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Janeway lesions are non-tender, small, erythematous or hemorrhagic macular or nodular lesions on the palms and soles that are pathognomonic of infective endocarditis. Infective endocarditis is a form of endocarditis or inflammation of the inner tissues of the heart (such as its valves) caused by infectious agents. The presence of Janeway lesions indicates the systemic impact of the infection, often involving the formation of microemboli that travel to distal sites, including the skin. These lesions are a result of septic emboli which cause microabscesses in the superficial layers of the skin. Unlike Osler's nodes, which are tender, raised lesions found on the hands and feet, Janeway lesions are not painful.

Etiology

Janeway lesions are primarily associated with infective endocarditis, a condition often caused by bacteria such as Staphylococcus aureus, Streptococcus viridans, and Enterococci. These organisms can enter the bloodstream through various means, including dental procedures, intravenous drug use, or the presence of indwelling catheters. Once in the bloodstream, they can adhere to damaged heart valves or other endothelial surfaces, leading to the formation of vegetations. These vegetations can fragment, leading to septic embolization and the formation of Janeway lesions.

Pathophysiology

The pathogenesis of Janeway lesions involves the deposition of immune complexes in the small vessels of the skin. This is followed by complement activation, recruitment of inflammatory cells, and subsequent hemorrhage and microabscess formation. The lesions are a manifestation of systemic infection and embolization, reflecting the severity of infective endocarditis.

Clinical Presentation

Patients with Janeway lesions typically present with other signs and symptoms of infective endocarditis, including fever, chills, malaise, and evidence of embolic phenomena elsewhere in the body. The lesions themselves are non-tender, erythematous to hemorrhagic, and can be found on the palms and soles. Their presence, along with other physical findings such as Osler's nodes, Roth's spots, and a new or changed heart murmur, can help in the diagnosis of infective endocarditis.

Diagnosis

The diagnosis of infective endocarditis and the presence of Janeway lesions involves a combination of clinical evaluation, blood cultures, and echocardiography. The Duke criteria, a widely used diagnostic tool, incorporates both clinical and laboratory findings to establish a diagnosis. Janeway lesions, while specific, are not included in the Duke criteria but support the diagnosis of infective endocarditis when present.

Treatment

The treatment of infective endocarditis involves prolonged antibiotic therapy, often requiring hospitalization for intravenous antibiotics. The choice of antibiotic regimen depends on the causative organism and its antibiotic sensitivities. In some cases, surgical intervention may be necessary to repair or replace damaged heart valves or to remove large vegetations.

Prognosis

The prognosis of infective endocarditis varies depending on several factors, including the causative organism, the presence of complications, and the timeliness of treatment initiation. The presence of Janeway lesions indicates systemic embolization, which may be associated with a more complicated clinical course.

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