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tation depends on the infecting organism and the valve or valves that are infected More virulent organisms S aureus in particular tend to produce a more rapidly progressive and destructive infection Endocarditis caused by more virulent organisms often presents as an acute febrile illnesses and is complicated by early embolization, acute valvular regurgitation, and myocardial abscess formation Viridans strains of streptococci, enterococci, other bacteria, yeasts, and fungi tend to cause a more subacute picture Underlying valvular disease, less common than in the past, is present in about 50% of cases Valvular disease alters blood flow and produces jet effects that disrupt the endothelial surface, providing a nidus for attachment and infection of microorganisms that enter the bloodstream Predisposing valvular abnormalities include rheumatic involvement of any valve, bicuspid aortic valves, calcific or sclerotic aortic valves, hypertrophic subaortic stenosis, mitral valve prolapse, and a variety of congenital disorders such as ventricular septal defect, tetralogy of Fallot, coarctation of the aorta, or patent ductus arteriosus Rheumatic disease is no longer the major predisposing factor in developed countries Regurgitation lesions are more susceptible than stenotic ones The initiating event in native valve endocarditis is colonization of the valve by bacteria or yeast that gain access to the bloodstream Transient bacteremia is common during dental, upper respiratory, urologic, and lower gastrointestinal diagnostic and surgical procedures It is less common during upper gastrointestinal and gynecologic procedures Intravascular devices are increasingly implicated as a portal of access of microorganisms into the bloodstream A large proportion of cases of S aureus endocarditis is attributable to healthcareassociated bacteremia Native valve endocarditis is usually caused by viridans streptococci, group D streptococci, S aureus, enterococci, or HACEK organisms (an acronym for Haemophilus aphrophilus, Haemophilus parainfluenzae, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae) Streptococcal species formerly accounted for the majority of native valve endocarditis cases, but the proportion of cases caused by S aureus has been increasing, and this organism is now the leading cause Gram-negative organisms and fungi account for a small percentage In injection drug users, S aureus accounts for over 60% of all endocarditis cases and for 80 90% of cases in which the tricuspid valve is infected Enterococci and streptococci comprise the balance in about equal proportions Gramnegative aerobic bacilli, fungi, and unusual organisms may cause endocarditis in injection drug users The microbiology of prosthetic valve endocarditis also is distinctive Early infections (ie, those occurring within 2 months after valve implantation) are commonly caused by staphylococci both coagulase-positive and coagulase-negative gram-negative organisms, and fungi In late prosthetic valve endocarditis, streptococci are commonly identified, although coagulase-negative and coagulase-positive staphylococci still cause many cases.



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Super Simple WYSIWYG Editor on Bootstrap Summernote is a JavaScript library that helps you create WYSIWYG editors online.

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You can get pretty fancy, even using the built-in JavaScript tools in a PDF editor , to handle number strings, email a completed form, and insert the current date or ...

tions and is particularly useful for identifying valve ring abscesses as well as prosthetic valve endocarditis Clinical criteria, referred to as the Modified Duke criteria, for the diagnosis of endocarditis have been proposed Major criteria include (1) two positive blood cultures for a microorganism that typically causes infective endocarditis or persistent bacteremia, (2) evidence of endocardial involvement documented by echocardiography (eg, definite vegetation, myocardial abscess, or new partial dehiscence of a prosthetic valve), or (3) development of a new regurgitant murmur Minor criteria include the presence of a predisposing condition; fever 38 C; vascular phenomena, such as cutaneous hemorrhages, aneurysm, systemic emboli, pulmonary infarction; immunologic phenomena, such as glomerulonephritis, Osler nodes, Roth spots, rheumatoid factor; and positive blood cultures not meeting the major criteria or serologic evidence of an active infection A definite diagnosis can be made with 80% accuracy if two major criteria, one major criterion and three minor criteria, or five minor criteria are fulfilled A possible diagnosis of endocarditis is made if one major and one minor criterion or three minor criteria are met If fewer criteria are found, or a sound alternative explanation for illness is identified, or the endocarditis syndrome has resolved and the patient has defervesced within 4 days, endocarditis is unlikely





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A general-purpose, web standards-based platform for parsing and rendering PDFs.

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Virtually all patients have fever at some point in the illness, although it may be very low grade (less than 38 C) in elderly individuals and in patients with heart failure or renal failure Rarely, there may be no fever at all The duration of illness typically is a few days to a few weeks Nonspecific symptoms are common The initial symptoms and signs of endocarditis may be caused by direct arterial, valvular, or cardiac damage Although a changing regurgitant murmur is significant diagnostically, it is the exception rather than the rule Symptoms also may occur as a result of embolization, metastatic infection or immunologically mediated phenomena These include cough; dyspnea; arthralgias or arthritis; diarrhea; and abdominal, back, or flank pain The characteristic peripheral lesions petechiae (on the palate or conjunctiva or beneath the fingernails), subungual ( splinter ) hemorrhages, Osler nodes (painful, violaceous raised lesions of the fingers, toes, or feet), Janeway lesions (painless erythematous lesions of the palms or soles), and Roth spots (exudative lesions in the retina) occur in about 25% of patients Strokes and major systemic embolic events are present in about 25% of patients, and tend to occur before or within the first week of antimicrobial therapy Hematuria and proteinuria may result from emboli or immunologically mediated glomerulonephritis, which can cause renal dysfunction

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18 May 2015 ... After some time, our reflection lead to the idea of displaying the PDF ... to use the javascript library PDF .js in order to display these PDFs. PDF .js ...

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