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Gonococcal endocarditis: twenty-five year experience.

J D Jackman1, D B Glamann

  • 1Department of Internal Medicine, University of Texas Southwestern Medical Center, Dallas 75235-9034.

The American Journal of the Medical Sciences
|March 1, 1991
PubMed
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Gonococcal endocarditis, a rare complication of gonorrhea, is re-emerging. This study details its characteristics in young patients, highlighting frequent heart failure and aortic valve issues, with a concerning 19% mortality rate.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Microbiology

Background:

  • Gonococcal endocarditis (GE) was historically rare and nearly eradicated by antibiotics.
  • Recent observations suggest a resurgence of GE, necessitating updated understanding.

Observation:

  • The authors report six episodes of GE in five patients, a significant series since 1983.
  • The disease predominantly affects young individuals lacking pre-existing valvular heart disease.
  • Clinical presentation often includes congestive heart failure, nephritis, and aortic valve involvement with ring abscesses and large vegetations.

Findings:

  • Uncommon presentations include simultaneous involvement of all four heart valves and recurrence on prosthetic valves.
  • A high incidence of terminal complement deficiencies was noted in affected patients.

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  • Despite appropriate treatment, rapid hemodynamic decline is frequent, contributing to a 19% mortality rate.

    • Implications:

    • The re-emergence of GE underscores the need for vigilance and potentially revised treatment strategies.
    • Understanding risk factors, such as complement deficiencies, may aid in early diagnosis and prevention.
    • This study highlights the severe morbidity and mortality associated with contemporary GE, even with antibiotic therapy.