Subacute bacterial endocarditis

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Subacute bacterial endocarditis
Other namesEndocarditis lenta
Endocarditis ultrasound.gif
Vegetation of tricuspid valve by ECHO
Specialty Cardiology   OOjs UI icon edit-ltr-progressive.svg
Symptoms Malaise, weakness [1]
CausesStreptococcus mutans, mitis, sanguis or milleri bacteria [2] [3]
Diagnostic method Blood culture specimens over 24-hour period/analysis [4]
TreatmentIntravenous penicillin [2]

Subacute bacterial endocarditis, abbreviated SBE, is a type of endocarditis (more specifically, infective endocarditis). [5] Subacute bacterial endocarditis can be considered a form of type III hypersensitivity. [6]

Contents

Signs and symptoms

Among the signs of subacute bacterial endocarditis are: [1]

Causes

Streptococci Streptococci.jpg
Streptococci

It is usually caused by a form of Viridans group streptococcus bacteria that normally live in the mouth [3] ( Streptococcus mutans, mitis, sanguis or milleri). [2]

Other strains of streptococci can cause subacute endocarditis as well. These include streptococcus intermedius, which can cause acute or subacute infection (about 15% of cases pertaining to infective endocarditis). [7]

Enterococci from urinary tract infections and coagulase negative staphylococci can also be causative agents. [5]

Mechanism

The mechanism of subacute bacterial endocarditis could be due to malformed stenotic valves which, in the company of bacteremia, become infected via adhesion and subsequent colonization of the surface area. This causes an inflammatory response, with recruitment of matrix metalloproteinases and destruction of collagen. [8]

Underlying structural valve disease is usually present in patients before developing subacute endocarditis, and 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.[ medical citation needed ] In cases of subacute bacterial endocarditis, the causative organism (streptococcus viridans) needs previous heart valve disease to colonize. [9] On the other hand, in cases of acute bacterial endocarditis the organism can colonize on the healthy heart valve, causing the disease. [10]

Diagnosis

Subacute bacterial endocarditis can be diagnosed by collecting three blood culture specimens over a 24-hour period for analysis, [4] also it can usually be indicated by the existence of:

Treatment

Aminoglycoside Streptomycin2.svg
Aminoglycoside

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. [2]

Leo Loewe of Brooklyn Jewish Hospital was the first to successfully treat subacute bacterial endocarditis with penicillin. Loewe reported at the time seven cases of subacute bacterial endocarditis in 1944. [14]

See also

Related Research Articles

<i>Streptococcus</i> Genus of bacteria

Streptococcus is a genus of gram-positive or spherical bacteria that belongs to the family Streptococcaceae, within the order Lactobacillales, in the phylum Bacillota. Cell division in streptococci occurs along a single axis, thus when growing they tend to form pairs or chains, which may appear bent or twisted. This differs from staphylococci, which divide along multiple axes, thereby generating irregular, grape-like clusters of cells. Most streptococci are oxidase-negative and catalase-negative, and many are facultative anaerobes.

<span class="mw-page-title-main">Group A streptococcal infection</span> Medical condition

Group A streptococcal infections are a number of infections with Streptococcus pyogenes, a group A streptococcus (GAS). S. pyogenes is a species of beta-hemolytic Gram-positive bacteria that is responsible for a wide range of infections that are mostly common and fairly mild. If the bacteria enters the bloodstream, the infection can become severe and life-threatening, and is called an invasive GAS (iGAS).

<i>Streptococcus pyogenes</i> Species of bacterium

Streptococcus pyogenes is a species of Gram-positive, aerotolerant bacteria in the genus Streptococcus. These bacteria are extracellular, and made up of non-motile and non-sporing cocci that tend to link in chains. They are clinically important for humans, as they are an infrequent, but usually pathogenic, part of the skin microbiota that can cause Group A streptococcal infection. S. pyogenes is the predominant species harboring the Lancefield group A antigen, and is often called group A Streptococcus (GAS). However, both Streptococcus dysgalactiae and the Streptococcus anginosus group can possess group A antigen as well. Group A streptococci, when grown on blood agar, typically produce small (2–3 mm) zones of beta-hemolysis, a complete destruction of red blood cells. The name group A (beta-hemolytic) Streptococcus is thus also used.

