Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0024141 (systemic lupus erythematosus)
 44,322 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Bacterial endocarditis is an elusive disease that challenges clinicians' diagnostic capabilities. Because it can present with various combinations of extravalvular signs and symptoms, the underlying primary disease can go unnoticed.A review of the various extracardiac manifestations of bacterial endocarditis suggests three main patterns by which the valvular infection can be obscured. (1) A major clinical event may be so dramatic that subtle evidence of endocarditis is overlooked. The rupture of a mycotic aneurysm may simulate a subarachnoid hemorrhage from a congenital aneurysm. (2) The symptoms of bacterial endocarditis may be constitutional complaints easily attributable to a routine, trivial illness. Symptoms of low-grade fever, myalgias, back pain and anorexia may mimic a viral syndrome. (3) Endocarditis poses a difficult diagnostic dilemma when it generates constellations of findings that are classic for other disorders. Complaints of arthritis and arthralgias accompanied by hematuria and antinuclear antibody may suggest systemic lupus erythematosus; a renal biopsy study showing diffuse proliferative glomerulonephritis may support this diagnosis. The combination of fever, petechiae, altered mental status, thrombocytopenia, azotemia and anemia may promote the diagnosis of thrombotic thrombocytopenic purpura. When the protean guises of bacterial endocarditis create these clinical difficulties, errors in diagnosis occur and appropriate therapy is delayed. Keen awareness of the varied disease presentations will improve success in managing endocarditis by fostering rapid diagnosis and prompt therapy.
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PMID:Extracardiac manifestations of bacterial endocarditis. 51 15

The cutaneous, necrotizing, palisading granuloma (Churg-Strauss granuloma) was observed on histopathologic study of skin specimens from seven patients. Two patients had Wegener's granulomatosis and one patient each had allergic granulomatosis, limited Wegener's granulomatosis, bacterial endocarditis, systemic lupus erythematosus, and rheumatoid arthritis. The microscopic picture consists of extravascular, palisading, dermal granuloma. The center of the granuloma consists of basophilic fibrillar necrosis in which linear bands of destroyed tissue are interspersed with masses of polymorphonuclear leukocytes and leukocytoclastic debris. This necrotic leukocytic mass is surrounded by histiocytes and some lymphocytes. The clinical lesions are symmetric, erythematous papules or nodules on the extremities. The histopathologic picture of the Churg-Strauss granuloma is unique and, as demonstrated in these cases, indicates the presence of systemic vasculitis.
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PMID:The Churg-Strauss granuloma: cutaneous, necrotizing, palisading granuloma in vasculitis syndromes. 58 51

Systemic lupus erythematosus (SLE) is associated with multiple cardiac complications, including valvular damage and an increased risk of bacterial endocarditis. The purpose of this study was to evaluate prospectively a group of patients with SLE for the presence of valvular abnormalities in order to assess their candidacy for antibiotic prophylaxis prior to invasive dental procedures. Of the 43 participants, 19 (44%) had echocardiographic evidence of valvular pathology; however, only seven (16%) had a physical exam consistent with pathologic valve anatomy or function. Because of the high percentage of SLE patients with valvular abnormalities, and the poor sensitivity of the physical exam, referral to a cardiologist for echocardiography is suggested prior to invasive dental care for patients with SLE. If cardiac valvular pathology is detected, antibiotic prophylaxis should be considered.
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PMID:Detecting cardiac valvular pathology in patients with systemic lupus erythematosus. 130 15

The purpose of this study was to determine the prevalence of valvular pathosis in a population of patients with SLE, to assess the candidacy of such patients for antibiotic prophylaxis before dental treatment. The hospital records of 112 patients with SLE were reviewed and screened for endocarditis, heart murmurs, and other valvular pathosis. Two of the 112 patients had confirmed cases of bacterial endocarditis. This prevalence is comparable to endocarditis prevalence rates in patients with prosthetic valves and is also three times that in patients with rheumatic heart disease. The high prevalence of endocarditis in this population of patients with SLE suggests that according to present perspectives on patient management, patients with SLE should be considered for antibiotic prophylaxis before dental therapies associated with formation of a bacteremia.
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PMID:The prevalence of cardiac valvular pathosis in patients with systemic lupus erythematosus. 214 81

Immune Complexes are involved in the Pathogenesis of many diseases of varied aetiology such as autoimmune disorders, protozoal diseases, bacterial and viral infections. Quantitation of immune Complexes in these diseases can be used for diagnosis and to ascertain the prognosis. The simple method of precipitation by polyethylene glycol and quantitation by single Radial Immunodiffusion has been used in leprosy, syphilis, bacterial endocarditis and systemic lupus erythematosus (SLE). This method found significantly higher levels of circulating immune complexes (CICs) in erythema nodosum leprosum, culture positive bacterial endocarditis and SLE where CICs are known to play an important role in the pathogenesis.
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PMID:A simple method to quantitate circulating immune complexes in different diseases. 251 53

