Bartonella henselae bacilli in cardiac valve of a patient with blood culture-negative endocarditis. The bacilli appear as black granulations.
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Infective endocarditis

Endocarditis is an inflammation of the inner layer of the heart, the endocardium. The most common structures involved are the heart valves. more...

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Endocarditis can be classified by etiology as either infective or non-infective, depending on whether a foreign micro-organism is causing the problem.

Infective endocarditis

As the valves of the heart do not actually receive any blood supply of their own, which may be surprising given their location, defense mechanisms (such as white blood cells) cannot enter. So if an organism (such as bacteria) establish hold on the valves, the body cannot get rid of them.

Normally, blood flows pretty smoothly through these valves. If they have been damaged (for instance in rheumatic fever) bacteria have a chance to take hold.

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Infective Endocarditis: Immune Disturbances And Prognosis Of Outcomes - Abstract
From CHEST, 10/1/00 by Alex A Demin

Alex A Demin, MD, Prof(*) and Vera P Drobysheva, MD. Internal Medicine, Medical Academy, Novosibirsk, Russia.

PURPOSE: To determine the prognostic significance of immune disturbances in the clinical course and outcomes of 78 patients (pts) with infective endocarditis (IE).

METHODS: The basic indices of cellular (T lymphocytes, subpopulations of T cells, indexes of immune regulation, function of thymus, effectoral function by phytohemagglutinin) and humoral (B lymphocytes, immunoglobulins G, M, A, circulating immune complexes - CIC, complement) immunity were investigated.

RESULTS: The analysis of IE outcomes made it possible to distinguish 3 clinical groups: I (17 pts with fatal outcome in spite of antimicrobics and immunotherapy but without surgery), II (7 pts recovered in result of antimicrobics, immunotherapy and surgical treatment) and III (54 pts in remission only due to antimicrobics and immunotherapy). Revealed disturbances in cell-mediated and humoral immune responses corresponded to medium and frequency characteristics, of all pts in I, II and 33% pts in III clinical group. The presence of immunodefficiency in these pts was an indication for immunocorrection therapy with tactivin and immunoglobulin.

CONCLUSION: Parameters of immune disturbances (immunodefficiency, persistence of CIC) revealed in IE had a good correlation with the unfavourable clinical manifestations (uncontrollable sepsis, developing of glomerulonephritis).

CLINICAL IMPLICATIONS: Parameters of immune disturbances (immunodefficiency, persistence of CIC) revealed in IE may be used for prognostic and management suggestion.

COPYRIGHT 2000 American College of Chest Physicians
COPYRIGHT 2001 Gale Group

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