Corynebacterium jeikeium native valve infective endocarditis case report: a confirmed microbiological and pathological diagnosis from heart valvular tissue

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa365 ◽

2020 ◽

Author(s):

Wentzel Bruce Dowling ◽

Johan Koen

Keyword(s):

Infective Endocarditis ◽

Aortic Valve ◽

Penicillin G ◽

Peripheral Vascular ◽

Native Valve ◽

Valve Tissue ◽

Case Summary ◽

Duke Criteria ◽

G Prior ◽

Initial Blood

Abstract Background The Modified Duke criteria is an important structured schematic for the diagnosis of infective endocarditis (IE). Corynebacterium jeikeium is a rare cause of IE that is often resistant to standard IE anti-microbials. We present a case of C. jeikeium IE, fulfilling the Modified Duke pathological criteria. Case summary A 50-year-old male presented with left leg peripheral vascular disease with septic changes requiring amputation. Routine echocardiography post-amputation demonstrated severe aortic valve regurgitation with vegetations that required valve replacement. Two initial blood cultures from a single venepuncture showed Streptococcus mitis which was treated with penicillin G prior to surgery. Subsequent aortic valve tissue cultured C. jeikeium with suggestive IE histological valvular changes and was successfully treated on a prolonged course of vancomycin. Discussion This is the first C. jeikeium IE case diagnosed on heart valvular tissue culture and highlights the importance for the fulfilment of the Modified Duke criteria in diagnosing left-sided IE. Mixed infection IE is rare, and this case possibly represents an unmasking of resistant C. jeikeium IE following initial treatment of penicillin G.

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Abstract WP335: Intracranial Mycotic Aneurysms in Infective Endocarditis: Incidence, Predictors and Outcome

Stroke ◽

10.1161/str.48.suppl_1.wp335 ◽

2017 ◽

Vol 48 (suppl_1) ◽

Author(s):

Mehmet A Topcuoglu ◽

Oguzhan Kursun ◽

Ferdinando S Buonanno ◽

Aneesh B Singhal

Keyword(s):

Infective Endocarditis ◽

Mitral Regurgitation ◽

Multivariable Analysis ◽

Native Valve ◽

Duke Criteria ◽

Mycotic Aneurysms ◽

Mean Size ◽

Pre Treatment ◽

Cardiac Valve Disease

Introduction: Intracranial mycotic aneurysms (IMA) are rare but serious complications of infective endocarditis (IE). Methods and Results: In this retrospective study (1980-2011) we used original Duke criteria to diagnose IE in 1149 episodes (1081 patients; 81% definite, 80% native valve). Neuro complications occurred in 28%, stroke in 22% (202 infarcts, 53 hemorrhages) and 1% had TIA/TMB. N=33 IMA were detected in 23 (2%) patients. IMA were detected in 8% with focal neuro deficits, 13% with seizures, and 3% with encephalopathy. IMA-related symptoms were present in 22 of 23 cases: headache 48%, seizure 13%, altered sensorium 35% and focal deficits 61%. IMA were detected in 0/885 without stroke, 5.4% with infarcts and 22.6% with hemorrhages (p<0.001); the latter included 9/36 (25%) with ICH, 3/13 (23%) with SAH, and 0/4 with SDH. Of the 23 IMA patients 61% had hemorrhage, 30% had SAH and 57% had infarcts. IMAs were detected by DSA in 21/166 (12.7%). The mean size was 3.6±2.4 mm; 30% multiple; 61% located in distal segments; and 67% in MCA branches. On MRI, 31 had any SAH and 45 had any ICH; IMA detected in 6/9 with diffuse SAH, 2/22 with convexal SAH, 11/45 with ICH, and 11/202 with infarcts. Patients with IMA had higher rates of women, hypertension, known cardiac valve disease, mitral regurgitation, mitral vegetation and S.viridians infection (all p<0.05). On multivariable analysis, mitral regurgitation with vegetation (OR 5.9, 95% CI 2.5-14.0, p<0.001) was the only independent predictor of IMA. Clipping was performed in 8 (all pre-2000); endovascular treatment in 7 (all post-1997); 2 died pre- treatment; 1 detected on autopsy; 1 no follow-up available, and 4 regressed/disappeared with antibiotics. Patients with and without IMA showed no difference in rates of in-hospital mortality (22% v. 19%, p=0.93), and length of stay (32d v. 24d, p=0.28). IMA rates did not decrease during the study period (2.2% in 784 episodes 1980-2000 vs. 1.6% of 365 episodes 2001-2011, p=0.653). Conclusion: IMA are invariably heralded by neurological symptoms and stroke (especially hemorrhages) on brain imaging. Mitral IE has the highest risk for IMA. IMAs can resolve with antibiotics however studies are needed to determine the efficacy of different treatment approaches.

