scholarly journals P1301 Opposite outcomes of two equally destructive forms of infective endocarditis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
R Carvalho ◽  
S Fernandes ◽  
L Santos ◽  
F Montenegro Sa ◽  
J Guardado ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Aortic Valve ◽  
Antibiotic Therapy ◽  
Broad Spectrum ◽  
Troponin I ◽  
Clinical Manifestations ◽  
Systolic Murmur ◽  
Hypoxemic Respiratory Failure ◽  
Blood Tests ◽  
First Case

Abstract Introduction Infective Endocarditis is a complex entity with great variability of clinical manifestations and a broad spectrum of complications. The prognosis depends not only on the baseline characteristics of the patient, but also on the agent and the complications, both local and systemic, with clinical repercussion. Two clinical cases are presented. A 67-year-old woman with history of uncharacterized aortic valve disease, presented in the emergency department with a 3-month evolution of asthenia and anorexia, and ocasional fever. She presented pallor, with a systolic murmur II/VI audible throughout the precordium and no other abnormalities in physical examination. Blood tests showed Hb 9g/dL with normal MCV and MCH, no leucocytosis, CRP 132mg/L, mild elevation of troponin I (0.32ng/ml; N <0.04ng / ml) and erythrocyturia. Transthoracic and transesophageal echocardiograms (TTE and TEE) showed a mass on the aortic valve suggestive of vegetation, conditioning a moderate aortic regurgitation (AoR) and mitroaortic pseudoaneurysm. Another 49-year-old female patient, submitted during childhood to a subaortic aneurysm, intraventricular comunication, AoR and aortic coarctation repair, presented with deterioration of functional and neurological status, associated with fever and lower limb edema. At examination she had tachypnea, tachycardia, pallor, aortic systolic murmur and signs of pulmonary congestion. Blood tests had leukocytosis and neutrophilia, CRP 174mg/L, Hb 9.6g/dL, elevation of liver enzymes, spontaneous INR 1.4 and no renal damage. TTE and TEE showed a mobile vegetation attached to the ventricular face of the aortic valve with major AoR and perivalvular abscess fistulized to the left ventricle. Both patients were treated with empirical therapy with gentamicin, ampicillin, and flucloxacillin. The first case evolved with hemodynamic stability, without heart failure or distant embolization. It was isolated a multisensitive Strept. gordonii and antibiotic therapy was de-escalated to ampicillin alone. In the second case, the patient showed rapidly progressive clinical deterioration with hypoxemic respiratory failure and cardiogenic shock requiring vasopressor support, and was urgently presented to a surgical center. No microorganism was isolated and broad-spectrum antibiotic therapy was maintained. She eventually died before she underwent valve surgery. On the other hand, in the first case, 6 weeks of antibiotic therapy were completed and aortic valve replacement surgery was performed without complications. She was discharged without cardiovascular symptoms and has an unremarkable follow-up of 6 months. With these cases it was possible to demonstrate the variability of presentations and prognosis of the same entity, even if ab initio with equally severe local complications. The initial stratification of the prognosis, the initiation of early treatment and the adequacy of the surgical time for intervention are of importance. Abstract P1301 Figure. Imaging study of endocarditis

scholarly journals Infective Aortic Valve Endocarditis Causing Embolic Consecutive ST-Elevation Myocardial Infarctions

2019 ◽  
Vol 2019 ◽  
pp. 1-5
Author(s):  
Kanksha Peddi ◽  
Alexander L. Hsu ◽  
Tomas H. Ayala
Keyword(s):  
Myocardial Infarction ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Index Case ◽  
Current Treatment ◽  
Myocardial Infarctions ◽  
Treatment Modalities ◽  
The Past ◽  
First Case ◽  
St Elevation

ST-elevation myocardial infarction (STEMI) is a rare and potentially fatal complication of infective endocarditis. We report the ninth case of embolic native aortic valve infective endocarditis causing STEMI and the first case to describe consecutive embolisms leading to infarctions of separate coronary territories. Through examination of this case in the context of the previous eight similar documented cases in the past, we find that infective endocarditis of the aortic valve can and frequently affect more than a single myocardial territory and can occur consecutively. Further, current treatment modalities for embolic infective endocarditis causing acute myocardial infarction are limited and unproven. This index case illustrates the potential severity of complications and the challenges in developing standardized management for such patients.

scholarly journals Aortic Valve Replacement and Penicillin Desensitization in a Patient with Abiotrophia defectiva Aortic Valve Endocarditis

