Collateral implications of the COVID-19 pandemic: belated presentation of infective endocarditis in a young patient.
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ABSTRACT:
SUBMITTER: Toth E
PROVIDER: S-EPMC7499668 | biostudies-literature | 2020 Dec
REPOSITORIES: biostudies-literature
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Collateral implications of the COVID-19 pandemic: belated presentation of infective endocarditis in a young patient.
Toth Eva E Dancy Luke L Amin-Youssef George G Papachristidis Alexandros A Dworakowski Rafal R
European heart journal 20201201 45
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Project description:The COVID-19 pandemic is a new challenge for the diagnosis and treatment of infective endocarditis (IE). Fever and other unspecific symptoms of coronaviral infection could be misleading or masking its manifestations. We present the case of a young patient admitted for persistent fever, profuse sweating, headache, articular pain, myalgias, and weight loss. She reported regression taste and smell disorders compared to a month earlier when diagnosed with moderate COVID-19 pneumonia. While the RT-PCR SARS-COV-2 test was positive, she was admitted to a COVID-19 ward. Investigations of febrile syndrome revealed two positive blood cultures with Streptococcus gordonii and the presence of vegetations on the aortic valve, supporting a certain diagnosis of IE. After six weeks of antibiotic treatment, the patient had clinical and biologic favorable outcomes. Streptococcus gordonii is a common commensal related to the dental biofilm, although there were no caries in our patient. The influence of COVID-19 infection on the human microbiome by modifying the virulence of some commensal germs may be a risk factor for IE pathogenesis on native valves and requires the vigilance of clinicians for suspicion of this disease.
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Project description:BackgroundDuring the COVID-19 outbreak, cardiovascular imaging, especially transoesophageal echocardiography (TOE), may expose healthcare personnel to virus contamination and should be performed only if strictly necessary. On the other hand, transthoracic echocardiography (TTE) and TOE represent the first-line imaging exams for the diagnosis of infective endocarditis (IE). To date, this is the first case of COVID-19 complicated by IE.Case summaryWe present the case of a 57-year-old man with severe COVID-19 pneumonia requiring mechanical ventilation. During the intensive care unit (ICU) stay, he developed fever and positive haemocoltures for methicillin-resistant Staphylococcus aureus infection. TTE did not identify endocardial vegetations. TOE was then performed and outlined IE of the aortic valve on the non-coronary cusp. Antibiotic therapy was given with progressive resolution of the septic state and improvement of inflammatory signs. After 30 days of ICU stay, the patient was transferred to the Sub-ICU and then to a rehabilitation hospital. A close follow-up has been scheduled: after full recovery, a new echocardiography will be performed (TTE and TOE, if the former is non-conclusive) to consider surgical valve repair in the case of persistence/progression of the valvular lesion or deterioration of the valve function.DiscussionIn COVID-19 patients, echocardiography remains the leading imaging exam for the diagnosis of IE. If the suspicion of IE is high, even in this setting of patients, TTE or TOE (if TTE is non-conclusive) are mandatory. A high degree of attention must be paid and appropriate preventive measures taken to avoid contamination of healthcare personnel.
| S-EPMC7717232 | biostudies-literature
Project description:BackgroundInfective endocarditis during pregnancy is a rare condition that compromises the health of both the mother and the foetus, presenting high rates of morbidity and mortality. The clinical manifestations of this disease are varied, with embolic phenomena being a frequent presentation.Case summaryWe report the case of a Hispanic 37-year-old patient, at 29 weeks of pregnancy, with no known cardiovascular history, who presented with 48 h of sudden mandibular and lingual pain. The study showed acute thrombosis of the right lingual artery and the rest of the right external carotid artery. In this context, searching for the origin of the embolism, acute mitral valve endocarditis was diagnosed, which was effectively treated with antibiotic therapy and biological mitral valve replacement, as well as early delivery.DiscussionWe report the first case where lingual artery thrombosis was the key diagnostic feature of infective endocarditis.
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Project description:Due to COVID 19 (Corona virus disease)pandemic, majority of surgeries, including surgery for cancer patients got delayed across the globe. Surgeries were limited to emergency set up only. At our institute we tried to perform colorectal cancer surgeries through out the pandemic, albeit in less numbers, as we thought cancer in itself is an emergency setting. we are planning to analyse the prospectively managed database of this particular group of patients over a period of last six 6 months and look out at 30 day post operative morbidity and mortality. Besides we will try to analyse the implications of our decision to carry on with cancer surgeries in terms of number of health care workers who got infected while being involved in primary care of these patients.
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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:IntroductionInfective endocarditis and mycotic tibioperoneal aneurysms are rare complications of COVID-19 infection. Medical therapy may not always be sufficient to reduce the high morbidity and mortality associated with these cardiovascular complications. Surgical treatment may need to be considered in such patients.ReportA 56 year old male patient with diabetes, hypertension, and hyperlipidaemia developed severe pneumonia from COVID-19 infection. He was admitted to the intensive care unit (ICU) at another facility where he was ventilated for a period of six weeks. Blood culture isolated coagulase-negative Staphylococcus and an echocardiogram showed a 1.4 × 1.5 cm mitral valve vegetation. He was treated for a period of 12 weeks with various antibiotic combinations including meropenem, levofloxacin, and teicoplanin with no improvement. On presentation at the current centre, he complained of painful right calf swelling. Computed tomography angiography showed a 7 cm right tibioperoneal trunk aneurysm. He underwent lung and cardiac assessment, following which it was decided to proceed with one stage synchronous surgery. Cardiac surgery was started through a median sternotomy and Guiraudon transeptal approach, with mitral valve replacement using a bioprosthesis (Edwards Magna, size 29). This was immediately followed by a medial lower limb approach with ligation of the aneurysm, followed by arterial reconstruction using a reversed saphenous vein graft from the superficial femoral artery to the posterior tibial artery. He was placed on intravenous vancomycin and ceftriaxone for a period of six weeks. He was discharged home after day 31 on 75 mg aspirin daily. At six month follow up, he was symptom free with a palpable posterior tibial pulse.DiscussionIncreased awareness and close surveillance are necessary for patients with severe COVID-19 infection. In those who develop unusual cardiovascular complications, one stage cardiac and vascular surgery may be feasible, as described in this case.
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Project description:A 74-year-old man with no co-morbidities presented to hospital with a 3-day history of diarrhoea and vomiting. He met the modified Duke's criteria for definite infective endocarditis and was immediately started on an intravenous antibiotic. Over Days 1-9, he developed renal failure. On Day 10, he was transferred to a tertiary hospital for mitral valve replacement. However, he tested positive for SARS-CoV-2 on arrival at the tertiary hospital, which delayed his surgery. He underwent bi-weekly nasopharyngeal swabs for SARS-CoV-2 with a plan to operate as soon as he tested negative, or as soon as his incubation period for COVID-19 pneumonia had elapsed. Unfortunately, he died on Day 31 from acute respiratory distress syndrome secondary to COVID-19 pneumonia. We describe the challenges in deciding on the optimal timing for valve replacement. We conclude by suggesting that earlier valve replacement may result in better outcomes.
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