An unusual bacillus from a case of bacterial endocarditis

Abstract

The patient was a thirty-five-year-old woman when first seen in the clinic. At the age of thirteen years she had tonsillitis and sore throats. These were followed by an attack of swelling, tenderness, and redness of several joints. Aseites and edema appeared after the acute attack of rheumatism. She was told she had heart disease. At the age of sixteen her tonsils were removed. She married at twenty-four years of age and went through two pregnancies, at twenty-six and thirty years, without di&ulty. The patient gained “15 pounds during the latter pregnancy and then voluntarily reduced her weight to 104 pounds. She never felt strong again and began to have mild dypsnea on exertion. During the five months prior to her admission to Billings Hospital she had several bouts of perspiration associated with sensations of chilliness. She had a cough that was productive of mucopurulent sputum for three weeks just before hospitalization. Although the patient was in bed she experienced dull aching pain over the precordium for a few days before admission. She also had pain in the right costovertebral angle and described her urine as being “unusually dark.” Several weeks before she was first seen a finger tip was tender and swollen. The admission examination revealed a sick-looking, undernourished, dyspneic woman whose temperature was 100.4” F. The pulse rate was lOd/min., the respiratory rate was ZO/min. and the blood pressure was 112/50. The diastolic range was poorly defined and may have been lower. Other salient features of the examination included scattered petechiae in the skin, a large, hyperactive heart and a large firm palpable spleen. The precordium heaved synchronously with the heart beat. A systolic thrill was palpable over the apex of the heart. The apical thrust was diffuse and prominent. The second sound was not heard at the aortic region. A loud systolic murmur was audible over the entire precordium. A short, faint diastolic murmur was detected over the aortic region replacing the second sound. The pharynx was not inflamed. The laboratory procedures gave the following results. On May 8, May 14, and August 5, 1936, blood cultures were taken. On each occasion a bacillus was obtained in pure culture. Agglutinations with the patient’s serum against the typhoid, paratyphoid and B. abortus groups were positive only with the E. typhoszcs antigen in a dilution of l/20. The others were entirely negative. Stereoscopic x-rays of the chest showed the heart to be “slightly less than 65 per cent over-size by film tracing.” Early congestive changes were reported in both lungs. Besides a tachycardia of lOO/min. an electrocardiogram showed broad P-waves in all leads and T, to be low in amplitude. The blood Kahn was weakly positive and the Wassermann was negative. From May 8 to May 15, 1936, while the patient was in the hospital, the leucocyte count varied from 9,100 to 11,100 cell/c.mm. The differential count showed a mild absolute increase in polymorphonuclear leucocytes. A moderate secondary anemia was present at all times.