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Aortic Valve Damage for the Study of Left-Sided, Native Valve Infective Endocarditis in Rabbits

Superantigens - Methods in Molecular Biology ◽

10.1007/978-1-4939-3344-0_6 ◽

2015 ◽

pp. 73-80 ◽

Cited By ~ 2

Author(s):

Wilmara Salgado-Pabón ◽

Patrick M. Schlievert

Keyword(s):

Infective Endocarditis ◽

Aortic Valve ◽

Native Valve

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Clinical and pathogen features of infective endocarditis:A retrospective study of 111 episodes in a teaching hospital in southwest China

10.21203/rs.2.9194/v1 ◽

2019 ◽

Author(s):

Yuanfang Wang ◽

Mei Kang ◽

Ya Liu ◽

Siyin Wu ◽

Weili Zhang ◽

...

Keyword(s):

Staphylococcus Aureus ◽

Heart Disease ◽

Infective Endocarditis ◽

Laboratory Data ◽

Clinical Manifestations ◽

Resistance Rate ◽

Native Valve ◽

Duke Criteria ◽

Preventive Medication ◽

History Of

Abstract Background Infective endocarditis (IE) is a health-threaten infectious disease. Diverse and complicated etiology and causative microorganisms make IE difficult to diagnose and treat. As we know, current investigations of clinical and pathogen features of IE in West china are scarce. In this study, we aimed to investigate the epidemiology and pathogen characteristic of IE in our region. Methods A retrospective analysis of clinical and laboratory data was performed from all blood culture positive IE patients between 2012 to 2017 in Westchina Hospital of Sichuan University。The diagnosis is traditionally based on the modified Duke criteria. Results The mean age of the patient cohort was 40.7±21.5 years (ranging from 2-78); 73 cases (65.2%) were males and 39 cases (34.8%) were females. Of the 111 cases, 100 were native valve endocarditis (NVE) while 11 were prosthetic valve endocarditis (PVE), 87 cases (78.4%) were left-heart infection. Congenital heart disease (28.6%) and rheumatic heart disease (11.6%) were most common history of heart disease. Primary clinical manifestations were fever (87.5%) and heart murmur (78.6%).Streptococci spp (20.7%) was the most common organism, followed by Staphylococcus spp(17.9%). Streptococcus viridians showed no resistance to penicillin, erythromycin and clindamycin resistance rate were 47.4% and 40%. Benzocillin resistance rate of staphylococcus aureus to was 26.3%. Vancomycin or linezolid resistance staphylococcus aureus were not found. 75 patients died while 36 patients survived at last. With respect to risk factors, history of heart disease was the only prognostic risk factor (OR: 0.239, 95%CI 0.08-0.68) Conclusions Epidemiological and clinical characteristics of infective endocarditis are various and complex, distribution of pathogen is regional difference. Our research of infective endocarditis with bloodstream infection verified regional characteristics of infective endocarditis. The variations we observed in the study will be of important value to clinical preventive medication in our region.

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Prosthetic valve endocarditis

ESC CardioMed ◽

10.1093/med/9780198784906.003.0392 ◽

2018 ◽

pp. 1720-1723

Author(s):

José A. San Román ◽

Javier López

Keyword(s):

