[Subacute endocarditis caused by Actinobacillus actinomycetemcomitans].
BACKGROUND
We describe the cases of endocarditis caused by Actinobacillus actinomycetemcomitans (EAA) observed at our hospital.


METHODS
We revised clinical records and microbiological documents from patients admitted at our hospital, with A. actinomycetemcomitans in blood cultures occurred from 1972-1998. We used Dukes's diagnostic criterion of infectious endocarditis.


RESULTS
Four patients were diagnosed of EAA for twelve years, there were males and two females. Two cases have had valvular prosthesis and three patients suffered a previous odontological manipulation. All cases were clinical subacute presentation. Two patients have had at a distance endocarditis clinical manifestation (neurological deficit and Osler nodules). All patients were febrile and elevation of acute reactants, two cases had inflammatory anemia and one had cardiac failure. We observed growing signs after 7 days of culture and it was necessary, on solid medium, adequate atmosphere and nutritional composition to procure A. actinomycetemcomitans growing. All isolates were susceptible to studied penicillins or aminopenicillins (except one isolate with intermediate susceptibility), aminoglycosides and quinolones. Treatment with penicillin G, lone or combined with aminoglycosides, controlled infection in three patients. No case needed cardiac surgery.


CONCLUSIONS
In our experience, EAA is a strange entity and there isn't a previous cardiac disease always. Usually, the place of entrance is a buccal focus. Subacute-chronic course and, sometimes, uncommon, can delay diagnostic during months. Our isolates have an uniform sensibility to penicillins and others betalactamic, anyway aminoglycosides and quinolones, therefore an antibiotic combination of two antibiotics from these families at least could be the choice treatment. Except evolutive complications in some patient, prognostic has been excellent with only antibiotic treatment, without valvular surgery.
Belloch
S L
SL
Unidad de Enfermedades Infecciosas, Hospital Universitario La Fe, Valencia.
Salavert
M
M
Lacruz
J
J
López-Aldeguer
J
J
Pérez-Bellés
C
C
D000189:Actinobacillus Infections / Q000188:drug therapy / Q000382:microbiology*; D000293:Adolescent; D000328:Adult; D016976:Aggregatibacter actinomycetemcomitans; D004698:Endocarditis, Subacute Bacterial / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies