Granulicatella Adiacens Infective Endocarditis: A Case Series

Abstract Background Homelessness has been a growing issue in the United States and worldwide. Bartonella quintana, the causative agent of “Trench fever”, is a well known illness among homeless populations in urban centers. While many cases of B. quintana are self limited, the disease can have advanced presentations including endocarditis. We present a short case series of three cases of B. quintana infective endocarditis (IE) in homeless individuals in Los Angeles and review the literature of cases of B. quintana IE in the homeless population. Methods Here we report three cases of B. quintana IE encountered in homeless individuals at the University of California, Los Angeles (UCLA) hospital system. A literature review was also conducted. PubMed was searched for published cases of human IE secondary to B. quintana in homeless individuals. Results All three patients were male with ages ranging from 39 to 57 years old with a history of homelessness and alcohol use. Presentations were subacute to chronic in nature consisting of constitutional symptoms as well as a range of symptoms corresponding with heart and renal failure. Each patient was found to have varying degrees of aortic insufficiency with either identified aortic valve vegetation or valvular thickening. Diagnosis was made with a combination of Bartonella serologies and whole genome sequencing PCR. All three patient’s courses were complicated by renal failure at varying points limiting the use of gentamicin for the full treatment course. Two patients ultimately underwent aortic valve replacement due to severe aortic insufficiency and completed therapy with doxycycline and rifampin. A single patient was discharged with plan to complete doxycycline and rifampin therapy however was lost to follow up. A literature review of 10 manuscripts describing 13 cases of B. quintana IE were identified. All the patients were male and the median age was 45. Six of the cases were in Europe and eight were in North America. All cases had left sided valve involvement (10 aortic, 6 mitral, 3 both valves). No cases of right sided IE were identified. Conclusion B. quintana IE should be considered in homeless patients with a clinical presentation concerning for IE. A combination of serology and PCR testing can be useful in diagnosis of this uncommon cause of infective endocarditis. Disclosures Jeffrey Klausner, MD, MPH, Nothing to disclose

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Novel double beta-lactam therapy for Granulicatella adiacens infective endocarditis

IDCases ◽

10.1016/j.idcr.2021.e01082 ◽

2021 ◽

Vol 24 ◽

pp. e01082

Author(s):

S. Khan ◽

C. Urban ◽

V. Singh ◽

D. Liu ◽

S. Segal-Maurer ◽

...

Keyword(s):

Infective Endocarditis ◽

Beta Lactam ◽

Granulicatella Adiacens

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Streptococcus pyogenes Infective Endocarditis – Association with Injection Drug Use: Case Series and Review of the Literature

Open Forum Infectious Diseases ◽

10.1093/ofid/ofab240 ◽

2021 ◽

Author(s):

Melanie T Rebechi ◽

Emily L Heil ◽

Paul M Luethy ◽

Sarah A Schmalzle

Keyword(s):

Infective Endocarditis ◽

Streptococcus Pyogenes ◽

People Who Inject Drugs ◽

Local Population ◽

Case Series ◽

Duke Criteria ◽

Group A ◽

Polymicrobial Bacteremia ◽

Predominantly Female ◽

Living With Hiv

Abstract Background Streptococcus pyogenes, or Group A Strep (GAS), is not considered a typical cause of infective endocarditis (IE), but has anecdotally been observed in unexpectedly high rates in people who inject drugs (PWID) at our institution. Methods All cases of possible or definite GAS IE per Modified Duke Criteria in adults at an academic hospital between 11/15/2015 and 11/15/2020 were identified. Medical records were reviewed for demographics, comorbidities, treatment, and outcomes related to GAS IE. Literature on cases of GAS IE was reviewed. Results 18 cases of probable (11) or definite (7) GAS IE were identified; mean age was 38 years, and the population was predominantly female (56%) and Caucasian (67%), which is inconsistent with local population demographics. Sixteen cases were in people who inject drugs (PWID) (89%), 14 were also homeless, six were also living with HIV (33%), and two were also pregnant. Antibiotic regimens were variable due to polymicrobial bacteremia (39%). One patient underwent surgical valve replacement. Four patients (22%) died due to complications of infection. Literature review revealed 42 adult cases of GAS IE, only 17 of which were in PWID (24%). Conclusions The 16 cases of possible and definite GAS IE in PWID over a five-year period in a single institution reported nearly doubles the number of cases in PWID from all previous reports. This suggests a potential increase in GAS IE particularly in PWID and PLWH, which warrants further epidemiologic investigation.

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The Gerbode defect: a case series

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa548 ◽

2021 ◽

Vol 5 (2) ◽

Author(s):

Nicholas Sunderland ◽

Ahmed El-Medany ◽

Justin Temporal ◽

Laura Pannell ◽

Gemina Doolub ◽

...

