7: Infective Endocarditis : Pathology USMLE Step 1

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7: Infective Endocarditis : Pathology USMLE Step 1

Dive into the intricate pathology of infective endocarditis (IE) tailored for USMLE Step 1 preparation. IE is a microbial infection of the endocardial surface of the heart, often affecting the heart valves. The condition typically arises from bacteremia, with bacteria adhering to damaged endothelium and forming vegetations composed of platelets, fibrin, and bacteria. The etiology includes both bacterial and fungal pathogens, with the most common causative organisms being viridans streptococci, Staphylococcus aureus, and enterococci. Clinical manifestations vary widely, ranging from nonspecific symptoms such as fever, malaise, and weight loss to more specific signs such as Osler's nodes, Janeway lesions, Roth spots, and splinter hemorrhages. Diagnosis relies on Duke criteria, which encompass major criteria (positive blood cultures, evidence of endocardial involvement on echocardiography) and minor criteria (predisposing factors, fever, vascular phenomena, immunologic phenomena). Treatment involves prolonged antibiotic therapy tailored to the specific pathogen, often requiring intravenous antibiotics followed by oral agents, with surgical intervention indicated for complications such as valve destruction, heart failure, or persistent infection. Understanding the complex etiology, varied clinical presentations, diagnostic criteria, and management strategies of infective endocarditis is crucial for medical students preparing for board exams and future clinical practice. 📚

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