<span class="mw-page-title-main">Impetigo</span> Human disease (bacterial infection)

Impetigo is a bacterial infection that involves the superficial skin. The most common presentation is yellowish crusts on the face, arms, or legs. Less commonly there may be large blisters which affect the groin or armpits. The lesions may be painful or itchy. Fever is uncommon.

Bloodstream infections (BSIs) are infections of blood caused by blood-borne pathogens. The detection of microbes in the blood is always abnormal. A bloodstream infection is different from sepsis, which is characterized by severe inflammatory or immune responses of the host organism to pathogens.

<i>Streptococcus pneumoniae</i> Species of bacterium

Streptococcus pneumoniae, or pneumococcus, is a Gram-positive, spherical bacteria, alpha-hemolytic member of the genus Streptococcus. S. pneumoniae cells are usually found in pairs (diplococci) and do not form spores and are non motile. As a significant human pathogenic bacterium S. pneumoniae was recognized as a major cause of pneumonia in the late 19th century, and is the subject of many humoral immunity studies.

<span class="mw-page-title-main">Infective endocarditis</span> Infection of the hearts inner surface (endocardium)

Infective endocarditis is an infection of the inner surface of the heart (endocardium), usually the valves. Signs and symptoms may include fever, small areas of bleeding into the skin, heart murmur, feeling tired, and low red blood cell count. Complications may include backward blood flow in the heart, heart failure – the heart struggling to pump a sufficient amount of blood to meet the body's needs, abnormal electrical conduction in the heart, stroke, and kidney failure.

<span class="mw-page-title-main">Viridans streptococci</span> Species of bacterium

The viridans streptococci are a large group of commensal streptococcal Gram-positive bacteria species that are α-hemolytic, producing a green coloration on blood agar plates, although some species in this group are actually γ-hemolytic, meaning they produce no change on blood agar. The pseudo-taxonomic term "Streptococcus viridans" is often used to refer to this group of species, but writers who do not like to use the pseudotaxonomic term prefer the terms viridans streptococci, viridans group streptococci (VGS), or viridans streptococcal species.

<i>Streptococcus mutans</i> Species of bacterium

Streptococcus mutans is a facultatively anaerobic, gram-positive coccus commonly found in the human oral cavity and is a significant contributor to tooth decay. It is part of the "streptococci", an informal general name for all species in the genus Streptococcus. The microbe was first described by James Kilian Clarke in 1924.

<span class="mw-page-title-main">Imipenem/cilastatin</span> Combination antibiotic medication

Imipenem/cilastatin, sold under the brand name Primaxin among others, is an antibiotic useful for the treatment of a number of bacterial infections. It is made from a combination of imipenem and cilastatin. Specifically it is used for pneumonia, sepsis, endocarditis, joint infections, intra-abdominal infections, and urinary tract infections. It is given by injection into a vein or muscle.

Streptococcus bovis is a group of strains of Gram-positive bacteria, originally described as a species, that in humans is associated with urinary tract infections, endocarditis, sepsis, and colorectal cancer. S. bovis is commonly found in the alimentary tract of cattle, sheep, and other ruminants, and may cause ruminal acidosis. It is also associated with spontaneous bacterial peritonitis, a frequent complication occurring in patients affected by cirrhosis. Equivalence with Streptococcus equinus has been contested.

Gemella morbillorum is a species of bacteria within the genus Gemella. It is a facultative anaerobic Gram positive coccus usually preferring capnophilic or microaerophilic environments. From its discovery in 1917 until 1988, it was known as Streptococcus morbillorum. The name change followed closer examination with DNA filter hybridization which found it was very close to the species Gemella haemolysans.

