DOI 10.1007/s10517-015-2878-9
16
Bulletin of Experimental Biology and Medicine, Vol. 159, No. 1, May, 2015
GENERAL PATHOLOGY AND PATHOPHYSIOLOGY Mitral and Aortic Valvulitis in Primary Chronic Septic Endocarditis G. M. Bushmanova, I. G. Zorina*, D. B. Nikityuk, R. D. Nepomnyashchikh, G. A. Lapii, O. A. Postnikova, and D. E. Semenov Translated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 159, No. 1, pp. 21-25, January, 2015 Original article submitted April 9, 2014 Results of long-term prospective follow-up of patients with early stages of mitral and aortic valvulitis and primary chronic septic endocarditic are presented. Clinical diagnostics of the diseases is described and the key role is assigned to pathognomic (absolute) clinical symptoms. The tendency to progressive fibrosis of endocardial structures with subsequent gradual development of valve dysfunction and stenosis (especially for the mitral valve) is revealed. It is shown that early treatment increases the effective valve area and promotes reversion of mitral stenosis. The possibility of early diagnostics of primary chronic septic endocarditis in combination with adequate etiopathogenetic therapy provide the basis for prevention of acquired valvular disease. Key Words: primary chronic septic endocarditis; combined valvulitis; progressive fibrosis of endocardial structures; mitral stenosis
During recent decades, a surge of infectious endocarditis has been registered [10,13]. Widely used diagnostic criteria [15] cannot always diagnose the disease at the early stages. However, the results of long-term studies allowed us to establish primary chronic septic endocarditis (PCSE) as a “new” clinical phenomenon of XX-XXI centuries [14]. We have previously explained why this name of endocarditis is more preferable than generally accepted “infectious” endocarditis [10]. The disease onset is benign and takes place in fact in clinically healthy subjects. The criteria of early diagnostics of PCSE developed by us [1,4] help to overcome diagnostic problems and to perform prospective study in patients with early stages of the disease. The results of long-term prospective study of PCSE with Research Institute of Regional Pathology and Pathomorphology, Siberian Division of the Russian Academy of Medical Sciences; *E. N. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation, Novosibirsk, Russia. Address for correspondence: [email protected]. G. M. Bushmanova
initial monovalvulitis are summarized in our previous articles [3]. Here we perform a prospective study of specific features, stages, and progression of PCSE with initial valvulitis of the mitral (MV) and aortic (AV) valves.
MATERIALS AND METHODS Forty-three clinical cases of PCSE with initial MV and AV valvulitis (30 women and 13 men, mean age 27.4 years) were studied examined in 1983-2012. Early clinical diagnostics was performed by estimation of classical pathognomic (absolute) symptoms and clinical marker pentade, which includes frequent extracardial microsymptoms pathognomic for chroniosepsis and PCSE: necrosis of the conjunctiva, spontaneous subungual hemorrhages, small-vesicular enanthema of the soft palate at the interface with the hard palate, and elements of small-focal skin atrophy and/or hypertrophy [1]. Visual examinationof the conjunctiva was supplemented by biomicroscopy.
