Osler's nodules are what? Causes of appearance, pathogenesis, treatment

Endocarditis is an inflammation of the endocardium, the inner shell of our heart. It can cause pathologies in many organs and systems of the human body, trauma, hypercoagulation and other non-infectious causes. Therefore, endocarditis itself is only their symptom, in the presence of which Rota spots, Osler's nodules and other characteristic rashes on the body do not appear. Patients may not feel any discomfort at all, and in rare cases complain about heart murmurs, fever. And only if the inflammation of the endocardium caused microorganisms parasitizing in the blood, it becomes an independent disease and is called infectious, bacteriological or septic endocarditis. Osler's nodules are one of his external features. Described in 1885 by the wonderful Canadian therapist William Osler. Infective endocarditis is a very dangerous disease, leading to irreversible deformations in the heart, so it is vital to know what it is and how it manifests itself.

Features of infective endocarditis

This disease is caused by almost all pathogenic bacteria and fungi, and sometimes even by viruses and protozoa that are in the bloodstream of a person. They can infiltrate the endocardium with infectious diseases of the respiratory system, rheumatism, periodontitis, tonsillitis, tuberculosis, catheterization of the urethra, tooth extraction and other manipulations. Osler's nodules are a clear signal that the underlying disease has caused a complication - infective endocarditis. In the overwhelming majority of cases for the beginning of parasitic activity of microorganisms, in the heart there should be any damage:

- venous catheters;

- pacemakers;

- Prostheses of blood vessels or heart valves;

- different heart defects;

- micro-trauma;

- surgical intervention.

Sometimes bacteria penetrate into the endocardium and without previous tissue damage. Then abscesses, fistulas and other defects are formed.

Symptoms

Infective endocarditis can manifest itself clearly and distinctly, and may initially disturb only fatigue, heart murmurs, general weakness, and more severe symptoms gradually increase. These include:

- fever;

- chills;

- profuse sweating;

- tenderness of muscles and joints;

- weight loss;

- change in skin color (becomes grayish, slightly yellowish);

Rash on mucous membranes.

Osler's nodules appear after the above symptoms. Some experts consider them a characteristic and indispensable sign of infective endocarditis, others, on the contrary, a relatively rare manifestation of it, in which the disease is subacute.

Nodes of Osler, pathogenesis

These formations appear on the palms, pads of the fingers, feet due to inflammation caused by the infection of the walls of small blood vessels and represent an infiltrate. In the histological examination of the nodules, they reveal enlarged venules and arterioles. Sometimes they are confused with an allergic rash or septic purpura. What Osler's nodules look like, the photo shows quite clearly. These are convex, the size of a pea or slightly less mobile formations of a red or purple hue, sometimes painful, sometimes not. They develop rapidly, disappear by themselves, are not a separate disease, so treatment with tablets or ointments does not require. But if a person has noticed such nodules, he should immediately consult a doctor for additional laboratory and clinical studies.

Rota spots

In addition to Osler's nodules, infectious endocarditis can have a hemorrhagic rash on the sides and extremities, hemorrhages under the nail plates, and Janevier spots, which also appear as Osler's nodules on the palms and soles of the feet. But, unlike the nodules, these spots are absolutely painless, do not look like peas and are the result of a surge of blood to the capillaries.

In infectious endocarditis, in addition to the skin, eyes can be affected. One of the common signs of such a reaction to inflammation are Rota spots. Described by their Swiss doctor Roth. Rota spots are microcirculation in the retina of the eyes. In form they are oval or round with a white dot in the middle. In patients, these formations can cause a decrease in vision, which, after treatment of the underlying disease, is restored.

Rota spots are a symptom of not only infective endocarditis, but also anemia, collagenosis. Therefore, additional diagnoses should be made for the diagnosis.

Other symptoms in infectious endocarditis

There are about a dozen symptoms that allow one to suspect an endocardial inflammation due to infection.

Osler's nodules, Lukin's spots (or the Lukin-Liebman symptom correctly), the symptoms of Roca, Dmitrienko, Janoye and others help doctors diagnose, especially when other characteristic signs of the disease are vague or absent.

The symptom of Lukin-Liebman is the appearance of point-like petechiae with a whitish center on the folds of eyelids and conjunctiva.

The symptom of Roca manifests itself in the dilatation of the pupil of the left eye.

The symptom of Janeway is the erythematous formations, like the Roth spots, protruding on the palms and feet, only in this case they are small in size.

Symptom Dmitrienko, is to some softening of the tone I tone, because of what it is also called "velvet tone." This symptom is observed at the earliest stages of the disease.

Treatment

The cause of the appearance of any specific symptom can only be determined by the doctor. As a rule, this requires laboratory tests of blood, ECG, echocardiography. Mandatory blood banks are used to identify the causative agent of infection. If the analysis showed the patient's infectious endocarditis, antibiotics of the appropriate group are prescribed. In severe cases, surgical intervention (plastic, prosthetic cardiac valve) is performed.

With the timely formulation of the correct diagnosis and timely treatment started, 50-90% of patients live more than 5 years. To prevent the occurrence of infective endocarditis, a special method for people at risk has been developed. It has several regimens of prevention based on the intake of medications in the marked situations.