechanism The mechanism of subacute bacterial endocarditis could be due to malformed stenotic valves which in the company of bacteremia, become infected, via adh ...
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Roth's Spot
Roth's spots, also known as Litten spots or the Litten sign, are non-specific red spots with white or pale centres, seen on the retina and although traditionally associated with infective endocarditis, can occur in a number of other conditions including hypertension, diabetes, collagen vascular disease, extreme hypoxia, leukemia and HIV. Red and white retinal spots were first observed in 1872 by Swiss physician Moritz Roth, and named "Roth spots" six years later by Moritz Litten. They are typically observed via fundoscopy (using an ophthalmoscope to view inside the eye) or slit lamp exam. The original retinal spots identified in 1872 were attributed to nerve-fibres that had burst. Present-day analysis shows that they can be composed of coagulated fibrin including platelets, focal ischaemia, inflammatory infiltrate, infectious organisms, or neoplastic cells. Cause Roth's spots occur in conditions that predispose to endothelial damage of retinal capillaries, that is when there is ...
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Janeway Lesion
Janeway lesions are rare, non- tender, small erythematous or haemorrhagic macular, papular or nodular lesions on the palms or soles only a few millimeters in diameter that are associated with infective endocarditis and often indistinguishable from Osler's nodes. Definition Janeway lesions are painless, frequently haemorrhagic lesions seen most commonly on the palms and soles, particularly on the base of the thumb and little finger, and seen in infective endocarditis. Differential Osler's nodes and Janeway lesions are similar and point to the same diagnostic conclusion. The most significant difference between the two is that Osler's nodes present with tenderness, while Janeway lesions do not. Osler's nodes are thought to be due to immunologic phenomenon where deposition of immune complexes provoke inflammatory response, leading to swelling, redness and pain. On the contrary, Janeway lesions are thought to be due to embolic phenomenon in cutaneous blood vessels of palms and soles w ...
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Lupus Erythematosus
Lupus erythematosus is a collection of autoimmune diseases in which the human immune system becomes hyperactive and attacks healthy tissues. Symptoms of these diseases can affect many different body systems, including joints, skin, kidneys, blood cells, heart, and lungs. The most common and most severe form is systemic lupus erythematosus. Signs and symptoms Symptoms vary from person to person, and may come and go. Almost everyone with lupus has joint pain and swelling. Some develop arthritis. Frequently affected joints are the fingers, hands, wrists, and knees. Other common symptoms include: * chest pain during respiration * joint pain (stiffness and swelling) * painless oral ulcer * fatigue * weight loss * headaches * fever with no other cause * Skin lesions that appear worse after sun exposure * general discomfort, uneasiness, or ill feeling ( malaise) * hair loss * sensitivity to sunlight * a "butterfly" facial rash, seen in about half of people with SLE * swollen lymp ...
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Marantic Endocarditis
Nonbacterial thrombotic endocarditis (NBTE) is a form of endocarditis in which small sterile vegetations are deposited on the valve leaflets. Formerly known as marantic endocarditis, which comes from the Greek , meaning "wasting away". The term "marantic endocarditis" is still sometimes used to emphasize the association with a wasting state such as cancer. Risk factors Marantic vegetations are often associated with previous rheumatic fever. Other risk factors include: * hypercoagulable states * malignant cancers, especially mucin-producing adenocarcinomas (most commonly associated with pancreatic adenocarcinomas) * systemic lupus erythematosus: Referred to as Libman-Sacks endocarditis * trauma (e.g., catheters) Valve predilection The disease affects the valves with following predilection: mitral valve > aortic valve > tricuspid valve > pulmonary valve Histopathology Grossly, vegetations form along lines of valve closure and are generally symmetric with a smooth or verruc ...
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Gonococcus
''Neisseria gonorrhoeae'', also known as ''gonococcus'' (singular), or ''gonococci'' (plural), is a species of Gram-negative diplococci bacteria isolated by Albert Neisser in 1879. It causes the sexually transmitted genitourinary infection gonorrhea as well as other forms of gonococcal disease including disseminated gonococcemia, septic arthritis, and gonococcal ophthalmia neonatorum. It is oxidase positive and aerobic, and it survives phagocytosis and grows inside neutrophils. Culturing it requires carbon dioxide supplementation and enriched agar (chocolate agar) with various antibiotics ( Thayer–Martin). It exhibits antigenic variation through genetic recombination of its pili and surface proteins that interact with the immune system. Sexual transmission is through vaginal, anal, or oral sex. Sexual transmission may be prevented through the use of barrier protection. Perinatal transmission may occur during childbirth, and may be prevented by antibiotic treatment of the ...
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Catheter
In medicine, a catheter (/ˈkæθətər/) is a thin tube made from medical grade materials serving a broad range of functions. Catheters are medical devices that can be inserted in the body to treat diseases or perform a surgical procedure. Catheters are manufactured for specific applications, such as cardiovascular, urological, gastrointestinal, neurovascular and ophthalmic procedures. The process of inserting a catheter is ''catheterization''. In most uses, a catheter is a thin, flexible tube (''soft'' catheter) though catheters are available in varying levels of stiffness depending on the application. A catheter left inside the body, either temporarily or permanently, may be referred to as an "indwelling catheter" (for example, a peripherally inserted central catheter). A permanently inserted catheter may be referred to as a "permcath" (originally a trademark). Catheters can be inserted into a body cavity, duct, or vessel, brain, skin or adipose tissue. Functionally, they all ...
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William Osler
Sir William Osler, 1st Baronet, (; July 12, 1849 – December 29, 1919) was a Canadian physician and one of the "Big Four" founding professors of Johns Hopkins Hospital. Osler created the first Residency (medicine), residency program for specialty training of physicians, and he was the first to bring medical students out of the lecture hall for bedside clinical training. He has frequently been described as the ''Father of Modern Medicine'' and one of the "greatest diagnosticians ever to wield a stethoscope". Osler was a person of many interests, who in addition to being a physician, was a bibliophile, historian, author, and renowned practical joker. Outside of medicine, he was passionate about medical libraries and medical history and among his achievements were the founding of the History of Medicine Society (formally "section"), at the Royal Society of Medicine, London. In the field of librarianship he was instrumental in founding the Medical Library Association of Great Brit ...
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Symptoms And Signs: Cardiac
Signs and symptoms are the observed or detectable signs, and experienced symptoms of an illness, injury, or condition. A sign for example may be a higher or lower temperature than normal, raised or lowered blood pressure or an abnormality showing on a medical scan. A symptom is something out of the ordinary that is experienced by an individual such as feeling feverish, a headache or other pain or pains in the body. Signs and symptoms Signs A medical sign is an objective observable indication of a disease, injury, or abnormal physiological state that may be detected during a physical examination, examining the patient history, or diagnostic procedure. These signs are visible or otherwise detectable such as a rash or bruise. Medical signs, along with symptoms, assist in formulating diagnostic hypothesis. Examples of signs include elevated blood pressure, nail clubbing of the fingernails or toenails, staggering gait, and arcus senilis and arcus juvenilis of the eyes. Indications ...
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