Classic Peripheral Signs of Subacute Bacterial Endocarditis

A 50-year-old female patient with visual disturbances was referred for further evaluation of a heart murmur. Fundoscopy revealed a Roth spot in both eyes. A physical examination showed peripheral signs of infective endocarditis, including Osler nodes, Janeway lesions, and splinter hemorrhages. Our preoperative diagnosis was subacute bacterial endocarditis with severe aortic regurgitation. The patient underwent aortic valve replacement and was treated with intravenous antibiotics for 6 weeks postoperatively. The patient made a remarkable recovery and was discharged without complications. We report this case of subacute endocarditis with all 4 classic peripheral signs in a patient who presented with visual disturbance.

Use of autologous pericardium for mitral leaflet reconstruction in a child with endocarditis / Uso de pericárdio autólogo para reconstrução de folheto mitral em criança com endocardite

We present a case of successful repair of the mitral valve for active infective endocarditis. Mitral valve repair was performed through debridement of vegetation and abscess, resection and repair of the posterior mitral leaflet and posterior repair with autologous pericardium. Postoperative period was uneventfully, with no evidence of recurrent infection, and echocardiogram showed mitral valve competence with mild mitral regurgitation. We demonstrate that valve repair is a feasible choice in cases of active endocarditis in children.

Apresentamos um caso de reparo bem-sucedido da valva mitral decorrente de endocardite infecciosa ativa. Reparo da valva mitral foi acompanhado de desbridamento da vegetação e do abscesso, ressecção e plastia do folheto mitral posterior, e anuloplastia posterior com pericárdio autólogo. Pós-operatório sem evidências de infecção recorrente, e ecocardiograma demonstrou competência da valva mitral com regurgitação mitral trivial. Concluímos que o reparo valvar é uma escolha viável em caso de endocardite ativa nas crianças.

Ruptured Intracranial Bacterial Aneurysms: Report of Two Cases

Two Cases of ruptured bacterial aneurysms involving the distal branches of the middle cerebral artery associated with an intracerebral hematoma are reported. Both patients presented with a medical history of valvular heart disease and subacute bacterial endocarditis. The mortality of ruptured intracranial bacterial aneurysms has been reported to be very. High and a proper treatment strategy for such aneurysms still remains controversial. Most authors have recommended aggressive antimicrobial therapy, serial antiographic follow-up studies, and surgery for aneurysm's that do not resolve or enlarge even after medical treatment. Both of the reported patients were treated with antibiotics and underwent surgical evacuation for huge-sized intracerebral hematomas, and in one patient, the aneurysm was completely resected.

A Case of Marfan Syndrome with Subacute Bacterial Endocarditis

Marfan syndrome is a hereditary disorder of connective tissue fibers, involving skeleton, eye and cardiovascular system. The cardiovascular complications, directly related to the cause of death, are associated with about 90% of the Marfan syndrome. The cardiovascular complications are aortic and mitral insufficiency, mitral valvular prolapse, bacterial endocarditis, arrhythmia and aneurysm of interatrial septum and aorta. Among the cardiovascular complications, bacterial endocarditis is unusual. The aortic valve, though commonly abonormal in Marfan syndrome, was rarely involved by endocarditis. In contrast the mitral valve was the favoured site of infection in these patients. The low incidence of aortic valve involvement remains unexplained. There is extreme mortality in Marfan patients affected by endocarditis. A 22-year-old man was admitted to Wallace Memorial Baptist Hospital because of intermittent fever with chill, dyspnea and orthopnea. He had characteristic Marfanoid features such as a slender body with sparsity of subcutaneous fat, arachnodactly and disproprtionate long extremities, axial myopia as well as suspicious family history. Three blood cultures produced a slowly growing gamma-hemolytic streptococcus sensitive to penicillin. Chest X-ray revealed increased C-T ratio and generalized congested lung parenchyme and increased lung markings with multiple dense, horizontal lines, so called Kerley's B lines. Echocardiogram showed thickened bicuspid arotic valve with vegetation and enlarged left ventricular cavity, grade 3/4 mitral and aortic regurgitation. The authors have experienced a rare case of Marfan syndrome with subacute infective endocarditis.

Isolation of Actinobacillus actinomycetemcomitans from the Blood of a Patient with Subacute Bacterial Endocarditis

Actinobacillus actinomycetemcomitans, a rare human pathogen, was repeatedly isolated from the blood of a 20-year-old male patient with patent ductus arteriosus who developed subacute bacterial endocarditis. Difficulties in isolating and identifying the organism are discussed. The bacterial isolate was found to be susceptible to various antimicrobial agents.