Infective Endocarditis in Adults — NEJM tiffany hjerte øredobber

Infective Endocarditis in Adults

Eleftherios Mylonakis, M.D., and Stephen B. Calderwood, M.D.

N Engl J Med 2001; 345:1318-1330November 1, 2001DOI: 10.1056/NEJMra010082

The cli veeoioks. tiffany thiessennical features of this complex infection have changed in the past several decades. It is now an infection of older people, and mitral-valve prolapse is the most common predisposing cardiovascular problem in developed countries. In contrast, rheumatic heart disease is an important predisposing problem in developing countries. This review article provides a comprehensive assessment of this serious infectious disease, including diagnostic challenges, cardiovascular and neurologic complications, and approaches to therapy.

Dr. Mylonakis is the recipient of a Postdoctoral Research Fellowship for Physicians from the Howard Hughes Medical Institute.

We are indebted to Dr. A.W. Karchmer for many very helpful comments, suggestions, and references, as well as for the photograph in Figure 1C; and to Dr. Mary Jane Ferraro for a critical review of the manuscript.

Source Information

From the Division of Infectious Diseases, Massachusetts General Hospital, Boston (E.M., S.B.C.); and the Department of Microbiology and Molecular Genetics, Harvard Medical School, Boston (S.B.C.).

Address reprint requests to Dr. Calderwood at the Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114.

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Media in This Article

Figure 1Common Peripheral Manifestations of Infective Endocarditis.Splinter hemorrhages (Panel A) are normally seen under the fingernails or toenails. They are usually linear and red for the first two to three days and brownish thereafter. Panel B shows conjunctival petechiae. Osler's nodes (Panel C) are tender, subcutaneous nodules, often in the pulp of the digits or the thenar eminence. Janeway's lesions (Panel D) are nontender erythematous, hemorrhagic, or pustular lesions, often on the palms or soles.
Table 1Microbiologic Features of Native-Valve and Prosthetic-Valve Endocarditis.

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The cli veeoioks. tiffany thiessennical features of this complex infection have changed in the past several decades. It is now an infection of older people, and mitral-valve prolapse is the most common predisposing cardiovascular problem in developed countries. In contrast, rheumatic heart disease is an important predisposing problem in developing countries. This review article provides a comprehensive assessment of this serious infectious disease, including diagnostic challenges, cardiovascular and neurologic complications, and approaches to therapy.

Dr. Mylonakis is the recipient of a Postdoctoral Research Fellowship for Physicians from the Howard Hughes Medical Institute.

We are indebted to Dr. A.W. Karchmer for many very helpful comments, suggestions, and references, as well as for the photograph in Figure 1C; and to Dr. Mary Jane Ferraro for a critical review of the manuscript.

Source Information

From the Division of Infectious Diseases, Massachusetts General Hospital, Boston (E.M., S.B.C.); and the Department of Microbiology and Molecular Genetics, Harvard Medical School, Boston (S.B.C.).

Address reprint requests to Dr. Calderwood at the Division of Infectious Diseases, Massachusetts General Hospital, Boston, MA 02114.

Access this article: Subscribe to NEJM | Purchase this article

Media in This Article

Figure 1Common Peripheral Manifestations of Infective Endocarditis.Splinter hemorrhages (Panel A) are normally seen under the fingernails or toenails. They are usually linear and red for the first two to three days and brownish thereafter. Panel B shows conjunctival petechiae. Osler's nodes (Panel C) are tender, subcutaneous nodules, often in the pulp of the digits or the thenar eminence. Janeway's lesions (Panel D) are nontender erythematous, hemorrhagic, or pustular lesions, often on the palms or soles.
Table 1

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