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[Diagnostic utility of Osler's nodules in infectious endocarditis among parenteral drug users]
F J Espinosa Parra1, J M Ramos Rincón, F Herrero Huerta
1Servicio de Medicina Interna, Hospital General Universitario J.M. Morales Meseguer, Murcia.
Background:
The objective of study is to describe of clinic, microbiological and histological data of five cases of infective endocarditis (IE) with Osler's nodes in intravenous drug users. PATIENTS Y METHODS: Prospectively, 43 cases of IE in intravenous drugs users was revised. In 4 patients, a aspirate puncture of Osler's node was performed and in one patient a biopsy of Osler's node was done with Gram's stain and culture of specimen.
Results:
From 43 episodes of IE, 33 were right-side IE, 9 left-side y 1 right and left side. No patients with right-side IE presented Osler's nodes, however five of 10 (50%) patients with left-side endocarditis. In all of cases gram positive cocci were observed in Gram's strain and Staphylococcus aureus growth on culture of lesion with the same antibiotype than isolated from blood culture. One case a cutaneous biopsy was performed, and inflammatory infiltrate with necrosis was found.
Conclusions:
The Gram's strain and culture of specimen aspirated from Osler's nodes were of high utility in the diagnosis of IE in intravenous drugs users. The presence of Osler's nodes in a patient with infective endocarditis must be suggest that the location in left-side. These data suggest that Osler's nodes in infective endocarditis by S. aureus in intravenous drugs users was originated by microvascular septic emboli.
Insights
Osler's nodes in infective endocarditis (IE) cases among intravenous drug users indicate left-side infection. Diagnostic utility of Osler's node aspiration and culture for Staphylococcus aureus is high.
Area of Science:
- Infectious Diseases
- Cardiology
- Dermatology
Context:
- Intravenous drug use is a significant risk factor for infective endocarditis (IE).
- Osler's nodes are rare peripheral manifestations of IE, typically associated with specific etiologies.
- Understanding the clinical significance of Osler's nodes in IE among intravenous drug users is crucial for diagnosis and management.
Purpose:
- To describe the clinical, microbiological, and histological data of five cases of IE with Osler's nodes in intravenous drug users.
- To evaluate the diagnostic utility of aspirate Gram stain and culture from Osler's nodes.
- To determine the association between Osler's nodes and the location of IE in intravenous drug users.
Summary:
- Of 43 IE cases in intravenous drug users, 50% of left-side IE patients (5/10) presented with Osler's nodes, while none with right-side IE did.
- Gram stain revealed gram-positive cocci, and culture identified Staphylococcus aureus in Osler's node specimens, matching blood culture antibiotypes.
- Histological examination of a cutaneous biopsy showed inflammatory infiltrate with necrosis.
Impact:
- Osler's node aspiration and culture are highly valuable for diagnosing IE in intravenous drug users.
- The presence of Osler's nodes in IE suggests left-side cardiac involvement.
- Osler's nodes in IE caused by S. aureus in this population may arise from microvascular septic emboli.
