19. Clinical picture and diagnosis of infective endocarditis (IE)

clinical picture. The manifestations of IE are presented as syndromes.

1. Syndrome of inflammatory changes and septicemia.

2. Syndrome of general intoxication of the body.

3. Syndrome of valve damage.

4. Syndrome of "laboratory" immune disorders.

5. Syndrome of thromboembolic complications.

6. Syndrome of generalization of lesions.

Diagnosis of IE is based primarily on early detection of the causative agent of the disease. For this purpose, the following laboratory and instrumental studies are used.

1. Obtaining a positive blood culture.

2. Carrying out NBT (nitrobluetetrazolium test).

3. A clinical blood test to detect acute phase indicators: an increase in ESR to 50 mm / h or more, leukocytosis with a shift of the leukocyte formula to the left or (in stage II) leukopenia and hypochromic anemia can be detected.

4. Identification of immunological changes.

5. Urinalysis is performed to clarify the lesions of various organs and systems, when glomerulonephritis is detected, manifested by proteinuria, cylindruria and hematuria.

6. A direct diagnostic sign of IE - the presence of vegetation on the heart valves - is detected by echocardiography.

Thus, from the whole variety of symptoms, the main and additional ones should be distinguished.

The main criteria for the diagnosis of IE:

1) fever with a temperature above 38 °C with chills;

2) Lukin spots;

3) Osler's nodules;

4) endocarditis on unchanged valves (primary) or against the background of rheumatic and congenital heart defects. infectious myocarditis;

5) multiple arterial thromboembolism, ruptures of mycotic aneurysms with hemorrhages;

6) splenomegaly;

7) positive blood culture;

8) a pronounced positive effect from the use of antibiotics.

Additional criteria for the diagnosis of IE:

1) increased body temperature to 38 °C, chilling;

2) hemorrhages on the skin;

3) rapid weight loss;

4) asymmetric arthritis of small joints of hands, feet;

5) anemization;

6) ESR over 40 mm/h;

7) sharply positive SRV;

8) the presence of rheumatoid factor;

9) a-globulins above 25%;

10) increase in the content of immunoglobulins M, E and A.

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