Parker R. Beamer

Vegetative endocarditis caused by higher bacteria and fungi: Review of previous cases and report of two cases with autopsies

Abstract 1. 1. Two cases of vegetative endocarditis are reported; in one, Actinomyces graminis was the cause, and, in the other, Histoplasma capsulatum . 2. 2. Ten previously reported cases of vegetative endocarditis caused by higher bacteria, yeasts, or fungi [Candida (Monilia), Actinomyces, Leptothrix, Erysipelothrix and Histoplasma] are reviewed briefly and compared with the present cases. 3. 3. From a study of twelve cases with autopsies, the following points may be of assistance in differentiating between vegetative endocarditis caused by bacteria and that caused by these higher forms: 1. (a) Greater incidence in men. 2. (b) Most patients were over 35 years of age. 3. (c) The serum proteins in the present cases were elevated, with reversal of the albumin-globulin ratio (in the other cases no data are available for comparison). 4. (d) In the presence of the Usual signs and symptoms of vegetative endocarditis, negative blood cultures by routine procedures may suggest a less common causal agent.

Histoplasmosis: Report of a case in an infant and experimental observations

Summary 1. A case of generalized histoplasmosis in a male infant, 11 months of age, with autopsy, mycologic, and experimental studies is reported. Lesions were found in the lungs, liver, spleen, adrenal glands, kidneys, colon, appendix, bone marrow, lymph nodes, and blood vessels. 2. Macroscopically visible colonies of Histoplasma capsulatum were observed on blood agar plates (indubated aerobically at room temperature) on the fourth day following inoculation with blood taken from the heart at autopsy. 3. Yeast like forms of the fungus were observed in blood films prepared post mortem. 4. Experiments indicate that Histoplasma capsulatum is resistant to drying and to low temperatures (from 5 to 8° C.). 5. Histoplasma capsulatum is destroyed in milk by heating at from 62 to 63° C. for twenty minutes. 6. Infection of guinea pigs, normal and vitamin C deficient, could not be established by oral feedings with large numbers of organisms.