Computed Tomography ◽

Infective Endocarditis ◽

Antibiotic Treatment ◽

Prosthetic Valve ◽

Photon Emission ◽

Clinical Manifestations ◽

Prosthetic Valve Endocarditis ◽

Native Valve ◽

Native Valve Endocarditis ◽

Duke Criteria

Prosthetic valve endocarditis (PVE) complicates the clinical course of 1–6% of patients with prosthetic valves and it is one of the types of infective endocarditis with the worst prognosis. In early-onset PVE (that occurs within the first year after surgery), the microbiological profile is dominated by staphylococci. In late-onset PVE, the microorganisms are similar to native valve endocarditis. Clinical manifestations are very variable and depend on the causative microorganism. The diagnosis is established with the modified Duke criteria although they yield lower diagnostic accuracy than in native valve endocarditis. Transoesophageal echocardiography is the main imaging technique in everyday clinical practice in PVE as the sensitivity is higher than transthoracic echocardiography. The findings of other techniques, as cardiac computed tomography (CT), positron emission tomography/CT, or single-photon emission computed tomography/CT have been recently recognized as new major diagnostic criteria and can be very useful in cases with a high level of clinical suspicion and negative echocardiography. Empirical antibiotic treatment should cover the most frequent microorganisms, especially staphylococci. Once the microbiological diagnosis is made, the antibiotic treatment is similar to native valve infective endocarditis, except for the addition of rifampicin in staphylococcal PVE and a longer length (up to 6 weeks) of the treatment. Surgical indications are also similar to native valve endocarditis, heart failure being the most common and embolic prevention the most debatable. Prognosis is bad, and during the follow-up, a team experienced with endocarditis is needed. Patients with a history of PVE should receive antibiotic prophylaxis if they undergo invasive dental manipulations.

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Addition of Rifampin to Standard Therapy for Treatment of Native Valve Infective Endocarditis Caused by Staphylococcus aureus

Antimicrobial Agents and Chemotherapy ◽

10.1128/aac.00300-08 ◽

2008 ◽

Vol 52 (7) ◽

pp. 2463-2467 ◽

Cited By ~ 83

Author(s):

David J. Riedel ◽

Elizabeth Weekes ◽

Graeme N. Forrest

Keyword(s):

Staphylococcus Aureus ◽

Infective Endocarditis ◽

Drug Interactions ◽

Standard Therapy ◽

Cohort Analysis ◽

Urban Hospital ◽

Hepatitis C Infection ◽

Native Valve ◽

Duke Criteria ◽

The Impact

ABSTRACT Staphylococcus aureus is a common cause of native valve infective endocarditis (IE). Rifampin is often added to traditional therapy for the management of serious S. aureus infections. There are no large, prospective studies documenting the safety and efficacy of adjunctive therapy with rifampin for treatment of native valve S. aureus IE. We reviewed all cases of definite native valve S. aureus IE confirmed by modified Duke criteria in a large urban hospital between 1 January 2004 and 31 December 2005. A retrospective cohort analysis was used to assess the impact of the addition of rifampin to standard therapy. There were 42 cases of S. aureus IE treated with the addition of rifampin and 42 controls. Cases received a median of 20 days of rifampin (range, 14 to 48 days). Rifampin-resistant S. aureus isolates developed in nine cases who received rifampin before clearance of bacteremia (56%), while significant hepatic transaminase elevations also occurred in nine cases, all of whom had hepatitis C infection. Unrecognized significant drug-drug interactions with rifampin occurred frequently (52%). Cases were more likely to have a longer duration of bacteremia (5.2 versus 2.1 days; P < 0.001) and were less likely to survive (79% versus 95%; P = 0.048) than controls. Our results suggest that the potential for hepatotoxicity, drug-drug interactions, and the emergence of resistant S. aureus isolates warrants a careful risk-benefit assessment before adding rifampin to standard antibiotic treatment of native valve S. aureus IE until further clinical studies are performed.

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Disseminated melioidosis with native valve endocarditis: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytz097 ◽

2019 ◽

Vol 3 (2) ◽

Author(s):

Hariharan Subramony ◽

Sengottuvelu Gunasekaran ◽

Vinodh Kumar Paul Pandi

Keyword(s):

