Case Of Subacute Endocarditis Research Articles

Human Bartonella Infective Endocarditis is Associated with High Frequency of Antiproteinase 3 Antibodies

To the Editor: Bartonella henselae and B. quintana are the 2 Bartonella species most commonly involved in human disease and are associated with the formation of vasoproliferative tumors1. Chronic infections are bacteremia (particularly affecting homeless patients), endocarditis, bacillary angiomatosis, and liver peliosis2. Antineutrophil cytoplasmic antibody (ANCA)-associated vasculitides are a group of diseases characterized by necrotizing vasculitis of small vessels and associated with autoantibodies against neutrophil constituents such as myeloperoxidase (MPO) and proteinase 3 (PR3)3. Granulomatosis with polyangiitis (GPA), microscopic polyangiitis (MP), and Churg-Strauss syndrome (CSS) are all forms of vasculitis associated with anti-PR3. Several chronic infectious diseases (mycobacterial infections, chronic hepatitis C virus infection, and amoebic liver abscess) have been reported to be associated with a positive ANCA by immunofluorescence, but the specificity was not always defined by ELISA-testing specificity4. A few cases of subacute endocarditis have been reported to be associated with ANCA positivity, mainly anti-PR3. A 40-year-old … Address correspondence to Dr. E. Aslangul, Internal Medicine Department, Hôtel Dieu 1, Place du Parvis Notre Dame, 75004 Paris, France. E-mail: elisabeth.aslangul{at}htd.aphp.fr

Acute and subacute bacterial endocarditis.

A recently expressed point of view maintains that differentiation between acute and subacute bacterial endocarditis is unimportant. It is true that the histopathology of these conditions is usually indistinguishable. Contrariwise, awareness of certain differences between acute and subacute endocarditis emphasizes serious clinical and therapeutic implications. Six such differences deserve emphasis. The bacteria causing the two forms, for the most part, are different. Most cases of subacute endocarditis are caused by penicillin-sensitive Streptococcus viridans , of the mouth, which probably never produces acute endocarditis. Most cases of acute endocarditis are caused by Staphylococcus aureus , though patients infected with this organism will occasionally run a subacute course. Enterococci are versatile and may produce either acute or subacute endocarditis. The pneumococcus nearly always produces an acute infection. Second: the pre-existing heart disease. It is most unusual to find subacute bacterial endocarditis in a previously normal heart. Acute endocarditis occurs far too often in hearts

The cure of a patient with a very resistant streptococcus viridans endocarditis with massive penicillin therapy (average daily dose of eighty-six million units)

The effectiveness of penicillin in the treatment of nonhemolytic streptococcal endocarditis is well established. In most cases of subacute endocarditis, cure can be accomplished with conventional doses of penicillin, but now and then it is necessary to administer heroic doses. A review of reported treatment failures due to relapse or continued infection makes it quite clear that many such patients have not been given adequate daily doses of penicillin. If the circulating blood is not promptly sterilized or if relapse occurs subsequent to completion of a course of penicillin, it has been advised that the daily dose of penicillin should be drastically increased five- to tenfold; then the arrest of the infection would probably more nearly approach 100 per cent. 1 More than 90 per cent of the strains of nonhemolytic streptococcus are completely inhibited in vitro by 0.1 unit or less of penicillin per milliliter 2 and are classified as the sensitive group. 1 The moderately to very resistant group requires for inhibition of growth in vitro 0.5 to 10 units or more of penicillin per milliliter. The moderately sensitive group is inhibited by penicillin in vitro in amounts which are between the above two ranges. It has been recommended that patients infected with an organism which requires 1 unit of penicillin per milliliter for in vitro inhibition should receive a daily dose of at least 5,000,000 units of penicillin. 1 The purpose of this communication is to report a case of subacute bacterial endocarditis in which the patient was infected with a very resistant strain of Streptococcus viridans treated with an average daily dose of approximately 86,000,000 units of penicillin for a period of twenty-eight days.

