tetracycline and Heart-Valve-Diseases

To determine compliance with 1977 American Heart Association (AHA) recommendations for antibiotic prophylaxis (AbP) of subacute bacterial endocarditis (SBE), we mailed a questionnaire to 1019 licensed dentists from Dade County, Florida. Of the 614 practicing dentists who responded, 97.7% believe that AbP prevents SBE and 94.2% always obtain a cardiac history from new patients. AbP is given to patients with known rheumatic or other valvular heart disease by 98.9% of responders and to patients with known prosthetic heart valves by 81.5%. The majority of dentists prescribe the antibiotics recommended by the AHA, but the dosage, route, frequency and duration of therapy are usually not according to AHA guidelines. AbP completely consistent with these guidelines is prescribed by 15.4% of dentists for patients with heart disease and by only 6.7% of dentists for patients with prosthetic heart valves. The AHA recommends parenteral AbP for most patients with prosthetic heart valves, but approximately 80% of dentists use only oral agents for these patients. We conclude that most dental patients predisposed to SBE receive AbP, but not in accordance with AHA guidelines. The widest deviation occurs among patients with prosthetic heart valves.

Topics: Anti-Bacterial Agents; Dentists; Endocarditis, Subacute Bacterial; Erythromycin; Florida; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Medical History Taking; Penicillins; Surveys and Questionnaires; Tetracycline

Two cases of bacterial endocarditis caused by Haemophilus parainfluenzae are reported with a review of 33 other cases of H. parainfluenzae endocarditis and 5 cases of H. influenzae endocarditis. Although H. parainfluenzae is usually considered a non-pathogenic microorganism, this review firmly establishes its role as a causative agent in endocarditis. Furthermore, several clinical features were noted which were atypical when compared to findings usually present in patients with bacterial endocarditis. The mean age of the patients was only 27 years. Over 60% of the patients had no identifiable predisposing illness, an unexpected finding in view of the low degree of pathogenicity associated with this microorganism. Polymicrobial bacteremia, usually with viridans streptococci, was found in 11% of patients. Major arterial emboli were documented in 57% of patients, an incidence unchanged from the pre-antibiotic era. Diagnosis of the disease is dependent upon an awareness of the fastidious cultural requirements necessary for isolation of Haemophilus species. Culture media must contain a source of X and V factors. Mortality from H. parainfluenzae endocarditis has been reduced from 100 per cent prior to 1940 to about 12 per cent by use of appropriate antimicrobial agents. Awareness that Haemophilus species can cause bacterial endocarditis is important because the diagnosis is dependent upon utilization of special culture methods and the patient may not respond to some of the empiric regimens used for treating bacterial endocarditis. It should be especially considered as a possible cause of "culture-negative" or "abacteremic" endocarditis.

Topics: Adolescent; Adult; Anti-Bacterial Agents; Bacteriological Techniques; Cephalothin; Child; Drug Therapy, Combination; Embolism; Endocarditis, Bacterial; Female; Haemophilus; Haemophilus Infections; Haemophilus influenzae; Heart Valve Diseases; Humans; Male; Middle Aged; Streptococcal Infections; Streptomycin; Tetracycline

Sixteen cases of chronic Q fever are described. In eight there was a history of exposure to infection from farms or farm products. All had valvular heart disease, involving the mitral valve in nine and the aortic valve in seven. Infection occurred on a prosthetic valve in two patients. Arterial embolism was common. Venous thrombosis occured in three patients, and pulmonary embolism occurred in three other patients. Complement fixing antibodies to phase 1 antigen were found in a titre of 1:200 or greater in all except two patients. In one of these post-mortem examination revealed rickettsial bodies in mitral valve vegetations, and in the other Coxiella burneti was isolated from heart valve tissue. The majority presented with infective endocarditis but two presented primarily with liver disease. All patients had evidence of liver involvement and in one this led to death from cirrhosis. Abnormal tests of liver function, particularly hyperglobulinaemia, raised alkaline phsophatase and abnormal bromsulphthalein retention were found in all patients. Hepatic histology was abnormal in all eight patients in whom it was studied. The commonest features were mononuclear cell infiltration of the portal tracts and prominence of the sinusoidal Kupffer cells. Patchy focal necrosis of parenchymal cells, granulomata, fatty change, and eosinophilia of the sinusoidal walls were also noted in several patients and cirrhosis developed in one. Six patients had a purpuric rash, and in 12 there was thrombocytopenia. It is suggested that the presence of hepatomegaly and liver involvement and thrombocytopenia may help to differentiate Q fever endocarditis from bacterial endocarditis. Raised serum IgM and IgA levels occured frequently, but with only a moderate dominance of IgM. Sheep cell agglutination and latex fixation tests for rheumatoid factor were occasionally positive. Several features of the disease suggest the possibility that immune-complex mechanisms may play a role in chronic Q fever. Treatment was with prolonged courses of tetracycline usually combined with lincomycin. Seven patients underwent valve replacement surgery for haemodynamic reasons. Five patients died; two from heart failure, one from cirrhosis, one seven days after valve replacement and one from intraperitoneal haemorrhage following percutaneous liver biopsy. Three patients have survived for more than five years, and another six for more than three and a half years after diagnosis. Of these nine patients, th

Topics: Adult; Chronic Disease; Endocarditis; Female; Heart Valve Diseases; Hematologic Diseases; Humans; Hypergammaglobulinemia; Lincomycin; Liver Diseases; Male; Middle Aged; Q Fever; Tetracycline; Thrombocytopenia

A survey of Oxfordshire dentists showed that most practise prophlaxis of bacterial endocarditis, but that few follow currently recommended regimens. for example, prophylactic antibiotics are started one or more days before the procedure by 72 per cent of dentists, and two or more days before by 25 per cent. Eight-seven per cent administer antibiotics for a total of four or more days. Penicillin is most often given, but tetracyline remains the commonest second choice. Only 12 per cent use intramuscular drugs as first choice, and procaine penicillin is seldom used. These practices are contrasted with current medical recommendations and discussed with reference to fresh experimental evidence on prevention of bacterial endocarditis.

Topics: Administration, Oral; Anti-Bacterial Agents; Cephalosporins; Clindamycin; Dentistry, Operative; Drug Therapy, Combination; Endocarditis, Bacterial; Erythromycin; Heart Valve Diseases; Humans; Penicillin G; Penicillin V; Penicillins; Surgery, Oral; Surveys and Questionnaires; Tetracycline

Clinical and pathological features of two fatal cases of bacterial endocarditis with Candida albicans superinfection are described. One patient presented with combined Streptococcus viridans and Candida endocarditis of the aortic valve. The second patient, an addict to paregoric injected intravenously, developed Staphylococcus aureus of the tricuspid valve with eventual Candida endocarditis. The responsible organisms were identified from blood cultures during the hospital course, and by culture or tissue section of postmortem material. Candida endocarditis has emerged as a disease entity in the past 20 years. The incidence is increasing and patients with bacterial endocarditis are among those at risk. Antibiotic therapy appeared to facilitate the development of Candida endocarditis in these two cases.

Topics: Anti-Bacterial Agents; Antibiotics, Antitubercular; Aortic Valve; Candida albicans; Candidiasis; Dermatologic Agents; Endocarditis; Endocarditis, Bacterial; Heart Valve Diseases; Humans; Middle Aged; Pathology; Penicillins; Staphylococcal Infections; Staphylococcus aureus; Streptococcal Infections; Superinfection; Tetracycline; Tricuspid Valve; Viridans Streptococci