Collagen Diseases (C D.) Analysed from the Standpoint of Subacute Bacterial Endocarditis (SBE)


I. Introduction

In 1944, Albertini had stated that series of different diseases could be induced as the results of equilibrium between virulence of bacteria and resistance of host on the basis of rabbit experiment using hemolytic streptococci. 
From this experiment, he had plotted series of different diseases on his well-cited semi-circled schematic diagram. 
This schematic diagram was modified by several authors such as Mach (1951), Heilmeyer (1954) and Fanconi (1959) (Fig. 1). 
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A. 
Granulome. . . i l l l l l l l l l i PL, 1 I t , These diagrams illustrate that SBE stands very close to collagen diseases in the sense of so called allergic reaction to be called disease of reaction and/or mesenchymal reaction. 
In our clinical practice, indeed, we encounter not infrequently the cases in which it is difficult to differentiate chronic septicemia such as SBE or miliary tuberculosis from collagen diseases and vice versa. Purpose of this paper is to clarify the similarity and difference of the two from various angles. 
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In SBE, this substance was detected in every fraction eluted at all pH ranges (pH 8.0-4.6). 
Peak 1 from SBE which showed flocculating activity was sub- 



  Fig. 1. Semi-circled schematic diagram by G. Fanconi (1959). 




  only try to seek similarity of these two diseased conditions but also try to find the way of how to differentiate the two and give proper treatment in earlier stage. 


	ticemia and/or SBE antibiotics	plays the major role and single use
	of adrenocortical		steroid	hormones (glucocorticoids),	which is effec-
	tive to collagen	diseases,	is principally	contra-indicated,	although
	jected to ultracentrifugal in some cases beneficial	study. influence can be obtained It was composed of 6.3 S and 16.6S. from the com-
	Bentonite bined use of antibiotics flocculating		substance and steroid hormones. in collagen diseases Clinicians, such as SLE as we
	and PN, on the contrary, appeared in few places mostly two. Dif-ferent attitude of this substance to sensitized bentonite in SBE in are, not
	comparison	with	SLE and PN was the appearance	of this	substance
	in the fractions	eluted	even with pH 8.0-7.0 (Fig.	2).
				K	*	4
							«	*
							Euglobulin
				W		
							_a
	P 7						6.0 5.0	4.6
			Fig. 2. Distribution	of bentonite	flocculating	substances.
							5. Conclusion
	Since SBE is considered	to be caused by bacteria	of low-grade
	virulence, clinical	and laboratory	manifestations	are strongly	modi-
	fied by vital reaction of the host.	Such being the case, it is of no
	doubt that SBE has clinical	and laboratory	similarities	to collagen
	diseases	as the disease of reaction.
	On the other hand, definite	differences	exist between SBE and
	collagen	diseases.			Firstly,	there is an etiological	difference.	Sep-
	ticemia and/or SBE are diseases	directly	related	to bacterial	inva-
	sion.	Secondly,	there is a therapeutic	difference-that	is, in sep-
Masataka Katsu
Collagen Diseases (C D.) Analysed from the Standpoint of Subacute Bacterial Endocarditis (SBE)