Summary
The group B streptococcus has been shown to be a major cause of meningitis in the newborn and an occasional cause of endocarditis and sepsis in postpartum women. Little attention has been devoted to this organism as a cause of bacterial endocarditis. Twelve patients with group B streptococcal endocarditis were seen at The Presbyterian Hospital, New York, NY, between 1974 and 1985. There were seven women, five men. Ages ranged from 32 to 81 years. Serious underlying disease was present in all — diabetes mellitus in seven, carcinoma in three (bladder in two, and breast in one), alcoholism in three, malnutrition in two, heroin addiction in one, tuberculosis in one, serious prior valvular heart disease in two. The aortic valve was affected in four patients — mitral in two, mitral and aortic in one, tricuspid in four, unknown in one. The presentation was acute in seven patients. Metastatic infection occurred in seven, heart failure in six, major emboli in four, septic pericarditis in one, myocardial abscess in one. The group B streptococcus should be considered as a pathogen capable of causing acute endocarditis in certain patients with defects of host defense, particularly patients with diabetes mellitus, carcinoma or alcoholism. Cardiac surgery may be necessary in these patients due to the rapid destruction of the valves which occurs, in spite of the fact that the organisms are usually highly susceptible to penicillin.
Zusammenfassung
Streptokokken der Gruppe B haben sich als wichtige Erreger der Neugeborenenmeningitis erwiesen; gelegentlich lösen sie bei Frauen im Wochenbett eine Endokarditis oder Sepsis aus. Die Bedeutung dieses Mikroorganismus als kausaler Erreger der bakteriellen Endokarditis wurde bisher wenig beachtet. Am Presbyterian Hospital New York, NY, wurden zwischen 1974 und 1985 12 Fälle von Endokarditis durch Streptokokken der Gruppe B beobachtet, sieben Frauen und fünf Männer im Alter von 32 bis 81 Jahren. Bei allen Patienten bestand eine schwere Grundkrankheit, bei sieben ein Diabetes mellitus, bei drei ein Karzinom (zweimal Blasenkarzinom, einmal Mammakarzinom), bei drei Alkoholismus, bei zwei Malnutrition, bei einem Heroin-Sucht, bei einem Tuberkulose, und zwei Patienten hatten früher eine ernsthafte Herzklappenerkrankung durchgemacht. Die Endokarditis spielte sich bei vier Patienten an der Aortenklappe ab, bei zwei war die Mitralklappe, bei einem die Mitral- und Aortenklappe und bei vier die Trikuspidalklappe betroffen; in einem Fall war die Lokalisation unbekannt. Bei sieben Patienten bestand ein akutes Krankheitsbild. In sieben Fällen traten metastatische Infektionen auf, in sechs Fällen Herzversagen, bei vier Patienten kam es zu größeren Embolien, bei einem zur septischen Perikarditis und bei einem zu einem Myokardabszeß. Es sollte daran gedacht werden, daß B-Streptokokken bei bestimmten Patienten mit Abwehrschwäche, insbesondere bei Diabetes mellitus, Krebs oder Alkoholismus, eine akute Endokarditis auslösen können. Trotz der in der Regel hohen Empfindlichkeit gegen Penicillin führt die Infektion mit diesem Erreger rasch zur Klappenzerstörung; daher kann bei diesen Patienten ein herzchirurgischer Eingriff nötig werden.
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Scully, B.E., Neu, H.C. & Spriggs, D. Streptococcus agalactiae (group B) endocarditis — A description of twelve cases and review of the literature. Infection 15, 169–176 (1987). https://doi.org/10.1007/BF01646041
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DOI: https://doi.org/10.1007/BF01646041