Experimental infective endocarditis

摘要: I T WAS about 100 yr ago that bacteria were identified as the cause of infective endocarditis. Subsequently, there was a long period clinical observation, during which time natural history and secondary manifestations disease defined. This process culminated in 1940s 1950s with development powerful antibiotics capable curing great majority patients. There then delightful, “honeymoon” once uniformly fatal brought to its knees by modern technology. quickly followed, however, phase we now find ourselves, where continued technologic advances science have provided new breeding grounds for reemergence endocarditis serious medical problem. Whereas underlying congenital or rheumatic heart still represent important risk factors endocarditis, chronic hemodialysis, intracardiac catheters. prosthetic valve surgery, well narcotic addiction, are responsible susceptible populations. Clinical criteria changed; Weinstein Rubin put it succintly, pointing out if one use diagnostic 25-30 ago, would not suspect diagnosis at least 90% cases.’ The microbiologic features also changed. It has been pointed several times today, contrast preantibiotic era, viridans streptococci much less often recovered than staphylococci other microorganisms. patterns illustrated figures taken from three published series. Table 1, series is Mandell Sande,’ 2 Kenevan Zinneman,’ 3 Falase et aL4 progressive decrease importance streptococci, opposite trend seen staphylococci. All these within past 7 yr, but different parts world. Obviously, many influence prevalence infecting microorganisms addition presence absence antibiotics. In brief, an degree, represents elements biologic fallout resulting pollution advance. To carry analogy step further, impact social disruption accompanied progress frequency drug addicts. words, physician only fascinating always been, disease, today’s world posing complex problems prevention, diagnosis, treatment. no wonder desire reproduce animals, since questions answer. Although various models producing available almost older unsatisfactory points view: difficulty establishing infection, need large inconsistency necessity employ cardiac surgical procedures establish model.s.6