0007-4888/15/1591016 © 2015 Springer Science+Business Media New York
G. M. Bushmanova, I. G. Zorina, et al.
The diagnosis was verified by echocardiography (EchoCG) performed on a VIVID 7 (Dimension General Electric) expert class ultrasonic scanner and transesophageal EchoCG. Estimation of temporal dynamics of EchoCG was carried out using the data of prospective study in accordance to the individual chronological patient cards. Analysis of parasite cenosis forming during integration of persistent pathogens [2] included examination of the hemoculture, ELISA of persistent Herpesviridae and Togaviridae viruses, and cytological study of the blood for blood parasites [12]. The data are presented as the mean±standard error of the mean. Between-group differences were estimated using Student’s t test at significance level of p
16
Bulletin of Experimental Biology and Medicine, Vol. 159, No. 1, May, 2015
GENERAL PATHOLOGY AND PATHOPHYSIOLOGY Mitral and Aortic Valvulitis in Primary Chronic Septic Endocarditis G. M. Bushmanova, I. G. Zorina*, D. B. Nikityuk, R. D. Nepomnyashchikh, G. A. Lapii, O. A. Postnikova, and D. E. Semenov Translated from Byulleten’ Eksperimental’noi Biologii i Meditsiny, Vol. 159, No. 1, pp. 21-25, January, 2015 Original article submitted April 9, 2014 Results of long-term prospective follow-up of patients with early stages of mitral and aortic valvulitis and primary chronic septic endocarditic are presented. Clinical diagnostics of the diseases is described and the key role is assigned to pathognomic (absolute) clinical symptoms. The tendency to progressive fibrosis of endocardial structures with subsequent gradual development of valve dysfunction and stenosis (especially for the mitral valve) is revealed. It is shown that early treatment increases the effective valve area and promotes reversion of mitral stenosis. The possibility of early diagnostics of primary chronic septic endocarditis in combination with adequate etiopathogenetic therapy provide the basis for prevention of acquired valvular disease. Key Words: primary chronic septic endocarditis; combined valvulitis; progressive fibrosis of endocardial structures; mitral stenosis
During recent decades, a surge of infectious endocarditis has been registered [10,13]. Widely used diagnostic criteria [15] cannot always diagnose the disease at the early stages. However, the results of long-term studies allowed us to establish primary chronic septic endocarditis (PCSE) as a “new” clinical phenomenon of XX-XXI centuries [14]. We have previously explained why this name of endocarditis is more preferable than generally accepted “infectious” endocarditis [10]. The disease onset is benign and takes place in fact in clinically healthy subjects. The criteria of early diagnostics of PCSE developed by us [1,4] help to overcome diagnostic problems and to perform prospective study in patients with early stages of the disease. The results of long-term prospective study of PCSE with Research Institute of Regional Pathology and Pathomorphology, Siberian Division of the Russian Academy of Medical Sciences; *E. N. Meshalkin Novosibirsk Research Institute of Circulation Pathology, Ministry of Health of the Russian Federation, Novosibirsk, Russia. Address for correspondence: [email protected]. G. M. Bushmanova
initial monovalvulitis are summarized in our previous articles [3]. Here we perform a prospective study of specific features, stages, and progression of PCSE with initial valvulitis of the mitral (MV) and aortic (AV) valves.
MATERIALS AND METHODS Forty-three clinical cases of PCSE with initial MV and AV valvulitis (30 women and 13 men, mean age 27.4 years) were studied examined in 1983-2012. Early clinical diagnostics was performed by estimation of classical pathognomic (absolute) symptoms and clinical marker pentade, which includes frequent extracardial microsymptoms pathognomic for chroniosepsis and PCSE: necrosis of the conjunctiva, spontaneous subungual hemorrhages, small-vesicular enanthema of the soft palate at the interface with the hard palate, and elements of small-focal skin atrophy and/or hypertrophy [1]. Visual examinationof the conjunctiva was supplemented by biomicroscopy.
0007-4888/15/1591016 © 2015 Springer Science+Business Media New York
G. M. Bushmanova, I. G. Zorina, et al.
The diagnosis was verified by echocardiography (EchoCG) performed on a VIVID 7 (Dimension General Electric) expert class ultrasonic scanner and transesophageal EchoCG. Estimation of temporal dynamics of EchoCG was carried out using the data of prospective study in accordance to the individual chronological patient cards. Analysis of parasite cenosis forming during integration of persistent pathogens [2] included examination of the hemoculture, ELISA of persistent Herpesviridae and Togaviridae viruses, and cytological study of the blood for blood parasites [12]. The data are presented as the mean±standard error of the mean. Between-group differences were estimated using Student’s t test at significance level of p
