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Endocarditis After the Use of an Oral Irrigation Device

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Division of Infectious Diseases
Newton-Wellesley Hospital
Newton Lower Falls, MA 02162

Ann Intern Med. 1977;87(4):455. doi:10.7326/0003-4819-87-4-455_1
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Bacteremia can occur after a variety of oral and other manipulations (1). These transient bacteremia assume major importance only when serious infection ensues, particularly endocarditis. I have recently treated two patients for endocarditis that followed the use of an oral irrigation device (Water-Pik®; Aqua Tek, Fort Collins, Colorado). Such use has previously been shown to provoke transient bacteremia in patients with diseased (2, 3) or normal (4) gingiva.

A 26-year-old man was admitted to the Massachusetts General Hospital because of positive blood clutures. For 2 weeks before admission, he had experienced malaise, anorexia, easy fatigability, and daily fever. When outpatient


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