Suppurative thrombophlebitis

Infective endocarditis is microbial infection of the endocardium, usually a heart valve, producing vegetations that cause valve destruction, embolism, and systemic infection. Diagnosis uses the modified Duke criteria combining blood cultures and echocardiography, and treatment is prolonged targeted intravenous antibiotics with surgery for complications.

Infection tracking through the fascial spaces of the neck, most often from an odontogenic, tonsillar, or salivary source, that threatens the airway and can spread to the mediastinum. Diagnosis rests on contrast-enhanced CT of the neck; treatment is airway protection, intravenous antibiotics, and surgical drainage of any organized collection.

Peritonsillar abscess is the most common deep-space neck infection, presenting with unilateral sore throat, trismus, a muffled hot potato voice, and uvula deviation away from the affected side, treated with prompt drainage plus antibiotics covering group A streptococcus, Staphylococcus aureus, and oral anaerobes.

Pelvic inflammatory disease is an ascending polymicrobial infection of the upper female genital tract, most often caused by Neisseria gonorrhoeae, Chlamydia trachomatis, or Mycoplasma genitalium, diagnosed clinically on uterine, adnexal, or cervical motion tenderness. Most women are treated as outpatients with a single dose of ceftriaxone plus 14 days of doxycycline, while parenteral cefotetan or cefoxitin plus doxycycline, or clindamycin plus gentamicin, is reserved for hospitalized patients, with tubo-ovarian abscess and infertility among the major complications of delayed treatment.

Deep vein thrombosis or pulmonary embolism occurring in a patient with active malignancy, driven by tumor-derived procoagulant activity plus stasis and vascular injury. Diagnosis is confirmed by compression ultrasonography or CT pulmonary angiography, and first-line treatment is apixaban, rivaroxaban, or low molecular weight heparin continued while cancer is active.

Nonbacterial thrombotic endocarditis (marantic endocarditis) is sterile platelet-fibrin vegetations on cardiac valves associated with malignancy and autoimmune disease, notably antiphospholipid syndrome and lupus (Libman-Sacks). It rarely destroys valves but embolizes readily, so treatment is anticoagulation and management of the underlying disease.

Superficial venous thrombosis is thrombosis of a superficial vein, presenting as a tender, warm, palpable cord, often in a varicose vein. Once considered benign, extensive disease near the deep system carries a real risk of extension to deep vein thrombosis, so evaluation includes ultrasound and treatment may include prophylactic-dose anticoagulation.

Fever of unknown origin is a defined clinical syndrome, not a single diagnosis, in which fever of at least 38.3C persists for weeks despite an appropriate initial evaluation. Management is a staged, ordered search across infectious, malignant, rheumatologic, and miscellaneous causes, followed by treatment of whatever is found.

Bacteremia is the presence of viable bacteria in the blood, confirmed by positive blood cultures, that ranges from transient and clinically silent to the trigger for sepsis and septic shock requiring urgent source identification and antimicrobial therapy.

Sepsis is life-threatening organ dysfunction caused by a dysregulated host response to infection, identified by an acute rise in SOFA score of 2 points or more in a patient with known or suspected infection. Survival depends on recognizing the pattern early and completing the hour-1 bundle: lactate, blood cultures before antibiotics, broad-spectrum antibiotics such as cefepime 2 g IV every 8 hours, and 30 mL/kg crystalloid for hypotension or a lactate of 4 mmol/L or higher.