MONILEMIA ASSOCIATED WITH TOXIC PURPURA

Several cases of infections of the blood stream with closely related strains of Monilia (e. g., Candida parakrusei), all occurring in drug addicts, have been found recently. A case of subacute endocarditis with systemic mycosis 1 and another case, almost identical except that there was cerebral involvement, 2 have been reported, with detailed autopsy observations. The organism in both cases was identified as C. (Monilia) parakrusei. In the present case, this organism was cultured from the blood stream of a patient, a drug addict, four days before his death. The clinical course and the autopsy observations were quite different from those in the 2 cases previously reported and may have been due to an unrelated, coincidental idiosyncrasy to a drug. Nevertheless, close study of the clinical record failed to rule out the possibility that the whole picture was one of invasion of the blood stream by C. (M.) parakrusei, and

MYCOTIC ENDOCARDITIS

Endocarditis due to fungi is an exceedingly rare clinical entity. Joachim and Polayes1described a case of subacute endocarditis with systemic mycosis (moniliasis) in a drug addict and referred to another case in which autopsy revealed evidence of mycotic endocarditis. The following case, also in a drug addict, is similar in many respects to that of Joachim and Polayes and is considered worthy of reporting because of its apparent rarity, and because of its possible public health importance, since these cases occurred in drug addicts. A white man aged 49 was admitted to the United States Public Health Service Hospital on May 11, 1940 for treatment of drug addiction (heroin) which dated from 1914. His previous medical and personal history showed nothing relevant to the present report. Physical examination on admission was negative except for many missing and some artificial teeth, defective vision and hemorrhoids. Serologic tests for syphilis

FINAL REPORT ON THE IDENTIFICATION OF THE ORGANISM OF THE PREVIOUSLY REPORTED CASE OF SUBACUTE ENDOCARDITIS AND SYSTEMIC MYCOSIS (MONILIA)

In the report of the first case of subacute endocarditis with systematic moniliasis ever to have been clinically diagnosed and published¹it was not possible to state the identity of the causative organism, although it was definitely known to be a species of Candida (Monilia). Since then, however, studies of cultures which had been submitted to the Division of Infectious Diseases of the U. S. Public Health Service have led to the definite identification of the fungus as Candida (Monilia) parakrusei. Because numerous requests have been made for the final results of our studies, it was deemed advisable to publish them at this time. The following, therefore, is a brief summary of the mycologic studies of the organism, including some of the more pertinent features mentioned in the previous publication. The present report also affords us the opportunity to publish a reproduction of a photomicrograph of a typical smear

HEART FAILURE IN SUBACUTE BACTERIAL ENDOCARDITIS

Heart failure is often regarded as one of the important negative features of subacute bacterial endocarditis. Attention has been repeatedly directed to the absence of myocardial insufficiency in the disease. In this respect subacute bacterial endocarditis has been contrasted with rheumatic carditis, in which heart failure may be prominent in the clinical picture and may exist in a chronic and advanced form. However, it is generally admitted that heart failure may make its appearance during the late stages of the disease. Toxemia, a prominent factor in subacute bacterial endocarditis, has commonly been considered causal. A short outline of the literature concerning the role of heart failure in subacute bacterial endocarditis is given in this paper, and the opinions on the character and extent of the anatomic changes in the myocardium in this disease are discussed. Observations in 40 cases of subacute endocarditis are presented, with special attention to evidence of

SUBACUTE ENDOCARDITIS SIMULATING MENINGITIS

Frank emboli of the brain are not uncommon in endocarditis of the acute or subacute variety and are usually manifest by hemiplegia, monoplegia or paralysis of a cranial nerve, but emboli producing symptoms of meningitis have only rarely been reported. In an article on subacute endocarditis, Osler 1 spoke of cases showing predominant meningeal symptoms but did not go into detail. My purpose in this paper is to record a case in which, as a complication of a subacute endocarditis, an accompanying meningitis occurred. Such complications are rare, yet they probably occur much more frequently than would seem to be the case, for in many such instances the usual diagnosis made is that of encephalitis. REPORTS OF CASES IN THE LITERATURE P. Lereboullet and J. Mouzon reported 2 a case of subacute endocarditis or, as the French call it, prolonged infectious endocarditis, which showed meningeal symptoms. Their patient had severe

A Case of Subacute Endocarditis With Aortic Valve and Pulmonary Artery Involvement

A Case of Subacute Endocarditis With Aortic Valve and Pulmonary Artery Involvement