12th March 2024

Clinical manifestations

The majority of patients will present with nonspecific symptoms, including fever, rigors, lethargy and weight loss. Other signs associated with IE include:

• A new or changing murmur: this can be found in up to 85% of patients
• Splinter haemorrhages: septic emboli from the heart valve become lodged in small capillaries and are visible beneath the nail bed
• Roth’s spots: pale lesions on the retina surrounded by a rim of haemorrhage usually diagnosed by fundoscopy. 
• Acute renal failure: occurs in up to 30% of patients and is an independent risk factor for inpatient mortality.
• Janeway lesions: non-tender haemorrhagic macules present over the soles and palms caused by septic microemboli.
• Osler’s nodes: tender nodules found on the tips of fingers and toes due to a local immunological response caused by immune complex deposition within the skin. 
• Embolic sequelae: due to the migration of septic thrombi from the heart. In left-sided IE, the brain and spleen are the most common site of embolism, whereas right-sided IE can lead to pulmonary emboli. Ischemic strokes are a common complication of cerebral emboli.