Septic endocarditis

Septic endocarditis according to the character of the clinical course is divided into two forms : 1) acute bacterial endocarditis (endocarditis septica acuta); 2) prolonged (subacute) septic endocarditis (endocarditis septica lenta).
Postmortem for septic endocarditis is characteristic pitting heart valves. Microbes from the blood into the endocardium valves, settle on him, reproduce and damage the heart valves, causing them to ulceration. Damaged (wounded) parts of the endocardium is the formation of loose layers of fibrin and platelets. In crops, taken from the wounded parts of valves, usually found abundant growth of pathogenic microflora (C. A. Giljarovsky, 1951). Particles of fibrin and platelets, looking up and getting into the blood stream, causing multiple embolism vessels of various organs.
The most common cause septic endocarditis are streptococci (viridans, hemolytic), less Staphylococcus and other microorganisms. For the development of septic endocarditis, except bacteremia, you must have damage to the endocardium caused by rheumatic process, or a congenital heart defect, or modify the reactivity of the endocardium associated with the altered immunologic reactivity of organism (G. F. lang, 1958).
Septic endocarditis can develop in children of any age. According to E. A. Nadezhdino (1969), about 10% of all diseases septic endocarditis occurs in children younger than 10 years.
Acute bacterial endocarditis is usually considered as a manifestation of sepsis. More often it occurs in children of the first years of life on the background of staphylococcal sepsis, flowing with destructive processes in the lungs. In addition, acute bacterial endocarditis can develop in children with congenital heart disease. Most often septic endocarditis complicates ventricular septal defect, open arterial duct. But in congenital heart disease is more likely to occur accession subacute septic endocarditis, which often proceeds remanifest, with a very poor clinical picture, which makes it difficult diagnosis. At a substantiation of the diagnosis of septic endocarditis, which developed on the background of a congenital heart defect, you must consider the provision in the history of unmotivated prolonged fever, appeared after acute respiratory disease, tonsillitis, extraction of a tooth, felon, etc. During the clinical examination of the patient symptoms are pale grey color of skin, often the presence of the body, petechial rash, positive due to increased fragility of small vessels symptoms of tug and pinch. Can be change auscultatory data heart (increase or change voice previously observed noise, the emergence of other noise). As a rule, patients emerge or grow symptoms of heart failure.
In a clinical study of blood found progressive anemia, leukocytosis, accompanied by neutrophilia and a shift to the left, sometimes quite significant (up of plasmic order has been revealed), a sharp increase in ESR. In urine determined microalbuminuria, microhematuria, leukocyturia. With ventricular septal defect, patent ductus arteriosus, resulting from the arteriovenous shunting of blood there is development embolism with the hit clots in the vessels of the small circle of blood and the occurrence as a result of heart attacks the lungs.
With the development of septic endocarditis on the background of the rheumatic process of clinical manifestations of the disease are similar to those seen in congenital heart defects, but localization clots in the vessels different. There are embolism vessels large circulation - kidney, brain, spleen and education infarctions of these bodies.
Forecast septic endocarditis until recently was absolutely negative. Currently, in connection with the use of massive complex therapy can achieve the elimination of the inflammatory process, but the prognosis of the disease continues to be very serious because of the possibility of the development of a number of complications, among which takes place the formation of a heart defect.