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PubMed1986

New concept in chemoprophylaxis of bacterial endocarditis resulting from dental treatment.

Bacteremia following dental procedures may lead to bacterial endocarditis in susceptible patients. Traditional methods of chemoprophylaxis with a parenteral loading dose of penicillin followed by oral penicillin have proved impractical outside the hospital. In 1978, it was suggested in England that amoxicillin be substituted as the drug of choice in the prophylaxis of bacterial endocarditis. The recommended mode of treatment was a single oral dose of 3 g amoxicillin administered 1 hour before onset of the dental procedure. Amoxicillin is absorbed to a greater extent and more rapidly than penicillin V. It maintains its effectiveness throughout the critical postoperative period at concentrations well over the minimum necessary to combat Streptococcus viridans. Amoxicillin has two mechanisms of protection: bactericidal and inhibition of bacterial adherence to the thrombotic vegetation on injured heart valves. Data obtained from 206 susceptible patients undergoing dental treatment under chemoprophylaxis with amoxicillin showed that in no case did infective endocarditis occur. Only in 13.1% of the patients could very mild side effects of this drug be observed. With this new method, there is a higher incidence of patient compliance and administration is easier to supervise.

Adult↗
PubMed1984

Mycotic aneurysm of the sinus of Valsalva due to Eikenella corrodens bacterial endocarditis.

A patient with a left sinus of Valsalva aneurysm secondary to bacterial endocarditis involving an unusual pathogen, Eikenella corrodens, is presented. This case and a review of previous reports on mycotic sinus of Valsalva aneurysm are analyzed. The distinctive M-mode and two-dimensional echocardiographic patterns of a sinus of Valsalva aneurysm as well as the usefulness and limitations of echocardiography in this condition are discussed. This rare complication of bacterial endocarditis can be diagnosed and clinically followed by serial echocardiographic studies, and its presence alone does not necessitate surgical intervention.

Adult↗
PubMedDate not supplied

Spinal epidural abscess: an unusual complication of bacterial endocarditis.

We are reporting a case of epidural abscess complicating bacterial endocarditis. To the best of our knowledge, this association has not been reported before. Streptococcus sanguis was isolated from the blood. A full recovery followed surgery and antibiotic therapy. The relevant characteristics of both diseases are reviewed. No explanation for this rare association is available as yet.

Abscess↗
PubMed2001

Massive hematuria due to right renal artery mycotic pseudoaneurysm in a patient with subacute bacterial endocarditis.

A 40-year-old woman with recently diagnosed bacterial endocarditis was admitted to the hospital with gross hematuria and anemia. Computed tomography revealed a large right upper pole renal artery pseudoaneurysm, a wedge-shaped hypoperfused region of the left kidney, and a splenic abscess. Radiographic embolization of the right renal artery was performed to stabilize the bleeding. The splenic abscess was drained. Subsequent right nephrectomy and splenectomy were performed for persistent leukocytosis. This unusual presentation of a septic embolus and its management are discussed.

Abscess↗
PubMed1984

Bacterial endocarditis presenting as acute vertebral osteomyelitis: 14 cases.

Association between bacterial endocarditis (BE) and vertebral osteomyelitis (VO) has infrequently been noted. In a retrospective analysis of BE (280 cases) and VO (150 cases) 14 cases were found to have this association. There were 12 males and 2 females, ages ranging from 39 to 72 years, mean age 56.6. Blood cultures were positive for Streptococcus viridans (6 cases). Str. faecalis (4 cases), staphylococcus (2 cases), Gram negative bacteria (1 case). Organism was not isolated in one case. Fever and severe back pain antedate the diagnosis of VO 3.5 and 2.5 months. X rays films of the spine and bone scans (4 cases) revealed lumbar (6 cases) or cervical (4 cases), or dorsal (3 cases) or combined cervical and dorsal (1 case) locations. History of murmur (4 cases) and development of mitral (8 cases) or aortic (4 cases) or combined mitral and aortic (2 cases) insufficiencies were consistent with concomitant BE. Echocardiogram revealed vegetations in 6 out of 9 cases. Patients received antibiotic therapy for 3.5 months. Ten patients were cured with antibiotics only, 4 required valve replacement. One died. Thus age, sex, history of heart disease, valvular involvement, duration of symptoms prior to admission and bacteriological pictures are the same in BE with VO as in BE without VO. Survival rates are also the same if early recognition of BE and VO with prompt and prolonged antibiotic therapy may prevent severe haemodynamic or vertebral problems.

Acute Disease↗