Subacute Bacterial Endocarditis Treated Unsuccessfully with Sulfapyridine
Abstract
Recent medical literature has contained a few reports of the successful treatment of subacute bacterial endocarditis with sulfanilamide or sulfapyridine. The most encouraging of these have been the reports of Kelson and White1 and of Major2. Recovery occurred in three of seven cases treated by Kelson and White with sulfapyridine and heparin in combination and in three of seven cases treated by Major with sulfanilamide or sulfapyridine alone. Stimulated by these reports, we have employed sulfapyridine in the treatment of five patients with subacute bacterial endocarditis, but the results have been uniformly disappointing. Two patients have died and the others are unimproved. Streptococcus viridans was the responsible organism in two of the cases, while a non-hemolytic streptococcus was found in two others, and in the fifth case an anaerobic streptococcus was recovered.
Case Reports
Case 1: A white boy, eighteen years of age, was admitted to the hospital on November 1, 1939 because of chills, fever, and sweats, one week in duration. The onset of symptoms had been sudden and there had been no recent acute illness. The past medical history disclosed nothing suggestive of an earlier rheumatic infection.
Physical examination revealed a well-nourished individual who did not appear particularly ill. The temperature, however, was 104° F. and the pulse rate 140 per minute. The blood pressure was 148 mm. systolic and 0 diastolic. The heart was not enlarged and its rhythm was regular. A prolonged diastolic murmur was present over the aortic area and was transmitted down along the. . .
