[ relationship between severity of the systemic inflammatory response syndrome [SIRS] and its etiology and outcome]

SIRS is known as a condition with the presence of four criteria of: Fever or hypothermia. Tachypnea. Tachycardia. Leukocytosis or leukopenia or bandemia. Sepsis is defined as the SIRS with an infectious etiology. Incidence rate is increasing during the recent 15 years. The key point in treatment of sepsis is early diagnosis and beginning of treatment according to the signs before the occurrence of complications like hypotension. This study was done to evaluate the relationship between the severity of SIRS and its etiology and outcome. This descriptive study was carried out in the year 2004 on 306 cases of SIRS, referring to Infectious Ward of Imam Reza Hospital, Mashhad, Iran. The study was accomplished through completing questionnaires, after getting medical history, physical and laboratory examinations [including CBC, urine analysis, platelet count, and ESR] of patients. Then the sensitivity, speeififity and positive predictive values for SIRS regarding differentiation of infectious from non- infectious diseases were studied. In addition, the severity of SIRS and its effects on mortality, also, the effects of severe SIRS on any infection in platelet count and ESR were evaluated. The Results were arranged as charts, graphs and described by MANN-WHITENY, T-student. According to the number of patients final diagnosis included pneumonia [n=56], meningitis [n=35], unknown origin infections [n=34], urosepsis [n=25], and miscellaneous etiologies such as brucellosis, hepatitis, etc. There were 23 non-infectious patients and 17 mortal cases. The highest mortality rate was in pneumonia [n=7] that often had serious leukocytosis. Severe SIRS has 20.1% sensitivity and 95% positive predictive value for diagnosis of infection. There was no statistically significant difference between the two groups, regarding the primary vital signs, laboratory findings, age, sex, and mortality rate. The mortality rate didn't have any relationship with thrombocytopenia, increased ESR or sex; but was related to hypotension, serious leukocytosis and severity of SIRS. Based on the primary vital signs and laboratory findings, the severity of SIRS has a clear correlation with the mortality rate. Heuce it is recommended that much attention should be paid to the documents of vital signs and routine laboratory findings for the early diagnosis and treatment

[Native Tricuspid valve endocarditis in the absence of intravenous drug use]

We presented two non-addicted patients with Tricuspid valve endocarditis. The first patient was a 38-year-old diabetic female with; fever chills, anemia, and microscopic hematuria and pyuria that occurred during several weeks. The plain radiography of chest was normal and high resolution computed tomography [HRCT] of chest, was done because of predominant pulmonary symptoms and signs that revealed consolidation and cystic formation in the left parynchyma. Based on these findings in HRCT we decided to start anti-tuberculosis treatment, but no significant response was seen. Tran's Thoracic Echocardiography [TTE] was done and revealed large vegetation of Tricuspid valve. The second patient was a 45 -year-old man who admitted with acute fever and left lower lobe infiltrate and systolic murmur. TTE was normal but Trans Esophageal Echocardiography showed large vegetation on the Tricuspid valve. Staphylococcus aurous grew in 2/3 blood cultures. We suggest that right-sided endocarditis must be considered in any patient with fever and recurrent pulmonary symptoms and signs, with or without abnormal chest X- ray, heart murmur or intravenous drug addiction