The Brief Case: An Unusual Cause of Infective Endocarditis after a Urological Procedure.
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ABSTRACT:
SUBMITTER: Diallo K
PROVIDER: S-EPMC6018331 | biostudies-literature | 2018 Jul
REPOSITORIES: biostudies-literature
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The Brief Case: An Unusual Cause of Infective Endocarditis after a Urological Procedure.
Diallo Kévin K Ferrand Janina J Goehringer François F Selton-Suty Christine C Folliguet Thierry T Alauzet Corentine C Lozniewski Alain A
Journal of clinical microbiology 20180625 7
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Project description:A 77-year-old woman presented to the emergency department with a 1-week history of anorexia, fatigue, general malaise and a 3-day history of fever. Clinical examination revealed livedo reticularis across the anterior aspect of her knees and a pansystolic murmur. Laboratory evaluation found neutrophil leucocytosis; elevated C reactive protein and blood cultures grew Streptococcus acidominimus. Transthoracic echocardiography displayed vegetation on the mitral valve and a left atrial myxoma. She was treated with intravenous benzylpenicillin and erythromycin for the infective endocarditis (IE) and remains well 3 months post-treatment. S. acidominimus is considered a common veterinary pathogen rarely found in humans. To the best of our knowledge, only two prior reports of IE due to this organism exist in the literature. This case highlights how rare pathogens can cause unusual presentation and the importance of IE as a differential even in the absence of classical signs, if fever and new murmur are present.
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Project description:Acute coronary syndrome is an uncommon complication in patients with infective endocarditis, either in the acute phase of infection or later in the course. We describe a case of unusual presentation of infective endocarditis as ST-elevation myocardial infarction secondary to coronary embolization from mitral valve endocarditis.
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Project description:BackgroundIncreased access to heart valves through early surgery and progress in molecular microbiology have reduced the proportion of infective endocarditis (IE) with no microbiological documentation and increased the proportion of IE associated with unusual microorganisms.MethodsWe performed an ancillary study of a large prospective population-based survey on IE. Unusual-microorganism IE was defined as definite IE (Duke-Li criteria) due to microorganisms other than streptococci, staphylococci, or enterococci.ResultsOf 471 cases of documented IE, 46 (9.8%) were due to unusal microorganisms; the following were involved in >1 case: Candida albicans (n = 4), Cutibacterium acnes (n = 4), Pseudomonas aeruginosa (n = 3), Cardiobacterium hominis (n = 3), and Coxiella burnetii (n = 2). Cases were documented with blood cultures (n = 37, 80.4%), heart valve polymerase chain reaction (PCR; n = 5), heart valve culture (n = 2), PCR on vertebral biopsy (n = 1), or serology (n = 1). As compared with IE due to staphylococci, streptococci, or enterococci (n = 420), IE due to unusual microorganisms occurred more frequently in patients with previously known heart disease (69.0% vs 44.3%; P = .002), prosthetic valve (40.5% vs 18.1%; P = .0006), longer duration of fever (mean, 35.1 ± 46.8 days vs 12.5 ± 17.8; P = .003), and who were more often nosocomial (38.1% vs 20.2%; P = .02).ConclusionsIn this population-based study, 9.8% of IE cases were due to unusual microorganisms, with a predominance of anaerobes, yeast, and gram-negative bacilli. As compared with IE related to staphylococci, streptococci, or enterococci, IE cases related to unusual microorganisms were associated with previously known heart disease, prosthetic valve, longer duration of fever, and nosocomial acquisition.Trial registrationORCID 0000-0003-3617-5411.
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Project description:Granulicatella elegans is a rare cause of infective endocarditis, accounting for 1–2% of all cases. It is well recognized that this pathogen can present in association with negative blood cultures. There are higher rates of both relapse and mortality compared with endocarditis caused by other bacteria. Microbiological diagnosis can be especially challenging because many conventional blood culture media lack pyridoxal, which can be found in automated blood culture broths like BACTEC™ or BACT/ALERT® and thus they may require ‘helper’ bacteria to be culture the organism. This current case report describes a 66-year-old male patient with a 10-year history of post-inflammatory combined aortic valve disease (moderate aortic stenosis and mild aortic regurgitation). He presented with a 3-month history of recurrent fever and general deterioration. Despite targeted, prolonged, combined antibiotic treatment with intravenous penicillin and gentamicin, surgery was eventually required. An aortic prosthetic valve implantation was performed with good results. In case of subacute endocarditis, especially when a causative organism proves difficult to detect, G. elegans should be considered. Identification is greatly enhanced by using polymerase chain reaction methods and this test should be considered in all cases of culture negative endocarditis.
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Project description:Invasive infections due to Pseudomonas stutzeri have rarely been described and mainly occur in immunocompromised individuals. We report a case of infective endocarditis caused by P. stutzeri after previous cardiac surgery in a Lebanese patient with Marfan syndrome. We review the literature and conclude that this pathogen may be of particular medical relevance in the Mediterranean Basin.
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Project description:BackgroundThe Ross procedure can be an ideal option in infective endocarditis (IE) due to greater resistance to infection. However, limited literature has highlighted the comparison with conventional prostheses in this setting.MethodsBetween February 2013 and September 2022, 25 patients (median age, 50 years) underwent a Ross procedure for IE (Ross group). The results were compared with those after other aortic valve procedures (aortic valve replacement and aortic root replacement) for IE (n = 37, other group.ResultsThe patients in the Ross group included more intravenous drug users and had more prosthetic valve endocarditis and annular abscess formation compared with the other group. Although cardiopulmonary bypass time and aortic cross-clamp time were significantly longer (P < .001 and P = .003, respectively) and the blood requirements were significantly higher (P = .001) in the Ross group, most postoperative short-term outcomes were equivalent between the 2 groups. During follow-up, 1 patient (4%) required reoperation in the Ross group, whereas 6 patients (16%) required reoperation in the other group. Freedom from composite events was significantly better in the Ross group (P = .04). Multivariable analysis found the Ross procedure, compared with other procedures, was a significant independent protective factor for composite end points (P = .03).ConclusionsFor IE, despite surgical complexity, the Ross procedure yielded short-term outcomes similar to other procedures. In the midterm, the Ross procedure provides a lower reoperation rate, resulting in significantly fewer composite events. The Ross procedure appears to be a better option for patients with IE, but long-term follow-up is necessary.
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