Low levels of C1q may be found in sera of patients with diseases such as systemic lupus erythematosus, serum sickness and bacterial endocarditis. In vitro, C1q can be bound by immune complexes and induce activation of the proenzymes C1r and C1s, resulting in an activated C1 molecule. In the presence of C1-In in the reaction mixture C1r and C1s are dissociated rapidly from the immune complex-bound C1q. This C1q has the possibility to interact with free precursor C1r and C1s to form a new C1 molecule at the surface of the immune complex and induce a new cycle of activation. In vivo, however, such a possibility does not seem to play a major role, because low levels of C1q are found in various diseases which are thought to be mediated by immune complexes. Therefore we studied the clearance rate of C1q in rats in the presence and absence of soluble aggregates of IgG (AIgG). It was found that 125I-C1q is cleared from the circulation of rats with a halflife of 12.4 hrs and increasing concentrations of AIgG enhanced the clearance of 125I-C1q in vivo. Studies in which various organs were analyzed for 125I-C1q indicated that the liver is the main site of clearance and that the Kupffer cells seem to play a major role. These, and other in vitro studies, indicate that in vivo complement activation, may contribute to a higher degree of turnover of C1q in vivo and cause depletion of circulating C1q.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Possible mechanisms of degradation of C1q in vivo and in vitro: role of macrophages. 252 43

Endothelial damage to heart valves, similar to that seen with rheumatic heart disease, occurs in 50% of all patients with systemic lupus erythematosus. Bacterial endocarditis is a consequence in 1% to 4% of these patients. This rate is greater than the incidence of endocarditis after rheumatic heart disease and compares favorably with the incidence of endocarditis in patients with prosthetic heart valves. At present, it is not possible to accurately delineate the subpopulation of patients with SLE that is at risk for this disease; hence, it is recommended that antibiotic prophylaxis (standard regimen suggested by the American Heart Association) be considered for all patients with systemic lupus erythematosus undergoing dental procedures associated with transient bacteremias.
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PMID:Systemic lupus erythematosus: a consideration for antimicrobial prophylaxis. 295 52

An anti-C1q capture method kit (C1q-immunoglobulin G [IgG]) (Ortho Diagnostics, Inc., Raritan, N.J.) for measuring circulating immune complexes (CIC) was evaluated. The kit showed poor diagnostic sensitivity (P less than 0.005) for identifying CIC in patients with systemic lupus, rheumatoid arthritis, and bacterial endocarditis, as compared with polyethylene glycol-IgG and Raji cell tests (12, 24, and 24 positive, respectively, of 31 patients). Of the patients who were positive with the C1q-IgG test, 25% showed discrepancies when their results were compared with the polyethylene glycol-IgG and C1q-binding test results. Gel filtration chromatography of two of these discrepant sera showed the only peak of C1q-IgG activity to be associated with monomeric IgG (molecular weight, less than 200,000). We concluded that the kit method may be measuring substances other than CIC in some sera, because molecules of C1q attached to IgG should exhibit a molecular weight of greater than 500,000.
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PMID:Evaluation of anti-C1q capture assay for detecting circulating immune complexes and comparison with polyethylene glycol-immunoglobulin G, C1q-binding, and Raji cell methods. 295 87

Eighteen patients with occipital hematomas are analyzed. Six patients with medial occipital hematomas presented with headache and visual blurring and examination showed homonymous hemianopsia. Three of these six patients were normotensive; three others were hypertensive with chronic vascular changes. Three patients with lateral occipital hematomas presented with headache but had no neurological deficit. All were hypertensive and had evidence of chronic hypertensive vascular changes. Nine patients with larger occipital hematomas which extended into the temporal and parietal region with intraventricular and tentorial extension had an underlying etiology defined by laboratory studies (excessive anticoagulation, coagulation disorder, systemic lupus erythematosus, bacterial endocarditis). None of these patients were hypertensive. The clinical outcome was good in patients with medial and occipital hematomas; however with the larger and more extensive occipital hematomas, clinical outcome was dependent upon the underlying etiology. None of these 18 patients had recurrent stroke.
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PMID:Occipital lobe hemorrhages; clinical-computed tomographic correlations. 320 38

Levels of interleukin-2 receptors (IL-2R), as measured by a double-antibody "sandwich" enzyme-linked immunosorbent assay technique, were markedly elevated in the serum of patients with systemic lupus erythematosus, rheumatoid arthritis, and bacterial endocarditis, but not in patients with acute gout. Serum levels of IL-2R correlated strongly with clinical and laboratory indicators of disease activity in patients with lupus and in those with rheumatoid arthritis. This relationship was confirmed by sequential determinations in individual patients. Serum IL-2R values correlated with disease activity better than did the Westergren erythrocyte sedimentation rate. Our findings indicate that serum levels of IL-2R may serve as a reliable serologic indicator of disease activity in inflammatory diseases characterized by immune system activation.
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PMID:Serum levels of interleukin-2 receptor and activity of rheumatic diseases characterized by immune system activation. 326 65


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