[Infectious endocarditis induced by Actinobacillus actinomycetemcomitans. 8 new cases].
A commensal organism of the buccal cavity, Actinobacillus actinomycetemcomitans (AAC) has been responsible for at least four new cases of infectious endocarditis by year in France. This retrospective study was based on 90 new cases of infectious endocarditis by AAC, including 8 personal observations. One third of patients had no known cardiac disease before their infectious endocarditis, the portal of entry of which was usually dental. In cases of suspected infectious endocarditis, rapid and severe weight loss (43% of cases) and, less commonly, anicteric cholestasis (8%) should alert the physician for the possible pathological role of AAC. The echocardiographic appearances are non-specific. The diagnosis is confirmed on blood cultures but the organism grows slowly in CO2 enriched atmosphere. Initially, the course of the disease was favourable in one third of patients but, in two thirds of cases, complications were observed almost renal (26%), cardiac (24%) and neurological (18%). Two thirds of patients were cured by the time they were discharged whereas the remainder had sequellae, mainly valvular and neurological. The hospital mortality was 9%; late mortality was 6%. Therefore, the prognosis of AAC endocarditis, seems to be better than that of other bacteriological forms. A combination of cephalosporin and aminoside, or even a simple third generation cephalosporin antibiotic therapy for at least 4 weeks are usually effective. The complementary surgical indications are the same as for other forms of infectious endocarditis. Prophylaxis depends on strict prophylactic amoxicillin therapy for all cardiac patients at risk of infectious endocarditis before dental treatment and on good bucco-dental hygiene.
Grand
A
A
Service de cardiologie, Centre hospitalier de Valence.
Laye
J M
JM
Etienne
J
J
Pernot
F
F
Durand de Gevigney
G
G
Delahaye
F
F
Touboul
P
P
Froment
A
A
D000189:Actinobacillus Infections / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D000293:Adolescent; D000328:Adult; D000368:Aged; D016976:Aggregatibacter actinomycetemcomitans; D002648:Child; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000209:etiology / Q000382:microbiology / Q000628:therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009061:Mouth Mucosa / Q000382:microbiology; D011379:Prognosis; D012189:Retrospective Studies; D013997:Time Factors; D014076:Tooth Diseases / Q000150:complications / Q000382:microbiology
Endocardite infectieuse à Actinobacillus actinomycetemcomitans. Huit nouvelles observations.