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Periodically, their health improves, however, after some time, the manifestation of the disease worsens again. In approximately 30% of patients, the disease develops 2-3 weeks after suffering a sore throat, pneumonia, purulent otitis, sinusitis, tooth extraction, cystoscopy, genitourinary infections, abortion or childbirth. This onset often develops with IE caused by viridans streptococcus. The first signs of the disease may also be hemorrhagic phenomena in the form of petechiae, bleeding (nasal, gastric, uterine), necrotic rash.

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Quite rarely (in 6-7% of cases) the disease begins with edema, as a manifestation of nephritis. The onset of isotretinoin pills with the development of heart failure (palpitations, shortness of breath) occurs on average in 10% of cases, usually in patients with secondary IE, and is a poor prognostic symptom. Even less commonly, the disease begins with lumbar pain and hematuria (with renal infarction), pain in the left hypochondrium (with splenic infarction), in the abdomen (with mesenteric vascular embolism), in the calf muscles and fingers and toes (peripheral vascular embolism), and joints. The course of IE may vary.

With a highly virulent pathogen or in the absence of adequate treatment, the disease develops rapidly, and death occurs within 1-2 months as a result of severe heart failure, kidney damage, or cerebral vascular occlusion. Acute IE is not common. With a low-virulent pathogen, the disease develops more slowly, with the classic clinical picture unfolding. If treatment is ineffective, death occurs within 1-2 years after the onset of the disease from cardiac or renal failure, hemorrhagic or embolic complications. This course is called subacute and occurs in most cases of IE.

It is also possible for the disease to buy accutane medication chronic with periods of remission and relapse. Under the influence of modern antibacterial therapy, the clinical picture is often blurred, not developed, with weak manifestations of the main symptoms of the disease. One of the most important signs of the disease is fever (occurs in 90-95% of cases). It is not uncommon to observe 2-3 week fever waves up to 38-390 C, alternating with one to two week periods of normal temperature or subfibrillation.

Against the background of subfibrillation, one or two day rises in temperature up to 39-400C can develop. Such suppositories are considered very characteristic of prolonged septic endocarditis. Fever can be constant, remitting, intermittent, hectic, or inverted. Sometimes the greatest increase in body temperature is detected at unusual hours for measurement. 12-14-24 hours, while morningand in the evening hours it remains normal. The headache accompanying fever is usually moderate and intensifies, as does general weakness, with an increase in body temperature.

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Fever can be caused not only by an infectious process, but also occur as a result of resorption of necrotic tissue during infarction of the spleen, kidneys, lungs, etc. Fever can also be caused by the development of abscesses of the spleen, liver, lungs, brain, etc. Sometimes fever is caused by autoimmune processes and is reduced only under the influence of corticosteroids and immunosuppressants. Fever may be absent in severe heart failure, kidney damage, uremia, in the elderly, and when antimicrobial agents are administered.

The absence of a decrease in temperature during treatment usually indicates the inadequacy of therapy and prompts a revision of the diagnosis or etiological factor of fever. Chills are a common and important, but not constant, sign of IE. Chills may not be expressed sharply (chilling), but sometimes take on an overwhelming character, accompanied by a high rise in temperature, followed by profuse sweating and a drop in body temperature. Sweating does not alleviate the patient�s condition, it is profuse, or only certain parts of the body are covered with perspiration (head, forehead, upper half of the body, etc.). The skin of patients is pale, pale gray or yellowish-earthy in color with a peculiar “coffee with milk” tint. The mucous membranes are pale.

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Pale skin and mucous membranes are explained by anemia. Mild jaundice may be due to buy isotretinoin online hemolysis of red blood cells. Sometimes severe jaundice occurs due to infectious-toxic hepatitis. Puffiness of the face and edema can be of cardiac, renal and dystrophic origin.

In 20-40% of untreated patients, short-lived petechial rashes are detected, which are localized on the conjunctiva, hard and soft palate, neck, chest, forearms, hands and legs. These flat red elements, 1-2mm in diameter, usually with a gray or white center, fade after 3-4 days and disappear.


Sometimes an intense hemorrhagic rash may occur, which is characterized by the wavy nature of accutane pills and the symmetry of its location. Most often it is localized on the lower and upper extremities, but can be on the face and other parts of the body, as well as on the mucous membranes.

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Surgical Procedures

Hemorrhages can become necrotic, leaving behind scars. When hemorrhages are located on the face, they resemble smallpox. A hemorrhagic rash can also be a consequence of a complication of the disease, such as uremia. Occasionally, patients develop reddish-brown hemorrhages in the form of stripes under the nails.

Non-surgical Procedures

In some cases, Janeway spots and Osler nodes are detected.