Keyword(s):

Infective Endocarditis ◽

Aortic Valve ◽

Case Series ◽

Decompensated Heart Failure ◽

Left Ventricular ◽

Cardiac Complications ◽

Low Grade ◽

Care Needs ◽

Intravenous Antibiotics ◽

Gerbode Defect

Abstract Background The Gerbode defect is a rare abnormal communication between the left ventricle (LV) and right atrium (RA). The lesion is either congenital or acquired. Acquired defects are largely iatrogenic or infective in origin. We present two cases of acquired Gerbode defects with similar clinical presentations but very different outcomes. Case summaries Patient 1 A 64-year-old male presented with features of decompensated cardiac failure and a low-grade temperature. Dehiscence of a recently implanted bioprosthetic aortic valve and high-velocity LV to RA jet (Gerbode defect) was found on echocardiography. Blood cultures grew Staphylococcus warneri and the diagnosis of infective endocarditis was established. The patient was treated with intravenous antibiotics and the aortic valve and Gerbode defect were successfully surgically repaired. Patient 2 An 81-year-old male presented after being found on the floor at home. On admission, he was clinically septic with evidence of decompensated heart failure. No clear infective focus was initially found. Transthoracic echocardiography revealed severe left ventricular impairment, with a normal bioprosthetic aortic valve. He was treated with intravenous antibiotics, but later deteriorated with evidence of embolic phenomena. Repeat echocardiography revealed a complex infective aortic root lesion with bioprosthetic valve dehiscence and flow demonstrated from the LV to RA. Unfortunately, the patient succumbed to the infection and cardiac complications. Discussion The Gerbode defect is a rare but important complication of infective endocarditis and valve surgery. Care needs to be taken to assess for Gerbode defect shunts on echocardiogram, especially in the context of previous cardiac surgery.

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Risk of Infective Endocarditis After Invasive Dental Treatments

Circulation ◽

10.1161/circulationaha.117.033131 ◽

2018 ◽

Vol 138 (4) ◽

pp. 356-363 ◽

Cited By ~ 5

Author(s):

Tzu-Ting Chen ◽

Yi-Chun Yeh ◽

Kuo-Liong Chien ◽

Mei-Shu Lai ◽

Yu-Kang Tu

Keyword(s):

Infective Endocarditis ◽

Confidence Interval ◽

Regression Model ◽

Conditional Logistic Regression ◽

Case Series ◽

Crossover Design ◽

The Self ◽

Series Design ◽

Case Crossover ◽

Study Designs

Background: Invasive dental treatments (IDTs) can yield temporary bacteremia and have therefore been considered a potential risk factor of infective endocarditis (IE). It is hypothesized that, through the trauma caused by IDTs, bacteria gain entry to the bloodstream and may attach to abnormal heart valves or damaged heart tissue, giving rise to IE. However, the association between IDTs and IE remains controversial. The aim of this study is to estimate the association between IDTs and IE. Methods: The data in this study were obtained from the Health Insurance Database in Taiwan. We selected 2 case-only study designs, case-crossover and self-controlled case series, to analyze the data. The advantage of these methods is that confounding factors that do not vary with time are adjusted for implicitly. In the case-crossover design, a conditional logistic regression model with exposure to IDTs was used to estimate the risks of IE following an IDT with 4, 8, 12, and 16 weeks delay, respectively. In the self-controlled case series design, a conditional Poisson regression model was used to estimate the risk of IE for the risk periods of 1 to 4, 5 to 8, 9 to 12, and 13 to 16 weeks following an IDT. Results: In total, 9120 and 8181 patients with IE were included in case-crossover design and self-controlled case series design, respectively. In the case-crossover design, 277 cases and 249 controls received IDTs during the exposure period, and the odds ratio was 1.12 (95% confidence interval, 0.94–1.34) for 4 weeks. In the self-controlled case series design, we observed that 407 IEs occurred during the first 4 weeks after IDTs, and the age-adjusted incidence rate ratio was 1.14 (95% confidence interval, 1.02–1.26) for 1 to 4 weeks after IDTs. Conclusions: In both study designs, we did not observe a clinically larger risk for IE in the short periods after IDTs. We also found no association between IDTs and IE among patients with a high risk of IE. Therefore, antibiotic prophylaxis for the prevention of IE is not required for the Taiwanese population.

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Isolated tricuspid valve endocarditis in immunocompetent juvenile patients: a series of three cases

BMJ Case Reports ◽

10.1136/bcr-2021-244312 ◽

2021 ◽

Vol 14 (8) ◽

pp. e244312

Author(s):

Atanu Chandra ◽

Shrestha Ghosh ◽

Uddalak Chakraborty ◽

Debojyoti Ray

Keyword(s):

Risk Factors ◽

Infective Endocarditis ◽

Tricuspid Valve ◽

Age Groups ◽

Case Series ◽

Venous Catheter ◽

Diagnostic Challenge ◽

Native Valve ◽

Younger Age ◽

High Index Of Suspicion

Right-sided native valve infective endocarditis is common in patients with congenital or valvular heart disease, intracardiac device, central venous catheter and intravenous drug abuse, usually manifesting in adulthood. However, in the absence of predisposing risk factors and in younger age groups, this disease may pose a diagnostic challenge. We report a case series of three juvenile patients with isolated tricuspid valve infective endocarditis without any risk factors and paucity of cardiovascular findings in two of them, in an attempt to highlight the importance of maintaining a high index of suspicion to arrive a timely diagnosis.

