- Email: [email protected]
Subacute bacterial endocarditis following ear acupuncture
62
IJC 0215B
Subacute bacterial endocarditis following ear acupuncture R.J.E. Lee ’ and J.C. McIlwain ’ Department
ofMedicine,The
’
Queen’s Unwersrty 01 BelJkt, and Ear, Nose and Throat Surge
(Received 24 July 1984: accepted 13 August 1984)
Ear acupuncture followed by sepsis caused subacute bacterial endocarditis in a patient with rheumatic valve disease. (Key words: acupuncture;
sepsis; endocarditis)
Any procedure involving skin puncture or implantation carries a risk of sepsis or disease transmission. The increasing use of acupuncture in Western society, often by non-medical practitioners, has generated concern that its casual use may cause serious morbidity in some patients. We report a case of subacute bacterial endocarditis following ear acupuncture, with subsequent sepsis, in a patient with known rheumatic valve disease. Case The patient, a 56-year-old housewife attended a non-medically qualified acupuncturist with the aim of quitting smoking. She was asked about her general health, and claims that she told the therapist about her vaive disease. No mention was made by either party about antibiotic prophylaxis. although the patient was aware of the need for this with dental treatment. Acupuncture therapy was by the insertion of a small metal stud into the pinna of the right ear. Within 5 days this became infected, and on advice from the acupuncturist the stud was removed. Her general practitioner prescribed ampicillin orally. but the swelling persisted and she was referred to an ENT specialist. A second combined antibiotic was prescribed (flucloxacillin and ampicillin), but it became clear that surgical debridement would be required. This was carried out 15 days after the insertion of the stud. Three days later the patient developed malaise, night sweats, chills and a low grade pyrexia. Examination revealed a cleanly healing ear wound. The previously documented murmurs of mitral and aortic incompetence were heard. There was no splenomegaly and no micro-embolic phenomena. The ESR was 135 mm/hr. the haemoglobin was 10.9 g/dl with normocytic indices. The white cell count was slightly raised at 12.4 thousand with a neutrophil leucocytosis. Blood culture grew Staphylococcus aureu~ in one bottle (out of eight). An echocardiogram did not detect any valvular vegetations. Treatment was begun with intravenous floxapen and netilmicin. Within 24 hr the temperature settled and the night sweats disappeared. After 1 week the patient felt well again. Correspondence to: Dr. R.J.E. Lee, Department of Medicine, institute of Clinical Science. Grosvenor Road. Belfast BT12 6BJ. U.K. Infernational Journal of Cardiology, 7 (1985) 62 -63 ST)Elsevier Science Publishers B.V.
63
Treatment was continued for 6 weeks. The ESR fell gradually towards normal, the white cell count became normal and the haemoglobin rose to 13.6 g/dl. At review 6 months later the patient remains well. Her prolonged hospital stay provided the opportunity for her to give up cigarettes! Discussion Despite the negative echocardiogram, which does not exclude endocarditis [I], and the dubious significance of one culture positive blood sample out of eight, we feel that the history, the clinical and laboratory abnormalities and the full and rapid response to treatment support the diagnosis of subacute bacterial endocarditis in this case. Acupuncture by insertion of metal studs is similar to ear piercing and hazards have been reported in each case [2-41. The more straightforward “in and out” kind of needling is not without danger either [5]. We have found one previous report of a case of subacute bacterial endocarditis following acupuncture in a clinical setting very similar to this case [2]. Acupuncture is here to stay. Any measure that reduces associated morbidity deserves consideration. We suggest that patients who can be identified as at risk for bacterial endocarditis be advised to have antibiotic cover. It seems obvious that the acupuncturist, medical or non-medical, be made aware of this requirement.
References Melvin ET, Berger M, Lutzker LG, Goldberg E, Mildvan D. Non-invasive methods for detection of valve vegetations in infective endocarditis. Am J Cardiol 1981;47:271-278, Jefferys DB, Smith S. Brennand-Roper DA, Curry PVL. Acupuncture needles as a cause of bacterial endocarditis. Br Med J 1983;287:326-327. Bodner G, Topilsky M, Greif J. Pneumothorax as a complication of acupuncture in the treatment of bronchial asthma. Ann Allergy 1983;51:401-403. Biggar RJ, Haughie GE. Medical problems of ear piercing. NY State J Med 1974;75:1460-1462. Carron H, Epstein BS, Grand 9. Complications of acupuncture. J Am Med Assoc 1974;228:1552-1554.
IJC 0215C
QT prolongation and torsades de pointes: the sole manifestation of coronary artery disease Anthony Y. Fung, Charles R. Kerr and T. Kier Maybee Department of Medicine, Division of Cardiology, Unirlersityof British Columbia, Vancouver, B.C., Canada (Received
27 February
1984; accepted
28 August
1984)
We describe a case of torsades de pointes as the sole manifestation disease, a presentation not previously reported to our knowledge. (Key words: myocardial
ischemia;
torsades
de pointes;
coronary
Dr. Kerr is a Scholar of the Medical Research Council of Canada. Reprint requests to: Dr. Charles R. Kerr, Division of Cardiology, 324-2775 Heather Street. Vancouver, B.C.. Canada V5Z 355. International Journal of Cardiology, 7 (1985) 63-66 c Elsevier Science Publishers B.V.
of coronary artery
artery disease)
Vancouver
General
Hospital.
