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PubMed1984

Glomerulonephritis in bacterial endocarditis.

The introduction of antibiotic therapy and changing epidemiologic patterns have altered the nature of glomerulonephritis as it occurs during the course of bacterial endocarditis. Observations made predominantly in the pre-antibiotic era suggested that infections with less virulent organisms, by virtue of their indolent subacute course, favored an antibody response predisposing to immune complex glomerulonephritis. Although antibiotic prophylaxis and therapy have reduced the incidence of both Streptococcus viridans bacterial endocarditis and concomitant glomerulonephritis, Staphylococcus aureus has become a major cause of acute bacterial endocarditis with a high incidence of glomerulonephritis. Parenteral drug abuse itself, which has emerged as a major factor predisposing to endocarditis, may also favor the development of glomerulonephritis. The course of glomerulonephritis has been altered in association with these changes in etiology and epidemiology. This review summarizes the clinical and morphologic features of glomerulonephritis as it currently occurs during the course of bacterial endocarditis.

Antigen-Antibody Complex↗
PubMedDate not supplied

The "incubation period" of subacute bacterial endocarditis.

In an attempt to gain information about the "incubation period" of subacute bacterial endocarditis, the literature was searched for case reports stating a specific interval between an event likely to cause bacteremia and the onset of symptoms. In 76 cases of streptococcal endocarditis for which this information was given, the median "incubation period" was one week. Symptoms began within two weeks in 64 of these cases (84%). Although there may be a bias toward reporting short incubation periods, it is concluded that the incubation period of subacute bacterial endocarditis is often shorter than is generally realized, and that procedures carried out more than two weeks before onset of symptoms are less likely to be causally related. In postcardiotomy cases, where timing of the bacteremia causing endocarditis is less easy to define, 27% of 122 cases of staphylococcal endocarditis developed within two weeks of surgery. This information is relevant to the planning and evaluation of prophylactic chemotherapy against bacterial endocarditis.

Cardiac Surgical Procedures↗
PubMed1975

Bacterial endocarditis in subjects 60 years of age and older.

Forty-two cases of bacterial endocarditis with pathologic confirmation are reviewed. Infection was restricted to one or both left-sided valves in 31 cases, right-sided valves in five cases, and valves in both sides of the heart in six cases. In those specimens available for review, underlying valvular disease was identifiable in 24 of 38 cases (63%). The common underlying diseases, in order of decreasing frequency, were calcified or otherwise deformed aortic valves (11 cases) and rheumatic fibrosis of the mitral valve (eight cases). The floppy mitral valve was the underlying condition in two cases and amyloid infiltration of the tricuspid valve in one. Among the 34 cases from which a specific organism was identified, the dominant organisms were Staphylococcus (14 cases) and various types of Streptococci(ten cases). Fungi were the causative organisms in two cases. The clinical suspicion for the presence of bacterial endocarditis was low (40% of 40 cases with adequate data). In those cases with adequate data, murmurs were present in 68% and fever in 93%. Of those patients with fever, clinical diagnosis was made or suspected in only 38%. When a murmur was present, the clinical diagnosis was made or suspected in 54% of the cases, while when a murmur was absent the disease was suspected in only 9% of the cases. The clinical diagnosis of bacterial endocarditis in older subjects depends upon 1) knowledge that the disease may occur in such subjects and 2) recognition that, although fever is commonly present, murmurs may be absent.

Age Factors↗
PubMed1998

Combined mitral and aortic homograft valve replacement for acute bacterial endocarditis.

Homograft replacement of the aortic valve in cases of acute bacterial endocarditis is considered the ideal choice because of the resistance of the homograft to reinfection. We report a case of aortic and mitral valve bacterial endocarditis, secondary to Streptococcus viridans, with severe aortic and mitral valve regurgitation and hemodynamic instability requiring surgical interventions with the use of aortic and mitral valve homografts.

Acute Disease↗
PubMed1984

Neurologic complications in a group of 86 bacterial endocarditis.

Criteria defined by von Reyn were applied to 86 cases of bacterial endocarditis. Neurologic complications (NC) were categorized according to Pruitt definitions. Neurologic accidents were observed in 48 cases. They were the first clinical manifestation in 20 patients. Neurologic events were of poor prognosis in BE, mortality increasing from 26% in patients without NC to 83% in patients with NC (P less than 0.01). Two factors affect the incidence of NC: first, the location of endocarditis with 76% of NC in mitral valve endocarditis compared with 37% in other cases (P less than 0.005); and second the infecting organism: 71% of NC in staphylococcus aureus endocarditis versus 45% in endocarditis with other bacteria (P less than 0.02). Cerebral embolism was the most common NC (25 cases) related to an occlusion of the middle cerebral artery in 21 cases with a fatal outcome in 19 patients. Other NC included 15 intracranial hemorrhages with the evidence of an aneurysm in 4 cases, 6 septic meningitis, 2 macroscopic abscesses, and 2 multiple microscopic abscesses. This study emphasizes the high rate and severity of NC in staphylococcal mitral endocarditis despite antibiotic therapy and supports early surgery in this group of bacterial endocarditis.

Adolescent↗
PubMed1984

[Prevention of bacterial endocarditis. Recommendations of the Swiss Work Group for the Prevention of Endocarditis].

Recommendations of the Swiss Working Group for Prophylaxis of bacterial endocarditis. Despite the lack of definitive evidence for the efficacy of antibiotics in the prevention of bacterial endocarditis (BE) in man, it is accepted practice for antibiotics to be administered to patients at risk of developing BE following a diagnostic or therapeutic procedure which may cause bacteremia. The prophylactic regimens so far recommended are cumbersome and compliance is poor. An attempt is made to unify and simplify Swiss recommendations, taking into account the authors' own recent experimental results, pharmacological data, and clinical experience. It is proposed that the patients be classified into two risk groups: First, patients with congenital and acquired heart disease, previous palliative or non-definitive cardiac surgery, mitral valve prolapse with mitral insufficiency, and hypertrophic obstructive cardiomyopathy should be considered at moderate risk. For those patients a single dose of an orally administered antibiotic should be given 1 h before the procedure. The first choice antibiotic should be amoxicillin (3 g orally) for all procedures, except when S. aureus is likely to cause bacteremia (i.e. after drainage of abscesses, where flucloxacillin (2 g orally) should be used 1 h before the procedure). Amoxicillin is also recommended for patients receiving penicillin during the days prior to the procedure (for prevention of rheumatic fever, or for any other reason). Patients allergic to penicillin should be given 600 mg clindamycin orally 1 h before the procedure. Second, patients with valvular prosthesis or previous BE should be considered at high risk.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1976

Bacterial endocarditis. Echocardiographic and clinical evaluation during therapy.

In two patients with bacterial endocarditis and apparent vegetations, the echocardiographic findings included thickening but normal excursion of the mitral leaflet and abnormal shaggy echoes superimposed on the mitral leaflet echogram. Both patients had had endocarditis several weeks before the study was performed. In both patients the abnormal echoes disappeared after antibiotic therapy. Whether or not the echocardiographic findings are specific to bacterial endocarditis must be determined by further studies. One patient had evidence of "immune complex disease" with vasculitis, hypocomplementemia, and renal failure which persisted for weeks after disappearance of vegetations on the echocardiogram. This sequence was unexpected, as a continued source of antigen for this reaction was not apparent.

Adult↗