Septicemia in these Days

III. Endocarditis lenta caused by Streptococci

Abstract

Twenty-one patients of endocarditis lenta (subacute bacterial endocarditis) admitted to the First National Hospital of Tokyo during the past 8-year period were analyzed in this review. The causative organisms isolated from the patients venous or arterial blood stream were Streptococcus viridans in nineteen cases and Streptococcus fecalis in two cases.
There were 13 males and 8 females. The age range of patients was from 11 to 73 years. Thirteen patients had underlying cardiac disease: 5 congenital heart failure and acquired valvular disease.
Dental sepsis or manipulations were frequent possible initiating factors (9/21). The most frequent abnormal physical and laboratory findings were fever (21), cardiac murmurs (21), abnormal ECG (17), hepatomegaly (17), chilly sensation (13), increased erythrocyte sedimentation rate (12) and anemia (12). Seven patients died in the hospital. Younger patients fared much better than those over 31. The advanced age, appearance of the symptoms of infarction and prolonged duration of illness prior to systemic chemotherapy were associated with a poor prognosis. The prognosis did not depend on the number of organisms in the blood stream and presence of the underlying cardiac diseases.
Sensitivity test of the causative organisms revealed that almost all the strains of streptococcus viridance were sensitive to chloramphenicol, tetracycline, erythromycine and penicillin, and partly resistant to streptomycine and sulfa drugs. Two strains of streptococcus fecalis showed a different sensitivity pattern. One was sensitive to all antibiotics beside sulfa and another was resistant to all antibiotics including kanamycine. The latter case was treated successively with a single dosage of aminobenzyl penicllin.