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Subacute bacterial endocarditis

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Title: Subacute bacterial endocarditis  
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Subject: Right atrial enlargement, Atrial enlargement, Coronary artery aneurysm, Myocardial scarring, Ventricular aneurysm
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Subacute bacterial endocarditis

Subacute bacterial endocarditis
Vegetation of tricuspid valve by ECHO
Classification and external resources
ICD-10 I33.0
ICD-9-CM 421.0
MeSH D004698

Subacute bacterial endocarditis (also called endocarditis lenta) is a type of endocarditis (more specifically, infective endocarditis).[1] Subacute bacterial endocarditis can be considered a form of type III hypersensitivity.[2]

Signs and symptoms

Among the signs of subacute bacterial endocarditis are:[3]



It is usually caused by a form of streptococci viridans bacteria that normally live in the mouth[4] (Streptococcus mutans, mitis, sanguis or milleri).[5]

Other strains of streptococci can also cause subacute endocarditis, streptococcus intermedius: acute and subacute infection ( can causes about 15% of cases pertaining to infective endocarditis). Additional enterococci (urinary tract infections) and coagulase negative staphylococci can also be causative agents.[6]


The mechanism of subacute bacterial endocarditis could be due to malformed stenotic valves which in the company of bacteremia, become infected, via adhesion and subsequent colonization of the surface area. This causes an inflammatory response, with recruitment of matrix metalloproteinases, and destruction of collagen.[7]

Underlying structural [9]


Diagnosis of subacute bacterial endocarditis can be done by collecting three blood culture specimens over a 24 hour period for analysis,[10] also it can usually be indicated by the existence of:



The standard treatment is with a minimum of four weeks of high-dose intravenous penicillin with an aminoglycoside such as gentamicin. The use of high-dose antibiotics is largely based upon animal models.[5] Leo Loewe of Brooklyn Jewish Hospital was the first to successfully treat subacute bacterial endocarditis with penicillin. Loewe reported at the time seven cases of subacute bacterial endocarditis in 1944.[14]


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  5. ^ a b
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  7. ^ Pathology of Infectious Endocarditis at eMedicine
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  13. ^ Clubbing of the Nails~clinical at eMedicine
  14. ^

Further references

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