#janeway lesions

[cluelessmedic]

Infective Endocarditis

Fever + new murmur = endocarditis until proven otherwise

Often S.aureus/epidermis, strep viridans

Clinical Features - fever, rigors, night sweats, new murmur, vasculitis, glomerulonephritis

Splinter haemorrhages, Janeway Lesions (painless), Oslers Nodes (painful pulp infarcts)

Risk Factors - IV drug use, diabetes, post op wounds, ?oral health

Diagnosis - blood cultures (x3), FBC (anaemia, neutrophilia), raised ESR/CRP, urine dip (?haematuria), CXR, ECG (prolonged PR), echocardiography (vegetations) 

Management - IV antibiotics, consider surgery

[medicineisnotmerchandise]

Janeway Lesions vs. Osler Nodes

Both found in bacterial endocarditis.

Osler Nodes: Painful, palpable red lesions usually on fingers/toes. They are caused by immune complexes. (Image Credit)

Janeway Lesions: Non-painful, macular lesions, usually onpalms/soles. They are caused by septic emboli, more common in Staph aureus endocarditis.

[mynotes4usmle]

My Mnemonic for Janeway lesions (Bacterial Endocarditis)

JANE SLAPPED me in the face, but it DIDN’T HURT

JANEway lesions in PALMS & soles, PAINLESS

[mynotes4usmle]

Acute VS. Subacute Bacterial Endocarditis

Acute

Staphilococcus aureus

Large, destructive vegetations

Mortality 50% :(

Subacute

Streptococcus group viridans

Previously damaged valve

CLINICAL PRESENTATIONS

Fever, chills, W loss, cardiac murmur

Roth spots: retinal emboli 

Janeway lesions: painless, red lesions, palms, soles 

Osler nodes: painfull, red SC nodules, finger, toes 

Splinter fingernail hemorrages