| 词条 | Subacute bacterial endocarditis |
| 释义 |
| name = Subacute bacterial endocarditis | synonyms = | image = Endocarditis ultrasound.gif | caption = Vegetation of tricuspid valve by ECHO | pronounce = | field = | symptoms = | complications = | onset = | duration = | types = | causes = Streptococcus mutans, mitis, sanguis or milleri bacteria[1][2] | risks = | diagnosis = Blood culture specimens over 24-hour period/analysis[3] | differential = | prevention = | treatment = Intravenous penicillin [1] | medication = | prognosis = | frequency = | deaths = }}Subacute bacterial endocarditis (also called endocarditis lenta) is a type of endocarditis (more specifically, infective endocarditis).[5] Subacute bacterial endocarditis can be considered a form of type III hypersensitivity.[1] Signs and symptomsAmong the signs of subacute bacterial endocarditis are:[2]
CausesIt is usually caused by a form of Viridans group streptococcus bacteria that normally live in the mouth[3] (Streptococcus mutans, mitis, sanguis or milleri).[4] Other strains of streptococci can also cause subacute endocarditis, streptococcus intermedius: acute and subacute infection (causes about 15% of cases pertaining to infective endocarditis). Additional enterococci (urinary tract infections) and coagulase negative staphylococci can also be causative agents.[5] MechanismThe 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.[6] 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|date=August 2015}} In cases of subacute bacterial endocarditis, the causative organism (streptococcus viridans) needs a previous heart valve disease to colonize.[7] On the other hand, in cases of acute bacterial endocarditis, the organism can colonize on the healthy heart valve, causing the disease.[8] DiagnosisDiagnosis of subacute bacterial endocarditis can be done by collecting three blood culture specimens over a 24-hour period for analysis,[9] also it can usually be indicated by the existence of:
TreatmentThe 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 at the time seven cases of subacute bacterial endocarditis in 1944.[13] References1. ^{{Cite book|title = Concise Clinical Immunology for Healthcare Professionals|url = https://books.google.com/books?id=cHGCAgAAQBAJ|publisher = Routledge|date = 2006-04-18|page=106|isbn = 9781134428021|first = Mary|last = Keogan|first2 = Eleanor M.|last2 = Wallace|first3 = Paula|last3 = O'Leary}} 2. ^{{Cite book|title = Neuropsychiatric Features of Medical Disorders|url = https://books.google.com/books?id=baraBwAAQBAJ|publisher = Springer Science & Business Media|date = 2012-12-06|page=28|isbn = 9781468439205|first = James W.|last = Jefferson}} 3. ^1 {{Cite book|title = Medical-Surgical Nursing: Concepts & Practice|url = https://books.google.com/books?id=sLjwAwAAQBAJ|publisher = Elsevier Health Sciences|date = 2014-04-14|page=101|isbn = 9780323293211|first = Susan C.|last = deWit|first2 = Candice K.|last2 = Kumagai}} 4. ^1 2 3 {{cite journal |last1=Verhagen |first1=DW |last2=Vedder |first2=AC |last3=Speelman |first3=P |last4=van der Meer |first4=JT |title=Antimicrobial treatment of infective endocarditis caused by viridans streptococci highly susceptible to penicillin: historic overview and future considerations |journal=The Journal of Antimicrobial Chemotherapy |volume=57 |issue=5 |pages=819–24 |year=2006 |pmid=16549513 |doi=10.1093/jac/dkl087 }} 5. ^1 {{Cite web|title = Infective Endocarditis. Information; prevention of endocarditis {{!}} Patient|url = http://patient.info/doctor/infective-endocarditis-pro|website = Patient|accessdate = 2015-08-28}} 6. ^{{EMedicine|article|1954887|Pathology of Infectious Endocarditis}} 7. ^{{Cite book|title = Alcamo's Fundamentals of Microbiology: Body Systems Edition|url = https://books.google.com/books?id=Uf_Hl3Exti8C|publisher = Jones & Bartlett Publishers|date = 2012-01-15|page=768|isbn = 9781449605940|first = Jeffrey C.|last = Pommerville}} 8. ^{{Cite book|title = Pathophysiology|url = https://books.google.com/books?id=i7jwAwAAQBAJ|publisher = Elsevier Health Sciences|date = 2014-06-25|page=395|isbn = 9780323293174|first = Lee-Ellen C.|last = Copstead-Kirkhorn|first2 = Jacquelyn L.|last2 = Banasik}} 9. ^1 {{Cite book|title = Laboratory Diagnosis of Infectious Diseases: Essentials of Diagnostic Microbiology|url = https://books.google.com/?id=l56-WMdyqzcC&pg=PA447&dq=subacute+bacterial+endocarditis+diagnosis#v=onepage&q=subacute%2520bacterial%2520endocarditis%2520diagnosis&f=false|publisher = Lippincott Williams & Wilkins|date = 2008-01-01|page=446|isbn = 9780781797016|first = Paul G.|last = Engelkirk|first2 = Janet L.|last2 = Duben-Engelkirk}} 10. ^{{Cite book|title = Signs and Symptoms|url = https://books.google.com/books?id=iDCuxfnbBgIC|publisher = Lippincott Williams & Wilkins|date = 2008-03-01|page= 234|isbn = 9780781770439|first = Scott|last = Kahan}} 11. ^{{Cite book|title = Quick Reference to Critical Care|url = https://books.google.com/books?id=Xk7znn4rxIMC|publisher = Lippincott Williams & Wilkins|date = 2011-02-15|page=391|isbn = 9781608314645|language = en|first = Nancy H.|last = Diepenbrock}} 12. ^{{EMedicine|article|1105946|Clubbing of the Nails|clinical}} 13. ^{{cite journal |last1=Loewe |first1=Leo |last2=Rosenblatt |first2=Philip |last3=Greene |first3=Harry J. |title=Combined penicillin and heparin therapy of subacute bacterial endocarditis |journal=Bulletin of the New York Academy of Medicine |volume=22 |issue=3 |pages=270–2 |year=1946 |pmid=19312479 |pmc=1871521 |doi=10.1001/jama.1944.02850030012003 }} Further references
External links{{Medical resources| DiseasesDB = | ICD10 = {{ICD10|I|33|0|i|30}} | ICD9 = {{ICD9|421.0}} | ICDO = | OMIM = | MedlinePlus = | eMedicineSubj = | eMedicineTopic = | MeshID = D004698 }}{{Heart diseases}}{{Hypersensitivity and autoimmune diseases}} 1 : Heart diseases |
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