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Daptomycin for the Treatment of Gram-Positive Bacteremia and Infective Endocarditis: A Retrospective Case Series of 31 Patients

Pharmacotherapy The Journal of Human Pharmacology and Drug Therapy ◽

10.1592/phco.26.3.347 ◽

2006 ◽

Vol 26 (3) ◽

pp. 347-352 ◽

Cited By ~ 68

Author(s):

John A Segreti ◽

Christopher W Crank ◽

Michael S Finney

Keyword(s):

Infective Endocarditis ◽

Case Series ◽

Retrospective Case ◽

Gram Positive ◽

Retrospective Case Series

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The utility of 18F-fluorodeoxyglucose positron emission tomography with computed tomography in Mycobacterium chimaera endocarditis: a case series

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytz209 ◽

2019 ◽

Vol 3 (4) ◽

pp. 1-6 ◽

Cited By ~ 1

Author(s):

Mohamed Dafaalla ◽

Nicholas Weight ◽

Verran Cajic ◽

Uday Dandekar ◽

Kishore Gopalakrishnan ◽

...

Keyword(s):

Infective Endocarditis ◽

Fdg Pet ◽

Delayed Diagnosis ◽

Case Series ◽

Unknown Origin ◽

Ct Scanning ◽

Blood Cultures ◽

Prosthetic Valves ◽

Pet Ct ◽

Fdg Pet Ct

Abstract Background Infective endocarditis secondary to Mycobacterium chimaera can present with classical constitutional symptoms of infective endocarditis but can be blood culture negative and without vegetations on transthoracic or transoesophageal echocardiogram. Patients with prosthetic valves are at particularly high risk. Case summary We present two patients who were diagnosed with infective endocarditis secondary to M. chimaera infection. They presented similarly with pyrexia of unknown origin and night sweats. Both patients had previously undergone aortic valve replacement; one with a tissue valve and the other with a metallic valve. New cardiac murmurs were evident on auscultation, but clinical examination showed no peripheral stigmata of endocarditis. Transoesophageal echo and transthoracic echo were both unremarkable, as were serial blood cultures. FDG PET CT scan was the key investigation, which showed increased uptake in the spleen beside other areas. Histopathology and mycobacterial cultures confirmed the diagnosis of M. chimaera infection in both cases. The first patient completed medical therapy and is now fit and well. However, the second patient unfortunately developed disseminated infection causing death. Discussion The management of M. chimaera infective endocarditis is challenging, often with delayed diagnosis and poor outcomes. In the context of negative blood cultures and inconclusive echocardiograms where there remains a high index of suspicion for endocarditis, FDG PET CT scanning can be a crucial diagnostic importance and should be considered early in patients with prosthetic valves.

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Case series of infective endocarditis caused by Granulicatella species

International Journal of Infectious Diseases ◽

10.1016/j.ijid.2014.10.023 ◽

2015 ◽

Vol 31 ◽

pp. 56-58 ◽

Cited By ~ 28

Author(s):

Eduardo Leal Adam ◽

Rinaldo Focaccia Siciliano ◽

Danielle Menosi Gualandro ◽

Daniela Calderaro ◽

Victor Sarli Issa ◽

...

Keyword(s):

Infective Endocarditis ◽

Case Series

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Endovascular intervention for acute stroke due to infective endocarditis

Neurosurgical FOCUS ◽

10.3171/2011.11.focus11263 ◽

2012 ◽

Vol 32 (2) ◽

pp. E1 ◽

Cited By ~ 21

Author(s):

Haitham Dababneh ◽

V. Shushrutha Hedna ◽

Jenna Ford ◽

Ziad Taimeh ◽

Keith Peters ◽

...

Keyword(s):

Infective Endocarditis ◽

Acute Stroke ◽

Case Reports ◽

Case Series ◽

Standard Of Care ◽

Clinical Decision ◽

Neurological Complications ◽

Endovascular Interventions ◽

First Case ◽

Risk Of Hemorrhage

The overall incidence of neurological complications due to infective endocarditis is as high as 40%, with embolic infarcts more common than hemorrhagic strokes. The standard of care for typical strokes does not apply to infective endocarditis because there is a substantial risk of hemorrhage with thrombolysis. In the last decade there have been multiple case reports of intravenous and intraarterial thrombolysis with successful outcomes for acute strokes with related infective endocarditis, but successful endovascular interventions for acute strokes associated with infective endocarditis are rarely reported. To the authors' knowledge, this report is the first case in the literature to use a mechanical retrieval device in successful vegetation retrieval in an infective endocarditis acute stroke. Although an interventional approach for treatment of acute stroke related to infective endocarditis is a promising option, it is controversial and a cautious clinical decision should be made on a case-by-case basis. The authors conclude that this approach can be tested in a case series with matched controls, because this condition is rare and a randomized clinical trial is not a realistic option.

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