Austrian syndrome

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Austrian syndrome
Other namesOsler’s triad
Streptococcus pneumoniae.jpg
Streptococcus pneumoniae is the leading cause of Austrian syndrome.
Symptoms Pneumonia, Endocarditis, and Meningitis
Causes Streptococcus pneumoniae
Risk factors Alcoholism.
Diagnostic method Rapid diagnostic test, X-Ray imaging, and Electrocardiogram
PreventionDecreased alcohol consumption.
TreatmentTreatment of Pneumonia, Endocarditis, and Meningitis
Prognosis Mortality rate of 32%.
FrequencyFewer than 60 cases reported.
Named after Robert Austrian

Austrian syndrome, also known as Osler's triad, is a medical condition that was named after Robert Austrian in 1957. The presentation of the condition consists of pneumonia, endocarditis, and meningitis, all caused by Streptococcus pneumoniae . It is associated with alcoholism due to hyposplenism (reduced splenic functioning) and can be seen in males between the ages of 40 and 60 years old. [1] Robert Austrian was not the first one to describe the condition, but Richard Heschl (around 1860s) or William Osler were not able to link the signs to the bacteria because microbiology was not yet developed.

Contents

Epidemiology

Signs of Austrian syndrome usually begin in Caucasian [2] males over 40. A study shows that middle-aged men with alcohol issues make up most patients with Austrian syndrome. [3]

Causes

The leading cause of Osler's triad (Austrian syndrome) is Streptococcus pneumoniae, which is usually associated with heavy alcohol use. The condition was named Osler's triad because of its associations with pneumonia, meningitis, and endocarditis. Excessive consumption of alcohol would put the user at risk. It was determined that alcoholism completed the tetrad of associated conditions.

The oldest recorded patient with Austrian syndrome had a history of health concerns such as hypertension, and diabetes mellitus which increased her risk of Austrian syndrome. [4] [5]

Pathophysiology

Osler's triad, also known as Austrian syndrome, was first introduced in the 19th century. Streptococcus pneumoniae is the cause of Osler's triad of meningitis, pneumonia, and endocarditis. The portal of entry for this triad is said to be the lungs, followed by meningitis and endocarditis. Significant risk factors are heavy alcohol consumption, old age, splenectomy, immunosuppression, etc. Endocarditis typically involves the aortic valve. The native aortic valve is the most frequent vegetation site for Streptococcus pneumoniae and is considered the most common cardiac lesion. [5] In fact it is a historic misnomer because Richard Heschl described the signs before Osler did, but he described this in german, so it got lost in the literature and the name was Osler's triad.

Signs and symptoms

The presentation of Austrian syndrome includes symptoms from all three of the triad: pneumonia, endocarditis, and meningitis. [3] Cough-producing mucus, shortness of breath, and chest pains during cough are associated with pneumonia.

Diagnosis

Early diagnosis of Austrian syndrome is beneficial. The disease is usually diagnosed later in an individual's life because it mostly affects older Caucasian men. Multiple tests are performed to determine if an individual has Austrian syndrome. Bacterial cultivation is the main method in diagnosing Streptococcus pneumoniae.

Rapid diagnostic test is when a liquid sample of the ear or nasal discharge is collected. In terms of Streptococcus pneumoniae, it is also used to confirm the causative bacterium. [6]

X-Ray imaging of the chest is performed to determine lung inflammation and aortic regurgitation.

Electrocardiogram is used to measure the sound waves of the heart. A physical exam is performed on lung and heart cavities and a spinal tap is also performed to collect cerebrospinal fluid.

Treatment

Since Austrian syndrome consists of meningitis, pneumonia and endocarditis, there are separate treatments for each. Pneumonia and endocarditis are usually treated with beta-lactam therapy penicillin, which has been said to be the most effective but sources have said that some bacterial strains are resistant to penicillin. High doses of penicillin do not affect pneumonia. Before penicillin was used for treatment, pneumococcus was a cause of several endocarditis cases. [5] Also, for endocarditis, a valve replacement would be performed to avoid cardiogenic shock. For meningitis, intravenous antibiotics are used. Earlier studies suggest that dexamethasone [7] improved the outcome of adults with pneumococcal meningitis. [5] In a specific case study, a patient who had symptoms of a fever and headache was treated with cefotaxime, ampicillin, [8] and dexamethasone and had to undergo an emergency valve surgery since the EKG showed mitral vegetation. [9]

Prognosis

In the 19th century, the mortality rate of Austrian syndrome was about 75%; it has since decreased to approximately 32%. [4] The mortality percentage is higher in immunocompromised individuals. Austrian syndrome's symptoms, including pneumonia, endocarditis, and meningitis, all have high mortality rates. [10]

Prevention

Decreased alcohol consumption is an effective way to lower the chances of developing Austrian syndrome. The incidence rate has reduced since the introduction of beta-lactam therapy in the early 1940s. Additionally, the introduction of the pneumococcal vaccination in 1977 further decreased the incidence of infection. However, 14% of patients don't have risk factors. [4]