<i>Streptococcus sanguinis</i> Species of bacterium

Streptococcus sanguinis, formerly known as Streptococcus sanguis, is a Gram-positive facultative anaerobic coccus species of bacteria and a member of the Viridans Streptococcus group. S. sanguinis is a normal inhabitant of the healthy human mouth where it is particularly found in dental plaque, where it modifies the environment to make it less hospitable for other strains of Streptococcus that cause cavities, such as Streptococcus mutans.

<span class="mw-page-title-main">Acute proliferative glomerulonephritis</span> Medical condition

Acute proliferative glomerulonephritis is a disorder of the small blood vessels of the kidney. It is a common complication of bacterial infections, typically skin infection by Streptococcus bacteria types 12, 4 and 1 (impetigo) but also after streptococcal pharyngitis, for which it is also known as postinfectious glomerulonephritis (PIGN) or poststreptococcal glomerulonephritis (PSGN). It can be a risk factor for future albuminuria. In adults, the signs and symptoms of infection may still be present at the time when the kidney problems develop, and the terms infection-related glomerulonephritis or bacterial infection-related glomerulonephritis are also used. Acute glomerulonephritis resulted in 19,000 deaths in 2013, down from 24,000 deaths in 1990 worldwide.

Pneumococcal infection is an infection caused by the bacterium Streptococcus pneumoniae.

<i>Streptococcus anginosus</i> group Species of bacterium

The Streptococcus anginosus group (SAG), also known as the anginosus group streptococci (AGS) or the milleri group streptococci (MGS), are a group of several species of streptococci with clinical similarities. The group is named after a principal member species, Streptococcus anginosus. The older name Streptococcus milleri is now pseudotaxonomic, as the idea that these streptococci constituted a single species was incorrect. The anginosus group streptococci are members of the viridans streptococci group. They have been implicated as etiologic agents in a variety of serious purulent infections, but because of their heterogeneous characteristics, these organisms may be unrecognized or misidentified by clinical laboratorians. The unique characteristic of them from other pathogenic streptococci, such as S. pyogenes and S. agalactiae, is their ability to cause abscesses.

<i>Streptococcus dysgalactiae</i> Species of bacterium

Streptococcus dysgalactiae is a gram positive, beta-haemolytic, coccal bacterium belonging to the family Streptococcaceae. It is capable of infecting both humans and animals, but is most frequently encountered as a commensal of the alimentary tract, genital tract, or less commonly, as a part of the skin flora. The clinical manifestations in human disease range from superficial skin-infections and tonsillitis, to severe necrotising fasciitis and bacteraemia. The incidence of invasive disease has been reported to be rising. Several different animal species are susceptible to infection by S. dysgalactiae, but bovine mastitis and infectious arthritis in lambs have been most frequently reported.

Acute infectious thyroiditis (AIT) also known as suppurative thyroiditis, microbial inflammatory thyroiditis, pyrogenic thyroiditis and bacterial thyroiditis.

Anaerobic infections are caused by anaerobic bacteria. Obligately anaerobic bacteria do not grow on solid media in room air ; facultatively anaerobic bacteria can grow in the presence or absence of air. Microaerophilic bacteria do not grow at all aerobically or grow poorly, but grow better under 10% carbon dioxide or anaerobically. Anaerobic bacteria can be divided into strict anaerobes that can not grow in the presence of more than 0.5% oxygen and moderate anaerobic bacteria that are able of growing between 2 and 8% oxygen. Anaerobic bacteria usually do not possess catalase, but some can generate superoxide dismutase which protects them from oxygen.

There are many circumstances during dental treatment where antibiotics are prescribed by dentists to prevent further infection. The most common antibiotic prescribed by dental practitioners is penicillin in the form of amoxicillin, however many patients are hypersensitive to this particular antibiotic. Therefore, in the cases of allergies, erythromycin is used instead.

References

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  13. Clubbing of the Nails~clinical at eMedicine
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Further references