BACTERIAL ENDOCARDITIS IN THE AGED

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Abstract
The occurrence of bacterial endocarditis in the older age group was inadequately emphasized. A review indicates that a considerable number of these cases occur. A series of 8676 consecutive autopsies performed from 1936 to 1950 was reviewed. Five hundred and nine (5.9%) were classified as rheumatic heart disease by fulfilling specific criteria. Bacterial endocarditis was present in 82 (16.1%) of the 509 patients with rheumatic heart disease (Group I) and in an additional 47 cases in whom the hearts did not meet these criteria (Group II). Thirteen patients in Group I and 17 patients in Group II more than 50 years of age are summarized. In older patients the endocarditis was usually an incidental terminal event, frequently in the postoperative period; associated illness included genitourinary infection, broncho-pneumonia (probably secondary), diabetes, and malnutrition; often caused by septic organisms; often presented an acute ulcerative valvulitis; underlying sclerotic changes in valves (in Group II); fewer glomerular lesions were present. In younger patients the bacterial endocarditis was usually the mechanism of illness and death, frequently following abortion or dental manipulation; associated illness included primary infections e.g., lobar pneumonia; more often caused by Streptococcus viridans; more often subacute vegetative endocarditis; underlying valvular changes included luetic aortis, lupus erythematosus, congenital lesions; glomerular lesions were more frequent.