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Long lasting subacute bacterial endocarditis often presents with marked anemia. Infective mechanisms and hemolysis are considered as most important pathophysiological mechanisms. Pronounced hemolytic anemia, thrombocytopenia and edema observed in two cases are possible misleading symptoms in the diagnosis of subacute bacterial endocarditis.
Bacterial aneurysms are aneurysms which develop on a vascular wall weakened as a result of a bacterial infection. They can develop anywhere. This paper describes a female patient with subacute bacterial endocarditis and multiple cerebral aneurysms. Conservative treatment followed.
Fourteen episodes of subacute bacterial endocarditis in 11 children were successfully treated with antibiotics, which in 13 cases were given largely by mouth. It is suggested that oral treatment of bacterial endocarditis should be considered for children who are only moderately but not severely ill, and who have sensitive organisms.
A classification, according to the Lancefield's method, of the streptocoques isolated in the blood, after teeth extractions, as well as a determination of their sensibility to the antibiotics, are attempted in this study. It concerns to 23 adults, well supported, to whom multiple extractions, under general anesthesia have been done. We studied both biochemical and serological reactions, and a test for the antibiotic resistance is realised. We insiste in the contrindiction of streptomycine and sulfanilamides in the treatment or the prevention of bacteremia of dental origine.
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A case of subacute bacterial endocarditis due to Streptococcus mutans is presented. The case was successfully treated by intravenous and oral penicillin. Streptococcus mutans is a member of the viridans streptococcal group with properties similar to enterococcal streptococci. Since the enterococci are resistant to penicillin, and isolates of Streptococcus mutans are usually sensitive to penicillin, it is important that medical technologists and microbiologists accurately identify these organisms. The combination of the following characteristics: 1) lack of Group D antigen, 2) acid formation in mannitol broth, 3) failure to hydrolyze hippurate, and 4) formation in five per cent sucrose broth of gelatinous adherent deposits on walls and bottom of tube, distinguish Streptococcus mutans from enterococcal streptococci.
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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.
Six strains of viridans streptococci isolated from confirmed cases of subacute bacterial endocarditis were studied for production of extracellular material. All six strains, when grown to the exponential phase, produced exoproducts that had similar elution profiles on a G-100 Sephadex column. Since essential nutrients, such as amino acids, may be periodically growth limiting to streptococci in the fibrin-covered lesions on heart valves, the potential to elaborate extracellular protein and other material by streptococci that were deprived of essential amino acids was studied. Examination of supernatant fluids from cultures of Streptococcus MG intermedius deprived of glutamate and cystine revealed the presence of a complex mixture of extracellular materials in amounts comparable to those produced by normallly growing cells, Although only a slight (21 to 24%) increase in total protein occurred during amino acid deprivation of 12 h, the extracellular material contained numerous protein components, several of which demonstrated proteolytic activity. On a cell dry weight basis, the amino acid-deprived cells produced four-to eightfold more protease(s) than did exponential cells grown in complete medium. These results demonstrate that viridans streptococci are capable of elaborating potentially damaging compounds even when their multiplication has been arrested by nutritional deprivation.
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The case of a patient who had palpable purpura on his lower extremities due to Lactobacillus-caused subacute bacterial endocarditis is reported. Histologic examination of the purpuric lesions demonstrated a leukocytoclastic angiitis. It is postulated that purpuric and other cutaneous lesions of subacute bacterial endocarditis are related to circulating immune complexes.
In the high-dose benzylpenicillin treatment of subacute bacterial endocarditis leucopenia can develop in rare cases. Often it is paralleled by anemia, sometimes also by a decrease in the number of platelets. Myalgia, gastric discomfort, or a sore threat deserve interest as premonitory symptoms. In every case this treatment inevitably needs through hematologic control.
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The case of a 49-year-old woman is described in which the presenting symptom of subacute bacterial endocarditis was the rare condition of a prepapillary abscess. There was a rapid decrease in visual acuity in the patient's left eye 10 days after the onset of an influenza-like episode, and ophthalmological examination revealed a pus-containing formation covering the optic disc, star-figure exudates in the macula, and some retinal hemorrhages with white centers. These findings in a patient known to have old valvular stenosis indicated a diagnosis of subacute bacterial endocarditis which was confirmed by further investigation. Both forms of endogenous primary retinitis were present in the same eye, i.e. (1) acute suppurative metastatic retinitis in the form of a prepapillary abscess and (2) subacute focal retinitis with the characteristic Roth's spots. Intensive antibiotic treatment was instituted, and within one month the prepapillary abscess was resorbed, with a parallel improvement in the general condition of the patient.
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