subacute bacterial endocarditis (SBE), a chronic bacterial infection of the valves of the heart. It is characterized by a slow, quiet onset with fever, heart murmur, splenomegaly, and development of clumps of abnormal tissue, called vegetations, around an intracardiac prosthesis or on the cusps of a valve. Various species of Streptococcus or Staphylococcus are commonly the cause of SBE. Dental procedures are associated with infection by Streptococcus viridans, surgical procedures with S. faecalis, and self-infection (especially by drug abusers) with Staphylococcus aureus. See also bacterial endocarditis, endocarditis, Janeway lesion. ▪ OBSERVATIONS: The infected vegetations may separate from the valve or prosthesis and form emboli. Osler’s nodes, petechiae, Roth’s spots, and splinter hemorrhages under the fingernails are common manifestations of blood-borne metastases of these emboli. Bacteriological examination of cultures of the blood may allow specific diagnosis and treatment. ▪ INTERVENTIONS: Treatment requires prolonged and regular administration of an antibiotic that is known to be effective against the causative organism. If a prosthesis has become infected, it is usually removed. Before surgery or a dental procedure, prophylactic antibiotics are given. During the acute phase of illness the fever is treated with antipyretic medication and bed rest; adequate high-protein diet and fluids are encouraged. ▪ PATIENT CARE CONSIDERATIONS: Bed rest and hospitalization may be necessary for several weeks. Emotional and psychological support may help the patient adjust to the necessary inactivity and to understand that SBE is a chronic illness.
