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Subacute bacterial endocarditis

subacute bacterial endocarditis, subacute bacterial endocarditis prophylaxis
Subacute bacterial endocarditis also called endocarditis lenta is a type of endocarditis more specifically, infective endocarditis1 Subacute bacterial endocarditis can be considered a form of type III hypersensitivity2


  • 1 Signs and symptoms
  • 2 Causes
  • 3 Mechanism
  • 4 Diagnosis
  • 5 Treatment
  • 6 References
  • 7 Further references

Signs and symptomsedit

Among the signs of subacute bacterial endocarditis are:3

  • Malaise
  • Weakness
  • Excessive sweat
  • Fever



It is usually caused by a form of streptococci viridans bacteria that normally live in the mouth4 Streptococcus mutans, mitis, sanguis or milleri5

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 agents1


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 collagen6

Underlying structural valve disease is usually present in patients before developing subacute endocarditis, and is less likely to lead to septic emboli than is acute endocarditis, but subacute endocarditis has a relatively slow process of infection and, if left untreated, can worsen for up to one year before it is fatalmedical citation needed In cases of subacute bacterial endocarditis, the causative organism streptococcus viridans needs a previous heart valve disease to colonize7 On the other hand, in cases of acute bacterial endocarditis, the organism can colonize on the healthy heart valve, causing the disease8


Diagnosis of subacute bacterial endocarditis can be done by collecting three blood culture specimens over a 24-hour period for analysis,9 also it can usually be indicated by the existence of:

  • Osler's nodes10
  • Roth's spots11
  • Nail clubbing12



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 models5

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 194413


  1. ^ a b "Infective Endocarditis Information; prevention of endocarditis | Patient" Patient Retrieved 2015-08-28 
  2. ^ Keogan, Mary; Wallace, Eleanor M; O'Leary, Paula 2006-04-18 Concise Clinical Immunology for Healthcare Professionals Routledge p 106 ISBN 9781134428021 
  3. ^ Jefferson, James W 2012-12-06 Neuropsychiatric Features of Medical Disorders Springer Science & Business Media p 28 ISBN 9781468439205 
  4. ^ deWit, Susan C; Kumagai, Candice K 2014-04-14 Medical-Surgical Nursing: Concepts & Practice Elsevier Health Sciences p 101 ISBN 9780323293211 
  5. ^ a b Verhagen, DW; Vedder, AC; Speelman, P; van der Meer, JT 2006 "Antimicrobial treatment of infective endocarditis caused by viridans streptococci highly susceptible to penicillin: historic overview and future considerations" The Journal of Antimicrobial Chemotherapy 57 5: 819–24 PMID 16549513 doi:101093/jac/dkl087 
  6. ^ Pathology of Infectious Endocarditis at eMedicine
  7. ^ Pommerville, Jeffrey C 2012-01-15 Alcamo's Fundamentals of Microbiology: Body Systems Edition Jones & Bartlett Publishers p 768 ISBN 9781449605940 
  8. ^ Copstead-Kirkhorn, Lee-Ellen C; Banasik, Jacquelyn L 2014-06-25 Pathophysiology Elsevier Health Sciences p 395 ISBN 9780323293174 
  9. ^ Engelkirk, Paul G; Duben-Engelkirk, Janet L 2008-01-01 Laboratory Diagnosis of Infectious Diseases: Essentials of Diagnostic Microbiology Lippincott Williams & Wilkins p 446 ISBN 9780781797016 
  10. ^ Kahan, Scott 2008-03-01 Signs and Symptoms Lippincott Williams & Wilkins p 234 ISBN 9780781770439 
  11. ^ Diepenbrock, Nancy H 2011-02-15 Quick Reference to Critical Care Lippincott Williams & Wilkins p 391 ISBN 9781608314645 
  12. ^ Clubbing of the Nails~clinical at eMedicine
  13. ^ Loewe, Leo; Rosenblatt, Philip; Greene, Harry J 1946 "Combined penicillin and heparin therapy of subacute bacterial endocarditis" Bulletin of the New York Academy of Medicine 22 3: 270–2 PMC 1871521  PMID 19312479 doi:101001/jama194402850030012003 

Further referencesedit

  • Goolsby, Mary Jo; Grubbs, Laurie 2011-04-28 Advanced Assessment: Interpreting Findings and Formulating Differential Diagnoses FA Davis ISBN 9780803625174 
  • Silverman, Sol; Eversole, Lewis R; Truelove, Edmond L 2002-01-01 Essentials of Oral Medicine PMPH-USA ISBN 9781550091465 
  • Kiefer, TL; Bashore, TM 2012 "Infective endocarditis: a comprehensive overview" Reviews in Cardiovascular Medicine 13 2-3: e105–20 PMID 23160159 

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