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
S. Kumar ◽  
S. Mahmood ◽  
A. Madras ◽  
A. Iyer
Keyword(s):  
Infective Endocarditis ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Antibiotic Therapy ◽  
Valve Replacement ◽  
Bicuspid Aortic Valve ◽  
Positive Outcome ◽  
Valvular Regurgitation ◽  
Abiotrophia Defectiva ◽  
Echocardiographic Evidence

Abiotrophia defectiva is an uncommon and insidious yet destructive cause of infective endocarditis preferentially treated with penicillin/gentamicin and often requiring surgical treatment. A 60-year-old man with penicillin anaphylaxis history presented with fevers and a nonspecific constellation of symptoms. He was ultimately diagnosed with bicuspid aortic valve infective endocarditis based on blood cultures growing A.defectiva and echocardiographic evidence of bicuspid aortic valve, severe valvular regurgitation, and 5 × 7   mm vegetation. Aortic valve replacement and culture yielded penicillin-sensitive A.defectiva. After successful penicillin desensitization, antibiotic therapy was switched from vancomycin/gentamicin to benzylpenicillin. This is the first published case of penicillin desensitization in a patient with A.defectiva-associated infection. Penicillin desensitization, optimal antibiotic therapy, prompt aortic valve replacement, and close collaboration between cardiology and various other specialties were essential in achieving a positive outcome.

scholarly journals Infective Endocarditis of the Aortic Valve with Anterior Mitral Valve Leaflet Aneurysm

2016 ◽  
Vol 43 (4) ◽  
pp. 345-349 ◽  
Author(s):  
Anton Tomsic ◽  
Wilson W.L. Li ◽  
Marieke van Paridon ◽  
Navin R. Bindraban ◽  
Bas A.J.M. de Mol
Keyword(s):  
Heart Failure ◽  
Infective Endocarditis ◽  
Mitral Valve ◽  
Aortic Valve ◽  
Mitral Regurgitation ◽  
Antibiotic Therapy ◽  
Medical Literature ◽  
Severe Mitral Regurgitation ◽  
Valve Leaflet ◽  
Mitral Valve Leaflet

Mitral valve leaflet aneurysm is a rare and potentially devastating complication of aortic valve endocarditis. We report the case of a 48-year-old man who had endocarditis of the native aortic valve and a concomitant aneurysm of the anterior mitral valve leaflet. Severe mitral regurgitation occurred after the aneurysm perforated. The patient showed no signs of heart failure and completed a 6-week regimen of antibiotic therapy before undergoing successful aortic and mitral valve replacement. In addition to the patient's case, we review the relevant medical literature.

scholarly journals Intraoperative diagnosis of mitral valve endocarditis secondary to Paenibacillus provencensis

2017 ◽  
Vol 99 (2) ◽  
pp. e54-e55 ◽  
Author(s):  
A-C Pinho-Gomes ◽  
A Nasir ◽  
R Mosca ◽  
S Mirza ◽  
I Kadir
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Aortic Valve ◽  
Gene Sequencing ◽  
Transoesophageal Echocardiography ◽  
16S Rdna Gene ◽  
Intraoperative Diagnosis ◽  
First Case ◽  
Mitral Valve Vegetation ◽  
16S Rdna Gene Sequencing

We report the first case of infective endocarditis caused by Paenibacillus provencensis. A mitral valve vegetation was incidentally discovered by intraoperative transoesophageal echocardiography in a 70-year-old woman undergoing aortic valve replacement. The precise identification of the causative agent was by means of genotypic characterisation with 16S rDNA gene sequencing. The patient was successfully treated with a 6-week course of antibiotics postoperatively, following debridement of the valve vegetation.

scholarly journals Infective endocarditis of an aortic bioprosthesis causing life-threatening incessant junctional tachycardia: a case report

2020 ◽  
Author(s):  
Quentin Chatelain ◽  
Andrea Carcaterra ◽  
Florian Rey ◽  
Haran Burri
Keyword(s):  
Case Report ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Electrophysiological Study ◽  
Atrioventricular Node ◽  
Transoesophageal Echocardiography ◽  
Junctional Ectopic Tachycardia ◽  
First Case ◽  
Intravenous Amiodarone ◽  
The Right

