A 47-year-old patient comes into practice and complaining about for several weeks existing lassitude, fatigue, night sweats, loss of power, loss of appetite and weight loss. A history of meaning are a several years known mitral valve prolapse and made eight weeks before tooth extraction.
On physical examination falls tachycardia at 110 / min. to continue the spleen is palpated enlarged and the heart, in particular, across the mitral valve, a holosystolic noise with propagation in the axillary is detected. In the area of two embolic Fingerendgliedern be changes in the skin show. The body temperature is measured excessively increased with 38.2 ° C, respiratory rate and blood pressure are still within the normal range. For more information on other organ infections can not be found. Echocardiography shows thrombotic vegetations on the Mitralklappensegeln. When the blood tests a significantly increased CRP fall to 70 mg / dL, an increased ESR of 45 mm in the first hour and a moderate leukocytosis of 12,000 cells / mm and a slight anemia with a hemoglobin of 11.2 g / dl.
A pronounced mitral valve prolapse predisposed to bacterial endocarditis. In the context of a history of tooth extraction described a few weeks ago it is obviously come to a bacteremia with infection of previously damaged mitral valve. As agents are at such a constellation, mainly bacteria of the oral flora as Streptococcus viridans into consideration.
Because of the severity of the disease and the apparently already past microemboli there was a hospitalization. There blood cultures Streptococcus mitis was demonstrated in several and a regimen of 20 IU Mega Penicillin G (for example, penicillin G JENAPHARM) plus 3 mg / kg gentamicin (Refobacin among others) initiated daily. This combined treatment is carried out over two weeks, followed by yet another two-week penicillin monotherapy. The therapy controls require regular echocardiographic monitoring and also the determination of CRP and noise findings. In allergy to penicillin G, ceftriaxone (Rocephin) at a dose of 2 g daily i.v. administered over the same period, this form of therapy can in principle also be carried out on an outpatient basis. The patient should receive a Endokarditisausweis with clear indications on a targeted antibiotic prophylaxis in certain interventions beyond.
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