Infectious Diseases in Critical Care Medicine

Table 8

Organ Involvement in NVE

Peripheral stigmata(20% of patients)

Musculoskeletal(40%–50% of patients)

Intracardiac

Janeway lesions

Low back pain (presenting symptom)

Valvular vegetations in 15% of patients

Osler’s nodes

Diffuse myalgias, especially of legs

CHF

Roth spots

Disc space infection

Myocardial abscess

Hypertrophic osteoarthropathy

Septal abscess (leading to heart block)

Splenomegaly

Vascular necrosis

Arthritis (ankle, knee, wrist)

Aortocardiac fistulaSuppurative pericarditisRupture of papillary muscles, chordae tendinaeAnnular abscessMycotic aneurysm of sinus of ValsalvaDestruction of valvular leafletsStaphylococcus aureus

responsible for 55%–70% of congestive heart failure

Neurological system

Renal

Mycotic aneurysms

Metastatic infections

Neurological complications are the

presenting symptoms in 50%–70%of patients.

Congestive heart failure and antibiotic

toxicity are currently the mostcommon causes of renal failure

Life-threatening in 2.5% of patients

Metastatic infections are produced by

septic emboli (usually in acute IE) toliver, spleen, gallbladder, coronaryarteries (myocardial infarction occursin 50% of patients), myocardium,lung, and retina

Hemorrhage

Renal abscesses due to highly invasive

organisms (i.e.,

Staphylococcus

aureus

)

Usually produced by organisms of low

invasive capacity (i.e.,

Stretococcus

viridans

)

Toxic manifestations (headache,

irritability)

Renal infarction (cortical necrosis)

occurs in two-thirds of infectedpatients.

Silent until they leak; seen most

commonly in brain

Psychiatric effects (neurosis).

Focal glomerulonephritis occurs in 50%

of untreated cases and is associatedwith renal failure and nephroticsyndrome

Sinus of Valsalva, abdominal aorta and

its branches, mesenteric, splenic,coronary, and pulmonary arteries

Psychoses, disorientation, delirium

(hallucinations) Stroke

“Flea-bitten” kidney, multiple emboli and

hemorrhage

MeningoencephalitisDyskinesiaSpinal cord and small nerves (girdle pain,

paraplegia, weakness, myalgias, andperhipheral neuropathy)

230 Brusch