Abstract Background  Infective endocarditis with paravalvular abscess can be complicated by atrioventricular block (AVB), but junctional ectopic tachycardia (JET) has as yet never been described. Case summary  A 68-year-old male recently admitted with Staphylococcal aureus endocarditis of his aortic valve bioprosthesis, presented with a regular tachycardia at 240 b.p.m. with a pre-existent right bundle branch block pattern. Haemodynamic collapse necessitated electrical cardioversion, following which high-grade AVB was observed. Multiple recurrences of the same tachycardia required repeated electrical cardioversions and emergent electrophysiological study, which indicated JET. The tachycardia was unresponsive to overdrive pacing, adenosine and intravenous amiodarone, and external cardioversions. Radiofrequency catheter ablation of the atrioventricular node was performed emergently with interruption of the tachycardia. A temporary external pacemaker was implanted via a jugular route. The tachycardia recurred after 48 h at a slower rate, and the patient underwent redo ablation. Transoesophageal echocardiography revealed a pseudoaneurysm of the right sinus of Valsalva probably corresponding to an evacuated abscess. A permanent pacemaker was implanted after active infection had been ruled out. At 3 months of follow-up, the patient had complete AVB, without arrhythmia recurrence. Discussion  This is the first case report of JET complicating a paravalvular abscess of the aortic valve with concomitant AVB. Junctional ectopic tachycardia is very rare arrhythmia which is usually seen in children as a congenital arrhythmia or following surgical correction of paediatric heart disease. The differential diagnosis is discussed in detail in the article.

Combination Therapy of Chloramphenicol and Daptomycin for the Treatment of Infective Endocarditis Secondary to Multidrug Resistant Enterococcus faecium

2021 ◽  
pp. 001857872110323
Author(s):  
Sunish Shah ◽  
Dayna McManus ◽  
Jeffrey E. Topal
Keyword(s):  
Aortic Valve ◽  
Combination Therapy ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Multidrug Resistant ◽  
Hypoxemic Respiratory Failure ◽  
First Case ◽  
Days Of Therapy ◽  
Coronary Cusp

A 38-years-old female with an aortic valve replacement presented to an outside hospital (OSH) with fevers and malaise. Blood cultures revealed VRE which was resistant to linezolid, resistant to ampicillin, non-susceptible to daptomycin (MIC of 8 mcg/mL), and exhibited susceptibility to gentamicin. The patient was therefore initiated on intravenous (IV) daptomycin 6 mg/kg q24h and gentamicin IV 1 mg/kg q8h. However, after 14 days of therapy with daptomycin and gentamicin, the patient was transferred to our institution for the management of cardiogenic shock and hypoxemic respiratory failure. Given the concern for treatment failure, her antimicrobial regimen was changed to IV chloramphenicol 12.5 mg/kg every 6 hours with IV daptomycin 10 mg/kg every 48 hours given an estimated creatinine clearance of 30 mL/minutes. In vitro susceptibilities for chloramphenicol were performed which confirmed susceptibility. A transesophageal echocardiogram revealed a possible abscess at the left coronary cusp and aortic valve dehiscence. The patient underwent aortic valve replacement with aortic root reconstruction. The aortic valve culture grew VRE susceptible to linezolid but resistant to ampicillin and doxycycline. The patient was deemed clinically cured after 42 days of combination therapy with daptomycin and chloramphenicol. After 6 years of follow-up, the patient has not had a recurrent VRE infection. To our knowledge, this is the first case of endocarditis secondary to VRE that was successfully managed with the combination of daptomycin and chloramphenicol.

scholarly journals Native Valve Endocarditis due toRalstonia pickettii: A Case Report and Literature Review

2015 ◽  
Vol 2015 ◽  
pp. 1-9
Author(s):  
Joseph Orme ◽  
Tomas Rivera-Bonilla ◽  
Akil Loli ◽  
Negin N. Blattman
Keyword(s):  
Case Report ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Literature Review ◽  
Heart Block ◽  
Complete Heart Block ◽  
Healthy Individuals ◽  
Native Valve ◽  
Native Valve Endocarditis ◽  
First Case

Ralstonia pickettiiis a rare pathogen and even more rare in healthy individuals. Here we report a case ofR. pickettiibacteremia leading to aortic valve abscess and complete heart block. To our knowledge this is the first case report ofRalstoniaspecies causing infective endocarditis with perivalvular abscess.

scholarly journals Infectious Esophagitis in Romanian Children: From Etiology and Risk Factors to Clinical Characteristics and Endoscopic Features

2020 ◽  
Vol 9 (4) ◽  
pp. 939
Author(s):  
Mădălina Adriana Bordea ◽  
Alexandru Pîrvan ◽  
Dan Gheban ◽  
Ciprian Silaghi ◽  
Iulia Lupan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Gastrointestinal Tract ◽  
Antibiotic Therapy ◽  
Broad Spectrum ◽  
Clinical Characteristics ◽  
Clinical Manifestations ◽  
Post Mortem ◽  
Appetite Loss ◽  
Broad Spectrum Antibiotics ◽  
Prolonged Antibiotic Therapy

