[Acute endocarditis and heart involvement in septic conditions]

A prospective study on septicemia. II. Clinical manifestations and complications, results of antimicrobial treatment and report of a follow-up study

In a prospective study at a hospital for infectious diseases 151 patients, 110 with proved and 41 with probable septicemia, were analysed. Clinical, laboratory, therapeutic data and prognostic experiences, partly from a follow-up study, are described. Secondary manifestations, mostly from skin, mucous membranes, nervous system and lungs, were present in 72%. They were more often caused by gram-positive cocci than by gram-negative baccilli and in some cases not revealed until autopsy. Lesions in the nervous system were most often caused by strepto- or penumococci or Haemophilus influenzae. In 2 splenectomized patients with extensive hemorrhages, pneumococci were isolated. Subacute courses were rare even in alpha-streptococcal infection and its "classical signs" were never observed. Shock and thrombocytopenia suggesting disseminated intravascular coagulation occurred together in 11%, and in one-third in the lethal cases. Gram-positive bacteria were often involved. Leukocytosis was absent in 53 patients; 20 were alcohol or narcotic drug abusers, and 7 died. ECG changes were registered in 33%. Initial antibiotic treatment was applied according to a fixed schedule, with cure in 61% on this first treatment, and especially so in infections with gram-positive cocci. During the initial hospital stay 20% died from uncontrolled infection. All had underlying diseases or factors, often major causes of death. The infection was regarded as hospital-acquired in 40% among the lethal cases. During a one-year follow-up period 3 patients died from a new septicemia and 10 from their underlying disease.