HELP my friend, a heart valve replacement, Streptococcus infection

John Berens jberens at medmicro.uct.ac.za
Fri Aug 25 09:47:30 EST 1995


infowave at ix.netcom.com (InfoWave) wrote:
>
> Would anybody have any opinion or theory?
> 
> My friend recently had a stroke and blood culture showed the infection
> of streptococcus.  A few days later, blood culture no longer shows
> streptococcus due to antibiotic medicare. He has an artificial heart
> valve, and the doctor says the valve must have the infection. 
> 
> Is there any possibility that the bacteria comes back? 
> 
> If the bacteria comes back, does my friend need the valve replacement?
> Can the infectin place be anywhere else?
> 
> I would appreciate it if anybody can email me or post any opinion and
> information. Of course, I just want to verify the doctor's theory. (BTW
> I agree with this doctor, but I need third person's opinion to calm
> down his family, or to look for more resources for the alternative
> thory.)
> 
This is a classic case of infective endocarditis.  There is a streptococcal
infection of the prosthetic valve.  This is the usual organism to cause
infection of "native" valves, but less commonly prosthetic valves.

The infection causes growth of "vegetations" on the prosthetic valve, which
are essentially clots.  Bits may break off and go to the brain
or elsewhere, giving a stroke or whatever.

Before antibiotics, these infections were fatal.  Now with appropriate
treatment, survival is good, and the infection can usually be cleared, 
even off a prosthetic valve.  The streptococcus is probably sensitive 
to penicillin, in which case he needs 4-6 weeks treatment (depending
on how sensitive the organism is to penicillin.  A second antibiotic should
probably be combined initially.

If he does not respond to antibiotic therapy, his valve may need to be removed. 
 This is unlikely.

If the infection is adequately treated, the bacterium should not "come back".  
However, he is always at risk of developing this type of infection.  Antibiotic
prophylaxis is needed for many surgical and dental procedures.

John Berens





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