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Value of the serum bactericidal test in management of patients with bacterial endocarditis.

A review is given of the available clinical data on the prognostic value of the serum bactericidal test in the treatment of patients with bacterial endocarditis. It is concluded that the test, even when performed in a standardized manner, does not provide useful information for the majority of patients with bacterial endocarditis. Until further clinical data are available, routine performance of the test in patients with bacterial endocarditis is not recommended.

Anti-Bacterial Agents↗

[The prevention of bacterial endocarditis].

The paper examines the prevention of bacterial endocarditis in risk patients undergoing outpatient treatment. The hypothesis of possible bacteremia provoked by either diagnostic or therapeutic surgery should be carefully assessed. For this purpose antibiotic prophylaxis should be commenced, using different methods and doses according to the type of patient, in association with hygienic and behavioural norms which the specialist will recommend and monitor.

Anti-Bacterial Agents↗

Reliability and clinical relevance of detection of vegetations by echocardiography in bacterial endocarditis.

The efficacy of M-mode echocardiography in identifying vegetations and the clinical relevance of such a finding were evaluated in 36 patients with bacterial endocarditis, 18 of whom had pre-existing valvar lesions. Of 22 patients with vegetations demonstrated by echocardiography, 21 had major complications of bacterial endocarditis and eight died, whereas only eight of the 14 patients without detectable vegetations had similar complications and only two died. Nine of the 11 patients with pre-existing valvar lesions and echocardiographic evidence of vegetations came to operation or necropsy, and in eight of these the presence of vegetations was confirmed. In the other, none was found at surgery performed after an interval of six months. M-mode echocardiography can reliably detect vegetations in patients with bacterial endocarditis even in the presence of pre-existing valvar lesions, and may permit the identification of a subset of high risk patients who may need early surgery.

Adolescent↗

Anti-MPO-ANCA-positive microscopic polyangiitis following subacute bacterial endocarditis.

Although infectious agents such as Staphylococcus aureus have been implicated in the pathogenesis of Wegener's granulomatosis, the role of bacterial infections in the pathogenesis of other types of small-vessel vasculitides associated with antineutrophil cytoplasmic antibodies (ANCA) is less clear. We describe a patient who developed a non-granulomatous necrotising small vessel vasculitis and perinuclear ANCA (p-ANCA) directed against myeloperoxidase (MPO) after recurrent episodes of bacterial endocarditis due to Staph. aureus. Although cytoplasmic ANCA (c-ANCA) directed against proteinase 3 have been reported in single patients with bacterial endocarditis, to our knowledge this patient is the first reported case of an anti-MPO-ANCA positive systemic vasculitis following bacterial endocarditis.

Antibodies, Antineutrophil Cytoplasmic↗

Experimental bacterial endocarditis in the opossum (Didelphis virginiana). 3. Comparison of spontaneously occurring endocarditis with that induced experimentally by pyogenic bacteria and fungi.

It was possible to induce bacterial endocarditis in opossums with single intravenous injections of Streptococcus viridans or Staphylococcus aureus. Fiftyeight percent of those animals given Streptococcus viridans developed bacterial endocarditis in which most of the lesions were on the left side of the heart. The experimentally induced streptococcal disease was similar to that which may occur spontaneously in opossums, both with respect to the distribution and structure of the vegetations. Single injections of Staphylococcus aureus resulted in endocarditis in 100% of the test animals. These lesions differed from those due to streptococci by having a relatively high frequency of right- as well as left-sided valvular disease and by being somewhat smaller than those due to streptococci.Endocarditis could not be successfully induced with injection of three different fungi.

Animals↗