Nonbacterial thrombotic endocarditis in a Japanese autopsy sample. A review of eighty cases

Chino, Fumitoshi; Kodama, Akiko; Ôtake, Masanori; Dock, Donald S.

doi:10.1016/0002-8703(75)90119-2

Cited by 52 publications

(18 citation statements)

References 16 publications

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“…The frequency of native IE is low, ranging from 0.68 to 6.5 cases per 100,000 person-years in the general population (3,11,23,30). A higher frequency would be expected, based on the findings that cardiac vegetations are present in 2 to 3% of elderly patients (5) and that low-grade bacteremia occurs daily in 30 to 70% of persons analyzed (3,12,15). We have now shown that circulating VS alone are not sufficient to cause IE in rabbits with preexisting vegetations; but with catheters removed.…”

Section: Discussionmentioning

confidence: 99%

Interleukin 1α Increases the Susceptibility of Rabbits to Experimental Viridans Streptococcal Endocarditis

et al. 2006

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Major predisposing conditions for infective endocarditis (IE) are the presence of a cardiac platelet-fibrin vegetation and of circulating bacteria with relatively low susceptibility to microbicidal activity of blood platelets. The influence of proinflammatory conditions on development of IE is unknown. We studied the effects of the presence of a catheter, inserted to induce platelet-fibrin vegetations, and of the proinflammatory cytokine interleukin-1␣ in rabbit experimental IE. Leaving the catheter in place after challenge with viridans streptococci predisposed for experimental IE. IE susceptibility rapidly decreased between 0 to 6 h after catheter removal. The catheter did not predispose for IE by providing a site for bacterial adherence, as almost all explanted catheters were culture negative. To mimic the proinflammatory influence of the catheter, rabbits were injected with interleukin-1␣ at 24 h after catheter removal and at 0, 1, and 3 h before bacterial challenge. Interleukin-1␣ injected 3 h prior to challenge significantly increased IE incidence due to a platelet releasatesusceptible Streptococcus oralis strain, with rapidly increasing numbers of bacteria within the vegetations. IE due to the Streptococcus sanguis strain less susceptible to platelet releasate was not enhanced. We conclude that proinflammatory stimuli, either a catheter or interleukin-1␣, enhanced susceptibility to IE due to the platelet releasate-susceptible S. oralis. As with rabbits, temporary intravascular proinflammatory conditions may predispose for IE in humans at risk for this serious infection.Infective endocarditis (IE) denotes infection of the endocardial surface of the heart (3). The presence of sterile vegetations at the damaged surface of the endocardium (1) and bacteria and fungi circulating in the bloodstream that are able to adhere to and to colonize the vegetation (3,9,13,29,35) are prerequisites in the pathogenesis of IE. A great diversity of microorganisms cause IE, with viridans streptococci (VS) as the predominant microorganisms encountered in native valve IE (3,14,16,24,27,30,33,34).Another major determinant for the development of IE is the susceptibility of the circulating microorganisms to platelet microbicidal activity (2, 7-9) due to cationic proteins such as thrombocidin or platelet microbicidal proteins, released after thrombin stimulation (7,9,26,36,39). Neutralization of this defense mechanism enhanced susceptibility of rabbits to IE due to platelet releasate-susceptible VS (8). Platelet microbicidal activity is very likely to operate in humans as well, as VS and Staphylococcus aureus isolated from vegetations of endocarditis patients are generally less susceptible than oral isolates (7,8,38). Despite an apparent selective advantage, the VS isolates from IE patients are presumably still subject to the platelet defense system, since these isolates are only slightly less susceptible to purified thrombocidins in vitro (9, 41).In the rabbit model of experimental IE, a catheter inserted retrograde across the aort...

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Section: Discussionmentioning

confidence: 99%

Interleukin 1α Increases the Susceptibility of Rabbits to Experimental Viridans Streptococcal Endocarditis

et al. 2006

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“…In the general population, the presence of cardiac vegetations is not rare. Vegetations were found in 2.4% of 3404 autopsies of hospitalized patients without IE [44]. The incidence of low-level transient bacteremia after daily activities such as chewing candy and eating (17%-51%) [1,45] or tooth brushing (7%-50%) [10], is high.…”

Section: Discussionmentioning

confidence: 99%

Platelet Microbicidal Activity Is an Important Defense Factor against Viridans Streptococcal Endocarditis

Dankert

Krijgsveld

Werff³

et al. 2001

J INFECT DIS

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To study the role of platelet microbicidal activity in host defense against infective endocarditis (IE) due to viridans streptococci (VS), the susceptibility to platelet releasate of blood and oral VS isolates from patients with and without IE was compared. The influence of neutralization of platelet microbicidal activity was studied in 2 experimental IE models. Resistance to platelet releasate was more prevalent among VS from blood of patients with IE than from blood of bacteremic patients without IE and among oral VS isolates. Serum from rabbits vaccinated with human platelet sonicate supernatants neutralized human and rabbit platelet-released microbicidal activity and had antibodies recognizing microbicidal proteins thrombocidin-1 and -2 and other human platelet proteins. In the 2 rabbit IE models, vaccination increased the susceptibility to experimental IE due to platelet releasate-susceptible VS. Thus, platelet-released microbicidal activity is an important host defense factor against IE due to VS.

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“…No cases of leukemia were found in the earlier study reported from this institution [6]. A review of English medical literature indicates the incidence of NBTE in leukemic patients to be extremely rare; only one out of over 200 cases of NBTE, reported by four large autopsy review studies, was found to have leukemia [3,5,9,13] . The reason for the increase in the incidence of NBTE in patients with hematologic malignancies and solid tumors is unknown.…”

Section: Discussionmentioning

confidence: 83%

Nonbacterial thrombotic endocarditis in cancer patients: Comparison of characteristics of patients with and without concomitant disseminated intravascular coagulation

Bedikian

Valdivieso

Luna

et al. 1978

Med. Pediatr. Oncol.

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Thirty-one cases with malignant neoplasm and nonbacterial thrombotic endocarditis (NBTE) were studied. A threefold increase in the incidence of NBTE over the five-year period ending in 1976 was noticed. Seventy-one percent of patients with NBTE had concomitant disseminated intravascular coagulation (DIC). Adenocarcinomas of the lung or ovary were the most common tumors (48%), followed by hematologic malignancies (25%). Five patients had acute leukemia, two of whom had received bone marrow transplantation. Sudden changes in the status of cardiovascular and central nervous systems were the most common manifestations of NBTE and its complications. The possible predisposing factors included disseminated malignant neoplasms and infection with gram-negative bacilli. Identification of high-risk patients and early administration of preventive measures including anticoagulation might decrease the morbidity and mortality related to NBTE.

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Nonbacterial thrombotic endocarditis in a Japanese autopsy sample. A review of eighty cases

Cited by 52 publications

References 16 publications

Interleukin 1α Increases the Susceptibility of Rabbits to Experimental Viridans Streptococcal Endocarditis

Interleukin 1α Increases the Susceptibility of Rabbits to Experimental Viridans Streptococcal Endocarditis

Platelet Microbicidal Activity Is an Important Defense Factor against Viridans Streptococcal Endocarditis

Nonbacterial thrombotic endocarditis in cancer patients: Comparison of characteristics of patients with and without concomitant disseminated intravascular coagulation

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