Subacute bacterial endocarditis
| Subacute bacterial endocarditis | |
|---|---|
| Classification and external resources | |
| ICD-10 | I33.0 |
| ICD-9 | 421.0 |
| MeSH | D004698 |
Subacute bacterial endocarditis (also called endocarditis lenta) is a type of endocarditis (more specifically, infective endocarditis).
It can be confused with essential mixed cryoglobulinemia.[1]
It can be considered a form of Type III hypersensitivity.[2]
Diagnosis
Osler's nodes as well as Roth's spots can indicate this condition.[3] Nail clubbing is also often seen in subacute endocarditis.
Causes
It is usually caused by a form of streptococci viridans bacteria that normally live in the mouth and throat (Streptococcus mutans, mitis, sanguis or milleri). Other strains of streptococci (bovis and equines) can also cause subacute endocarditis, usually in patients who have a form of gastrointestinal cancer. Additional causes are Enterococci (urinary tract infections) and coagulase negative staphylococci such as Staphylococcus epidermidis (skin).
Prognosis
Underlying structural valve disease is usually present in patients before developing subacute endocarditis. It is less likely to lead to septic emboli than is acute endocarditis, but subacute endocarditis has a relatively slow process of infection and, if left untreated, can worsen for up to one year before it is fatal.
Summary
In cases of subacute bacterial endocarditis, the causative organism (streptococcus viridans) needs a previous heart valve disease to colonize and cause such disease.
On the other hand, in cases of acute bacterial endocarditis, the organism can colonize on the healthy heart valve, causing the disease.
Treatment
The standard treatment is with a minimum of four weeks of high-dose intravenous penicillin with an aminoglycoside such as gentamicin. The use of high-dose antibiotics is largely based upon animal models.[4] Leo Loewe of Brooklyn Jewish Hospital was the first to successfully treat subacute bacterial endocarditis with penicillin. Loewe reported seven cases in 1944.[5]
References
- ↑ Agarwal A, Clements J, Sedmak DD et al. (December 1997). "Subacute bacterial endocarditis masquerading as type III essential mixed cryoglobulinemia". J. Am. Soc. Nephrol. 8 (12): 1971–6. PMID 9402102.
- ↑ "Definition: immune complex disease from Online Medical Dictionary".
- ↑ "Osler nodes" at Dorland's Medical Dictionary
- ↑ Verhagen DW, Vedder AC, Speelman P, van der Meer JT (2006). "Antimicrobial treatment of infective endocarditis caused by viridans streptococci highly susceptible to penicillin: historic overview and future considerations". J. Antimicrob. Chemother. 57 (5): 819–24. doi:10.1093/jac/dkl087. PMID 16549513.
- ↑ LEO LOEWE, M.D.; PHILIP ROSENBLATT, M.D.; HARRY J. GREENE, M.D.; MORTIMER RUSSELL. COMBINED PENICILLIN AND HEPARIN THERAPY OF SUBACUTE BACTERIAL ENDOCARDITIS. JAMA 1944;124(3):144-149
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