Endocarditis infecciosa por Streptococcus dysgalactiae subsp equisimilis / Infective endocarditis by Streptococcus dysgalactiae subsp equisimilis

La infección por Streptococcus dysgalactiae subsp equisimilis es causa frecuente de faringitis, artritis e infecciones de piel y tejidos blandos; excepcionalmente se ha descrito como causa de endocarditis infecciosa. Se presenta el caso de un paciente masculino de 42 años quien ingresa al Hospital Vargas de Caracas con fiebre, astenia, dolor en hombro derecho con limitación funcional y dolor en hipocondrio derecho; a las 48 horas se evidencia soplo mesosistólico en foco mitral, hemorragias en astillas y lesiones de Janeway, por lo que se plantea Endocarditis Infecciosa, y se inicia tratamiento con Vancomicina + Gentamicina. Los hemocultivos muestran crecimiento de Streptococcus equisimilis en ambos frascos; el ecocardiograma transtorácico evidencia una vegetación en valva posterior de válvula mitral. Luego de 48 horas de inicio de tratamiento remite la fiebre. El ecocardiograma control a los 14 días mostró la desaparición de la vegetación en la válvula mitral. El paciente recibió tratamiento por 6 semanas

Streptococcus dysgalactiae subsp equisimilis is frequent in patients with pharyngitis, arthritis and skin infections; it rarely causes infective endocarditis. We describe a 42 year-old male patient complaining of fever, malaise, right shoulder pain and right upper quadrant pain who was admitted to the Hospital Vargas, Caracas, Venezuela. After 48 hours his physical examination revealed mesosystolic murmur at the apex, splinter hemorrhages and Janeway lesions, suggestive of Infective Endocarditis Blood cultures identified Streptococcus equisimilis; transthoracic echocardiogram revealed a vegetation over the posterior leaflet of mitral valve; the patient was treated with Vancomycin + Gentamycin. After 48 hours of treatment the fever subsided. A transthoracic echocardiogram after 14 days showed no vegetations. The patient was treated during 6 weeks

Clinical aspects of tonsillar tuberculosis.

A clinical analysis of 6 patients with pathologically confirmed tonsillar tuberculosis was carried out retrospectively. The subjects comprised three men and three women, ranging in age from 20 to 74 years. All of the patients presented with a sore throat and 5 had lymphadenopathy. Ulcerations, masses and white patches characterized the tonsillar lesions; the pathological findings included caseous granuloma with positive acid-fast bacilli (AFB) in 5 patients and chronic granulomatous inflammation with negative AFB in one patient. Four of the six patients had pulmonary tuberculosis. The three patients who received complete treatment responded well. The presenting symptoms and abnormal tonsillar findings associated with tonsillar tuberculosis are similar to those of malignant tumors and therefore it is difficult to differentiate the two pathologies; moreover, tonsillar tuberculosis often occurs with pulmonary tuberculosis and AIDS and therefore, a chest X-ray and HIV-screening are recommended for all patients with tonsillar tuberculosis.