Research

Due to the rarity of the syndrome, with fewer than 60 cases reported, there has not been much research on the disease. However, there have been multiple case studies that discuss certain treatments, preventions, and diagnoses, depending on the individual. In a case study, an individual who had absolutely no history of alcohol abuse presented symptoms of the triad, such as low fever, myalgia, cough, and breathlessness. He had abnormal pupils, which indicated injury to the brain. A CT scan was performed, and CSF analysis showed 78 cells/mm3 a low glucose concentration, and positive latex agglutination. [11] The individual was treated with Ceftriaxone which caused the aortic valve to swell up so Vancomycin and Carbapenam were used next in the treatment process and the individual responded well and was able to recover at home with intensive therapy. [12] So antibiotics are used as tools of treatment. In another case of Austrian syndrome, a 76-year old woman with diabetes mellitus, [13] hypertension [14] and chronic cervical and lumbar degenerative disease presented with the disease. [5]

Related Research Articles

<i>Streptococcus</i> Genus of bacteria

Streptococcus is a genus of gram-positive coccus 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, so as they grow, they tend to form pairs or chains that 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">Pneumonia</span> Inflammation of the alveoli of the lungs

Pneumonia is an inflammatory condition of the lung primarily affecting the small air sacs known as alveoli. Symptoms typically include some combination of productive or dry cough, chest pain, fever, and difficulty breathing. The severity of the condition is variable.

<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 enter the bloodstream an infection can become severe and life-threatening, and is called an invasive GAS (iGAS).

Atypical pneumonia, also known as walking pneumonia, is any type of pneumonia not caused by one of the pathogens most commonly associated with the disease. Its clinical presentation contrasts to that of "typical" pneumonia. A variety of microorganisms can cause it. When it develops independently from another disease, it is called primary atypical pneumonia (PAP).

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

Streptococcus pneumoniae, or pneumococcus, is a Gram-positive, spherical bacteria, alpha-hemolytic member of the genus Streptococcus. They 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> Medical condition

Infective endocarditis is an infection of the inner surface of the heart, 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">Lower respiratory tract infection</span> Medical term

Lower respiratory tract infection (LRTI) is a term often used as a synonym for pneumonia but can also be applied to other types of infection including lung abscess and acute bronchitis. Symptoms include shortness of breath, weakness, fever, coughing and fatigue. A routine chest X-ray is not always necessary for people who have symptoms of a lower respiratory tract infection.

<span class="mw-page-title-main">Bacterial pneumonia</span> Disease of the lungs

Bacterial pneumonia is a type of pneumonia caused by bacterial infection.

Streptococcus suis is a peanut-shaped, Gram-positive bacterium, and an important pathogen of pigs. Endemic in nearly all countries with an extensive pig industry, S. suis is also a zoonotic disease, capable of transmission to humans from pigs.

<span class="mw-page-title-main">Valvular heart disease</span> Disease in the valves of the heart

Valvular heart disease is any cardiovascular disease process involving one or more of the four valves of the heart. These conditions occur largely as a consequence of aging, but may also be the result of congenital (inborn) abnormalities or specific disease or physiologic processes including rheumatic heart disease and pregnancy.

Community-acquired pneumonia (CAP) refers to pneumonia contracted by a person outside of the healthcare system. In contrast, hospital-acquired pneumonia (HAP) is seen in patients who have recently visited a hospital or who live in long-term care facilities. CAP is common, affecting people of all ages, and its symptoms occur as a result of oxygen-absorbing areas of the lung (alveoli) filling with fluid. This inhibits lung function, causing dyspnea, fever, chest pains and cough.

<span class="mw-page-title-main">Subacute bacterial endocarditis</span> Medical condition

Subacute bacterial endocarditis, abbreviated SBE, is a type of endocarditis. Subacute bacterial endocarditis can be considered a form of type III hypersensitivity.

Pneumococcal pneumonia is a type of bacterial pneumonia that is caused by Streptococcus pneumoniae (pneumococcus). It is the most common bacterial pneumonia found in adults, the most common type of community-acquired pneumonia, and one of the common types of pneumococcal infection. The estimated number of Americans with pneumococcal pneumonia is 900,000 annually, with almost 400,000 cases hospitalized and fatalities accounting for 5-7% of these cases.

Robert Austrian was an American infectious diseases physician and, along with Maxwell Finland, one of the two most important researchers into the biology of Streptococcus pneumoniae in the 20th century.

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

<span class="mw-page-title-main">Pneumolysin</span>

Pneumolysin is a virulence factor of the Gram-positive bacteria Streptococcus pneumoniae.

<span class="mw-page-title-main">Meningitis</span> Inflammation of the membranes around the brain and spinal cord

Meningitis is acute or chronic inflammation of the protective membranes covering the brain and spinal cord, collectively called the meninges. The most common symptoms are fever, intense headache, vomiting and neck stiffness and occasionally photophobia.

