Case series of infective endocarditis with mycotic aneurysm

<p class="p1"><span class="s1">Mycotic aneurysm of the superior mesenteric artery (SMA) is a rare complication of infective endocarditis. We report a case with infective endocarditis involving the aortic valve complicated by multiple septic embolisms. The patient was treated with antibiotics for 6 weeks. During preparation for surgical treatment, the patient developed acute abdominal pain and was diagnosed with a ruptured SMA aneurysm, which was successfully treated with an emergency operation of aneurysm ligation. The aortic valve was replaced 17 days later and the patient recovered uneventfully. In conclusion, we present a rare case with infective endocarditis (IE) complicated by SMA aneurysm. Antibiotic treatment did not prevent the rupture of SMA aneurysm. Abdominal pain in a patient with a recent history of IE should be excluded with ruptured aneurysm.</span></p>

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696. Bartonella quintana Endocarditis, A Case Series

Open Forum Infectious Diseases ◽

10.1093/ofid/ofaa439.888 ◽

2020 ◽

Vol 7 (Supplement_1) ◽

pp. S400-S400

Author(s):

Thomas D Dieringer ◽

Glen Huang ◽

Paul R Allyn ◽

Jeffrey Klausner

Keyword(s):

Renal Failure ◽

Infective Endocarditis ◽

Los Angeles ◽

Aortic Valve ◽

Literature Review ◽

Case Series ◽

The United States ◽

Aortic Insufficiency ◽

Homeless Population ◽

Bartonella Quintana

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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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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Unusual Intracranial Manifestation of Infective Endocarditis

The Open Neuroimaging Journal ◽

10.2174/1874440002114010028 ◽

2021 ◽

Vol 14 (1) ◽

pp. 28-32

Author(s):

Keerthiraj Bele ◽

Sonali Ullal ◽

Ajit Mahale ◽

Sriti Rani

Keyword(s):

Infective Endocarditis ◽

Early Diagnosis ◽

Cerebral Artery ◽

Mycotic Aneurysm ◽

Parent Artery ◽

Left Middle Cerebral Artery ◽

Risk Of Rupture ◽

Complete Obliteration ◽

Glue Embolization ◽

Left Middle

Objective: The mycotic aneurysm is a rare intracranial pathology seen with pre-existing infective endocarditis. It has a high mortality rate due to its risk of rupture and needs early diagnosis and treatment. Methods: A 23-year male patient who presented with infective endocarditis subsequently developed a left parietal-temporal intracranial haemorrhage with suspicion of aneurysm after the course of antibiotic treatment as seen on Computed Tomography (CT) scan. Digital Subtraction Angiography (DSA) revealed a ruptured fusosaccular aneurysm in the distal parietal branches of the left Middle Cerebral Artery (MCA), for which glue embolization of the distal parent artery and aneurysm was done. Result: The interventional endovascular procedure was done with complete obliteration of the distal parent artery, mycotic aneurysm, and normal filling of the left internal cerebral artery (ICA) branches. Conclusion: Mycotic intracranial aneurysms (MIA) are a rare form of cerebrovascular pathology which needs early diagnosis with endovascular intervention when rupture occurs.

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Ruptured distal middle cerebral artery mycotic aneurysm: A rare, first presentation of infective endocarditis

Asian Journal of Neurosurgery ◽

10.4103/1793-5482.180927 ◽

2018 ◽

Vol 13 (1) ◽

pp. 113

Author(s):

Sumit Sinha ◽

DipankerSingh Mankotia ◽

BhawaniShankar Sharma

Keyword(s):

Infective Endocarditis ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Mycotic Aneurysm ◽

Distal Middle Cerebral Artery

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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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