IJC 0215B
Subacute bacterial endocarditis following ear acupuncture R.J.E. Lee ’ and J.C. McIlwain ’ Department
ofMedicine,The
’
Queen’s Unwersrty 01 BelJkt, and Ear, Nose and Throat Surge
(Received 24 July 1984: accepted 13 August 1984)
Ear acupuncture followed by sepsis caused subacute bacterial endocarditis in a patient with rheumatic valve disease. (Key words: acupuncture;
sepsis; endocarditis)
Any procedure involving skin puncture or implantation carries a risk of sepsis or disease transmission. The increasing use of acupuncture in Western society, often by non-medical practitioners, has generated concern that its casual use may cause serious morbidity in some patients. We report a case of subacute bacterial endocarditis following ear acupuncture, with subsequent sepsis, in a patient with known rheumatic valve disease. Case The patient, a 56-year-old housewife attended a non-medically qualified acupuncturist with the aim of quitting smoking. She was asked about her general health, and claims that she told the therapist about her vaive disease. No mention was made by either party about antibiotic prophylaxis. although the patient was aware of the need for this with dental treatment. Acupuncture therapy was by the insertion of a small metal stud into the pinna of the right ear. Within 5 days this became infected, and on advice from the acupuncturist the stud was removed. Her general practitioner prescribed ampicillin orally. but the swelling persisted and she was referred to an ENT specialist. A second combined antibiotic was prescribed (flucloxacillin and ampicillin), but it became clear that surgical debridement would be required. This was carried out 15 days after the insertion of the stud. Three days later the patient developed malaise, night sweats, chills and a low grade pyrexia. Examination revealed a cleanly healing ear wound. The previously documented murmurs of mitral and aortic incompetence were heard. There was no splenomegaly and no micro-embolic phenomena. The ESR was 135 mm/hr. the haemoglobin was 10.9 g/dl with normocytic indices. The white cell count was slightly raised at 12.4 thousand with a neutrophil leucocytosis. Blood culture grew Staphylococcus aureu~ in one bottle (out of eight). An echocardiogram did not detect any valvular vegetations. Treatment was begun with intravenous floxapen and netilmicin. Within 24 hr the temperature settled and the night sweats disappeared. After 1 week the patient felt well again. Correspondence to: Dr. R.J.E. Lee, Department of Medicine, institute of Clinical Science. Grosvenor Road. Belfast BT12 6BJ. U.K. Infernational Journal of Cardiology, 7 (1985) 62 -63 ST)Elsevier Science Publishers B.V.
63
Treatment was continued for 6 weeks. The ESR fell gradually towards normal, the white cell count became normal and the haemoglobin rose to 13.6 g/dl. At review 6 months later the patient remains well. Her prolonged hospital stay provided the opportunity for her to give up cigarettes! Discussion Despite the negative echocardiogram, which does not exclude endocarditis [I], and the dubious significance of one culture positive blood sample out of eight, we feel that the history, the clinical and laboratory abnormalities and the full and rapid response to treatment support the diagnosis of subacute bacterial endocarditis in this case. Acupuncture by insertion of metal studs is similar to ear piercing and hazards have been reported in each case [2-41. The more straightforward “in and out” kind of needling is not without danger either [5]. We have found one previous report of a case of subacute bacterial endocarditis following acupuncture in a clinical setting very similar to this case [2]. Acupuncture is here to stay. Any measure that reduces associated morbidity deserves consideration. We suggest that patients who can be identified as at risk for bacterial endocarditis be advised to have antibiotic cover. It seems obvious that the acupuncturist, medical or non-medical, be made aware of this requirement.
References Melvin ET, Berger M, Lutzker LG, Goldberg E, Mildvan D. Non-invasive methods for detection of valve vegetations in infective endocarditis. Am J Cardiol 1981;47:271-278, Jefferys DB, Smith S. Brennand-Roper DA, Curry PVL. Acupuncture needles as a cause of bacterial endocarditis. Br Med J 1983;287:326-327. Bodner G, Topilsky M, Greif J. Pneumothorax as a complication of acupuncture in the treatment of bronchial asthma. Ann Allergy 1983;51:401-403. Biggar RJ, Haughie GE. Medical problems of ear piercing. NY State J Med 1974;75:1460-1462. Carron H, Epstein BS, Grand 9. Complications of acupuncture. J Am Med Assoc 1974;228:1552-1554.
IJC 0215C
QT prolongation and torsades de pointes: the sole manifestation of coronary artery disease Anthony Y. Fung, Charles R. Kerr and T. Kier Maybee Department of Medicine, Division of Cardiology, Unirlersityof British Columbia, Vancouver, B.C., Canada (Received
27 February
1984; accepted
28 August
1984)
We describe a case of torsades de pointes as the sole manifestation disease, a presentation not previously reported to our knowledge. (Key words: myocardial
ischemia;
torsades
de pointes;
coronary
Dr. Kerr is a Scholar of the Medical Research Council of Canada. Reprint requests to: Dr. Charles R. Kerr, Division of Cardiology, 324-2775 Heather Street. Vancouver, B.C.. Canada V5Z 355. International Journal of Cardiology, 7 (1985) 63-66 c Elsevier Science Publishers B.V.
of coronary artery
artery disease)
Vancouver
General
Hospital.