<span class="mw-page-title-main">Streptococcal intertrigo</span> Medical condition

Streptococcal intertrigo is a skin condition that is secondary to a streptococcal bacterial infection. It is often seen in infants and young children and can be characterized by a fiery-red color of the skin, foul odor with an absence of satellite lesions, and skin softening in the neck, armpits or folds of the groin. Newborn children and infants commonly develop intertrigo because of physical features such as deep skin folds, short neck, and flexed posture. Prompt diagnosis by a medical professional and treatment with topical and/or oral antibiotics can effectively relieve symptoms.

Necrotizing pneumonia (NP), also known as cavitary pneumonia or cavitatory necrosis, is a rare but severe complication of lung parenchymal infection. In necrotizing pneumonia, there is a substantial liquefaction following death of the lung tissue, which may lead to gangrene formation in the lung. In most cases patients with NP have fever, cough and bad breath, and those with more indolent infections have weight loss. Often patients clinically present with acute respiratory failure. The most common pathogens responsible for NP are Streptococcus pneumoniae, Staphylococcus aureus, Klebsiella pneumoniae. Diagnosis is usually done by chest imaging, e.g. chest X-ray, CT scan. Among these CT scan is the most sensitive test which shows loss of lung architecture and multiple small thin walled cavities. Often cultures from bronchoalveolar lavage and blood may be done for identification of the causative organism(s). It is primarily managed by supportive care along with appropriate antibiotics. However, if patient develops severe complications like sepsis or fails to medical therapy, surgical resection is a reasonable option for saving life.

<span class="mw-page-title-main">Competence stimulating peptide</span>

Competence stimulating peptide (CSP), a chemical messenger assisting quorum sensing initiation, exists in many bacterial genera. Bacterial transformation of deoxyribonucleic acids (DNA) is driven by CSP coupled quorum sensing.

References

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  2. "Definition of Caucasian". 26 December 2023.
  3. 1 2 Atkinson, Kate; Augustine, Daniel Xavier; Easaw, Jacob (15 September 2009). "Austrian syndrome: a case report and review of the literature". BMJ Case Reports. 2009: bcr0320091724. doi:10.1136/bcr.03.2009.1724. PMC   3028387 . PMID   21918664.
  4. 1 2 3 Nogué, Marta Rodríguez; Arraiz, Ignacio Gómez; Martín, Gema Ara; Valle, Mª Mar Fraj; Peligros, Antonio Gómez (April 2019). "Síndrome de Austrian: Una rara manifestación de la enfermedad neumocócica invasiva. Presentación de un caso y revisión bibliográfica" [Austrian syndrome: A rare manifestation of invasive pneumococcal disease. A case report and bibliographic review]. Revista Española de Quimioterapia (in Spanish). 32 (2): 98–113. PMC   6441982 . PMID   30880376.
  5. 1 2 3 4 5 Rakočević, Rastko; Shapouran, Sara; Pergament, Kathleen M (17 April 2019). "Austrian Syndrome – A Devastating Osler's Triad: Case Report and Literature Review". Cureus. 11 (4): e4486. doi: 10.7759/cureus.4486 . PMC   6581326 . PMID   31259104.
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  7. "Dexamethasone Uses, Dosage & Side Effects".
  8. "Ampicillin Uses, Side Effects & Warnings".
  9. Munoz, P.; Sainz, J.; Rodriguez-Creixems, M.; Santos, J.; Alcala, L.; Bouza, E. (1 December 1999). "Austrian Syndrome Caused by Highly Penicillin-Resistant Streptococcus pneumoniae". Clinical Infectious Diseases. 29 (6): 1591–1592. doi: 10.1086/313542 . PMID   10585831.
  10. Rodríguez Nogué, M.; Gómez Arraiz, I.; Ara Martín, G.; Fraj Valle, M. M.; Gómez Peligros, A. (April 2019). "Austrian syndrome: A rare manifestation of invasive pneumococcal disease. A case report and bibliographic review". Revista Espanola de Quimioterapia. 32 (2): 98–113. ISSN   1988-9518. PMC   6441982 . PMID   30880376.
  11. "Agglutination — definition, reactions and applications". 16 April 2021.
  12. Midon, Márcio Estevão; Goldoni, Fernando; Souza, Sylvian Greicy Rocha; Miyasato, Jan Norimitsu Schiemann (September 2011). "Austrian Syndrome: case report". Arquivos Brasileiros de Cardiologia. 97 (3): e50–e52. doi:10.1590/S0066-782X2011001200017 (inactive 1 August 2023). PMID   22030703.{{cite journal}}: CS1 maint: DOI inactive as of August 2023 (link)
  13. "Diabetes mellitus | Definition, Types, Symptoms, & Treatment". 5 January 2024.
  14. "Facts About Hypertension". cdc.gov. Retrieved 2 August 2022.

Further reading