Immunology of infective endocarditis

Renal Complications of Bacterial Endocarditis

“…55], Staphylococcal antigenic material has been demonstrated in the capillary wall of a patient with .S' , aureus endocarditis and diffuse glomerulonephritis [21]. Thus, the evidence for an immunologically me diated mechanism is quite convincing [23].…”

“…45]. The evidence for an immunologic mechanism in such cases is quite convincing [23]. Elec tron-dense deposits are noted on electron microscopy [51].…”

“…Initially, the clinical and morphologic features of the renal involvement were attributed to emboli from an infected valve with the kidney lesions representing injury and reaction to repeated microembolization. However, the presumed embolic etiology of the renal lesions was questioned particularly when focal glomerulonephritis was reported in cases of right-sided endocarditis [16,17], Indirect evidence for an immune etiology of the renal lesion was first advanced from the observation of low serum complement in 8 cases of endocarditis with mod erate to severe renal disease, in whom the complement level became normal as renal insufficiency abated [18], Subsequently, the demonstration of circulating immune complexes [19], electron-dense, immunoglobulin and complement deposits along the glomerular basement membrane [20], and ultimately the isolation of bacterial antigen [21] and antibody [22] from the glomerular eluate provided convincing evidence for an immune-mediated etiology of the glomerulonephritic lesions of bacterial endocarditis [23].…”

“…IgM. and complement deposition along the capillary basement membrane and mesangium [23,52], but cases that have no demonstrable immunoglobulins have also been re ported [48. 55], Staphylococcal antigenic material has been demonstrated in the capillary wall of a patient with .S' , aureus endocarditis and diffuse glomerulonephritis [21].…”

Reversible Brain Shrinkage Documented by Computerized Tomography

“…12 Immune complexes play a major role in the pathophysiology of bacterial endocarditis. 13 Recently, immune complexes have been blamed for vasculomyelinopathy of the central nervous system. 14 It is conceivable that this patient's psychiatric symptoms and CT scan changes were related to generalized immune complex disease that cleared with treatment of the infection.…”