digoxin and Streptococcal-Infections

Topics: Acute Kidney Injury; Airway Obstruction; Anemia, Hemolytic; Arteriovenous Fistula; Asphyxia Neonatorum; Cardiac Output; Digoxin; Ductus Arteriosus, Patent; Female; Heart Failure; Humans; Hyperthyroidism; Hypoglycemia; Infant; Infant, Newborn; Isoproterenol; Medical History Taking; Pregnancy; Pulmonary Edema; Pulmonary Valve; Sepsis; Streptococcal Infections; Tachycardia, Paroxysmal; Tricuspid Valve Insufficiency

The isoprenoid pathway produces three key metabolites--digoxin (membrane Na+-K+ ATPase inhibitor, regulator of neurotransmitter transport, and an immunomodulatory agent), dolichol (a regulator of N-glycosylation of proteins), and ubiquinone (a free radical scavenger). The pathway was assessed in acute rheumatic fever patients with recurrent streptococcal infections, and who were also studied for differences in right and left hemispheric dominance. The isoprenoid pathway was downregulated with decreased digoxin synthesis in these patients and in those with left hemispheric chemical dominance. The tryptophan catabolites were decreased and the tyrosine catabolites increased. In these groups of patients the dolichol and glycoconjugate levels were reduced and lysosomal stability was increased. The ubiquinone levels were elevated and free radical levels decreased in these patients. The membrane cholesterol:phospholipid ratios were decreased and membrane glycoconjugates increased. On the other hand in right hemispheric chemical dominance the reverse patterns and hyperdigoxinemia with an upregulated isoprenoid pathway were noticed. The role of the isoprenoid pathway in the pathogenesis of acute rheumatic fever and recurrent streptococcal infections and its relation to hemispheric chemical dominance is discussed.

Topics: Acute Disease; Adolescent; Analysis of Variance; Child; Digoxin; Disease Susceptibility; Dolichols; Dominance, Cerebral; Down-Regulation; Enzyme Inhibitors; Erythrocyte Membrane; Glycoproteins; Glycosaminoglycans; Humans; Hydroxymethylglutaryl CoA Reductases; Immunologic Deficiency Syndromes; Magnesium; Matched-Pair Analysis; Neuroimmunomodulation; Neurotransmitter Agents; Pharyngitis; Polyisoprenyl Phosphates; Recurrence; Rheumatic Fever; Sodium-Potassium-Exchanging ATPase; Streptococcal Infections; Ubiquinone

The authors report on a 47-years old woman with bacterial endocarditis involving both the mitral and aortic valves. At first echocardiographic examination, the mitral vegetation was small, while the aortic one was large highly mobile. Despite adequate antibiotic therapy, the aortic vegetation had become bigger and the valve regurgitation, initially mild to moderate, resulted severe and was associated with left heart failure. While awaiting surgery, the patient sustained an acute non Q wave myocardial infarction with ST segment elevation in inferior and anterolateral leads, complicated by ventricular arrhythmias. Thirty-six hours later, the patient received mitral and aortic valve replacement: at surgical view, the aortic vegetations was found to be very close to the right coronary orifice. After a period of further antibiotic therapy, the woman discharged and at a six months follow-up, she was fairly well. The authors review the mechanisms of acute coronary insufficiency in infective endocarditis and suggest an embolic pathogenesis in the case reported. Taking into account the possible life threatening embolic complications, it seems reasonable not to delay surgery when antibiotic therapy fails to reduce the size and mobility of valve vegetations.

Topics: Aortic Valve; Aortic Valve Insufficiency; Cardiotonic Agents; Digoxin; Diuretics; Echocardiography, Doppler, Color; Echocardiography, Transesophageal; Electrocardiography; Embolism; Endocarditis, Bacterial; Female; Follow-Up Studies; Furosemide; Heart Valve Prosthesis; Humans; Middle Aged; Mitral Valve; Mitral Valve Insufficiency; Myocardial Infarction; Penicillin G; Penicillins; Streptococcal Infections; Time Factors

Topics: Age Factors; Aged; Bundle-Branch Block; Cellulitis; Diabetic Ketoacidosis; Digoxin; Female; Glucose; Humans; Infusions, Parenteral; Insulin; Penicillins; Pneumonia; Potassium; Streptococcal Infections