DISEASE OF BODIES OF BLOOD CIRCULATION : SEPTIC ENDOCARDITIS (BACTERIAL), SUBACUTE (PROLONGED) (ENDOCARDITIS SEPTICA SUBACUTA) - etiology, pathogenesis, symptoms and course of, recognition, prediction and prevention
Кровеносная система, сердце, сосуды, кровь
Protracted endocarditis is part of the General sepsis caused by the usually green (or rather viridans) streptococci (Streptococcus viridans). Often sick people who previously suffering from rheumatism and heart disease (mitral or aortic). In Chernogubov showed that protracted bacterial endocarditis in a large percentage of cases affects perfectly healthy valves. The question of the transition of rheumatic process in the septic in relation to the evolution of reactivity and variability of the microbe is not allowed finally, as the unknown causative agent of rheumatism. Possible source of infection is considered chronic lesions:
The defeat of the valves (thromboangiitis) is more benign in nature than in acute septic endocarditis; necrosis is less pronounced thrombotic mass is less friable, and therefore less likely to serve as a source of emboli. In addition to the endothelium of the valves, the process involves the endothelium of capillaries (thrombovascular), whereby the capillaries are characterized by high vulnerability, fragility (easily obtained petechial hemorrhages in the skin when the tourniquet on the arm). A profuse hemorrhage associated with lesions of arteries of various calibers and the development of aneurysms (mycotic aneurysm).
The patient complains of fatigue, shortness of breath and reduced efficiency. In anamnesis often there is rheumatism, which is confirmed by an objective study that detects compensated heart disease (most often aortic or combined). The temperature initially is low, low grade. In this stage of the disease usually, the diagnosis of recurrence of rheumatic carditis.
The emergence of diastolic noise of the aorta, which is amplified and changed the nature, always suspicious in regards to the development of subacute septic endocarditis. Often, however, previously had rheumatic aortic valve or a combined defect with predominance of failure of the valves of the aorta. The temperature is higher, takes a remittent character. The blood is much impaired. Along with a significant hypochromic and hyporegenerative anemia, defined by a peculiar change in the white blood. White blood cell count often reduced. Among them are many monocytes (histiocytes), which are especially numerous in the blood obtained from the ear. Blood found formaleva reaction (the setting of serum 24 hours after the addition of formalin). The patient turns pale, color of skin becomes the color of coffee with milk. The skin sometimes is visible petechial rash. Quite early on connective shell eyes appear petechiae with a white center. Fingers often take the form of drum sticks. Konchalovsky symptom, or a symptom of the harness (the appearance of petechial hemorrhages on the skin after dragging a limb from the tourniquet), is positive.
The spleen is defined at first with difficulty, further increases uplotnaet; it is very painful after a heart attack on the soil of emboli, so frequent in this disease the vessels of the great circle (perisplenic).
Kidney developing septic focal (embolic) nephritis (albuminuria, microscopic hematuria usually at a normal or even low blood pressure). Often develop and diffuse glomerulonephritis with high blood pressure.
Cardio-vascular apparatus gradually develop the phenomenon of failure (enlargement of the heart, increased heart rate, shortness of breath, enlarged liver, edema, etc.).
Recognition is based on:
On special media could be sown from the blood of a green Streptococcus. Often in a large circle of blood circulation occur embolism (skin, spleen, brain, etc.); characterized by the absence in these patients of atrial fibrillation. It is important to note the early signs only emerging and even only suspect bacterial endocarditisto immediately start treatment. Diagnosis helps the finding of histiocytes in the blood from the ear lobe and the positive formaleva reaction (gelatinous clotting serum with the addition of formalin).
The prognosis unfavorable. Patients die, or when the symptoms of growing cardiovascular failureor from bleeding in the brain or some other complications (gangrene in clogged arteries, etc.).
Duration of disease from several months to 1 -1/2 years. Promptly initiated and vigorously pursued by penicillin therapy is used to improve the prognosis in terms of duration of remission of the process. Described cases apparently complete recovery.
You can count on a significant improvement, and sometimes, apparently, and to recover only long-term use of large doses of penicillin (up to 1 million units in scdi and more) and an earliest possible start of treatment. At the same time assigned to the aspirin of 0.3 three or four times a day and campolon 2.0 intramuscular injection every other day.