Objectives. The aim of this study is to provide information about prevalence, etiology, risk factors, clinical characteristics and endoscopic features of various types of infectious esophagitis in children. Methods. We performed a total of 520 upper gastrointestinal tract endoscopies in Pediatric Clinic II, Emergency Hospital for Children, Cluj-Napoca. Indications for endoscopy in our cohort were gastrointestinal tract symptoms such as dysphagia, heartburn, or appetite loss. Results. The prevalence of infectious esophagitis in the study population was 2.11% (11 patients). Candida albicans (C. albicans) was the most frequent cause. Our data illustrates that herpes simplex virus (HSV)-induced esophagitis is common in immunocompromised patients and should be systematically suspected in cases of severe dysphagia, heartburn, or hematemesis. In the present study, all cytomegalovirus (CMV) esophagitis patients were immunocompromised. Immunodeficiency (81.8%) and prolonged antibiotic therapy with broad-spectrum antibiotics were by far the most important risk factors involved in the pathogenicity of the disease. Dysphagia, appetite loss, heartburn, epigastralgia, and hematemesis were the main clinical manifestations. Infectious esophagitis was associated with significant mortality. In four patients, endoscopy during life showed signs of infectious esophagitis; however, the precise etiology was only established post-mortem, in the pathological anatomy laboratory department. A risk factor involved in pathogenesis of post-mortem diagnosed infectious esophagitis is the DiGeorge syndrome for CMV and HSV patients. Conclusions. The study illustrates that infectious esophagitis should be considered in immunocompromised infants with prolonged antibiotic therapy with broad-spectrum antibiotics.

scholarly journals The novel use of oral antibiotic monotherapy in prosthetic valve endocarditis caused by Finegoldia magna: a case study

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Siobhan Chien ◽  
David Gorman ◽  
Charilaos-Panagiotis Koutsogiannidis ◽  
Ramanish Ravishankar ◽  
Ganesh Kamath ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Aortic Valve ◽  
Antibiotic Therapy ◽  
Prosthetic Valve ◽  
Effective Means ◽  
Prosthetic Valve Endocarditis ◽  
Oral Antibiotic ◽  
Oral Antibiotics ◽  
Intravenous Antibiotic ◽  
Intravenous Antibiotic Therapy

Abstract Background Finegoldia magna, a Gram-positive anaerobic coccus, is part of the human normal microbiota as a commensal of mucocutaneous surfaces. However, it remains an uncommon pathogen in infective endocarditis, with only eight clinical cases previously reported in the literature. Currently, infective endocarditis is routinely treated with prolonged intravenous antibiotic therapy. However, recent research has found that switching patients to oral antibiotics is non-inferior to prolonged parenteral antibiotic treatment, challenging the current guidelines for the treatment of infective endocarditis. Case presentation This case report focuses on a 52-year-old gentleman, who presented with initially culture-negative infective endocarditis following bioprosthetic aortic valve replacement. Blood cultures later grew Finegoldia magna. Following initial intravenous antibiotic therapy and re-do surgical replacement of the prosthetic aortic valve, the patient was successfully switched to oral antibiotic monotherapy, an unusual strategy in the treatment of infective endocarditis inspired by the recent publication of the POET trial. He made excellent progress on an eight-week course of oral antibiotics and was successfully discharged from surgical follow-up. Conclusions This case is the 9th reported case of Finegoldia magna infective endocarditis in the literature. Our case also raises the possibility of a more patient-friendly and cost-effective means of providing long-term antibiotic therapy in suitable patients with prosthetic valve endocarditis and suggests that the principles highlighted in the POET trial can also be applicable to post-operative patients after cardiac surgery.

scholarly journals A Giant Pseudoaneurysm of the Forearm as Unusual Complication of Bacterial Endocarditis

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Michele Arcopinto ◽  
Teresa Russo ◽  
Antonio Ruvolo ◽  
Antonio Cittadini ◽  
Luigi Saccà ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Antibiotic Therapy ◽  
Radial Artery ◽  
Systemic Inflammation ◽  
Surgical Intervention ◽  
Bacterial Endocarditis ◽  
Unusual Complication ◽  
Streptococcus Bovis ◽  
First Case ◽  
Giant Pseudoaneurysm

A 59-year-old man with fever was diagnosed with endocarditis due toStreptococcus bovis. Two weeks after antibiotic therapy was started, he presented with red and painful swelling of the forearm without any sign of systemic inflammation. A giant hematoma connected to the radial artery was detected with ultrasound. Surgical intervention with the removal of multiple, sterile clots from the hematoma was performed, and the multiple lacerations of the artery detected were corrected. This is the first case reporting rupture of the radial artery as a complication of infective endocarditis.

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