Infective Endocarditis ◽

Burkholderia Pseudomallei ◽

Cardiac Involvement ◽

Clinical Presentation ◽

South East Asia ◽

Northern Australia ◽

Native Valve ◽

Gram Negative ◽

Native Valve Endocarditis ◽

Case Summary

Abstract Background Burkholderia pseudomallei is a Gram negative, soil-water saprophytic bacterium endemic in South-East Asia and Northern Australia. Melioidosis is being increasingly diagnosed in other regions like India, China, and Sri Lanka during recent years. The clinical presentation of melioidosis is extremely variable. Case summary We present a case of melioidosis presenting as native valve infective endocarditis with concomitant hepatic and splenic abscesses. This is the second case of melioidosis with infective endocarditis reported from India. Discussion Melioidosis can present with pneumonia, pleural effusion, subcutaneous abscesses, visceral abscesses, osteomyelitis, and septicaemia, but cardiac involvement is rare. Endocarditis due to melioidosis is rare (∼1%) and is rarely reported in literature. This case highlights the unusual presentation of this emerging disease.

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Human bite wounds as a portal of entry for infective endocarditis and purulent pericarditis: a very rare association

BMJ Case Reports ◽

10.1136/bcr-2020-241264 ◽

2021 ◽

Vol 14 (4) ◽

pp. e241264

Author(s):

Miguel Oyonarte Gómez ◽

Cesar Del Castillo Gordillo ◽

Manuel Rojas Romero ◽

Kenyin Loo Urbina

Keyword(s):

Infective Endocarditis ◽

Pericardial Effusion ◽

Aortic Valve ◽

Hospital Admissions ◽

Emergency Department Visits ◽

Purulent Pericarditis ◽

Native Valve ◽

Human Bite ◽

Human Bites ◽

Bite Wounds

Human bites are an infrequent cause of emergency department visits and hospital admissions. There are rarely published cases of complicated infection, such as infective endocarditis. We present a rare case of a patient with acute infective endocarditis in a healthy native valve and purulent pericarditis from a human bite. A 40-year-old man with obesity suffered deep human bites by an adult woman, with two deep lesions in the anterior thorax and one superficial lesion in the upper abdomen and admitted in intensive care unit with septic shock and a persistent aortic murmur. Echocardiography described evidence of vegetation, perforation and severe regurgitation of aortic valve. Scanner described moderate pericardial effusion. Cardiac surgery was performed, with evidence of purulent pericardial effusion after pericardiotomy, and subsequently aortic valve replacement with a 25 mm bioprosthesis. The patient showed positive progress.

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Infective endocarditis: a retrospective cohort study

QJM ◽

10.1093/qjmed/hcz134 ◽

2019 ◽

Vol 112 (9) ◽

pp. 663-667 ◽

Cited By ~ 2

Author(s):

C T O’Connor ◽

S O’Rourke ◽

A Buckley ◽

R Murphy ◽

P Crean ◽

...

Keyword(s):

Cohort Study ◽

Infective Endocarditis ◽

Retrospective Cohort Study ◽

Retrospective Cohort ◽

Electronic Device ◽

Intravenous Drug User ◽

Hospital Inpatient ◽

Tertiary Referral Centre ◽

Native Valve ◽

Duke Criteria

Abstract Background Infective endocarditis (IE) is a potentially life-threatening infection of the heart’s endocardial surface. Despite advances in the diagnosis and management of IE, morbidity and mortality remain high. Aim To characterize the demographics, bacteriology and outcomes of IE cases presenting to an Irish tertiary referral centre. Design Retrospective cohort study. Methods Patients were identified using Hospital Inpatient Enquiry and Clinical Microbiology inpatient consult data, from January 2005 to January 2014. Patients were diagnosed with IE using Modified Duke Criteria. Standard Bayesian statistics were employed for analysis and cases were compared to contemporary international registries. Results Two hundred and two patients were diagnosed with IE during this period. Mean age 54 years. Of these, 136 (67%) were native valve endocarditis (NVE), 50 (25%) were prosthetic valve endocarditis (PVE) and 22 (11%) were cardiovascular implantable electronic device-associated endocarditis. Culprit organism was identified in 176 (87.1%) cases and Staphylococcal species were the most common (57.5%). Fifty-nine per cent of NVE required surgery compared to 66% of PVE. Mean mortality rate was 17.3%, with NVE being the lowest (12.5%) and PVE the highest (32%). Increasing age was also associated with increased mortality. Fifty-three (26.2%) patients had embolic complications. Conclusions This Irish cohort exhibited first-world demographic patterns comparable to those published in contemporary international literature. PVE required surgery more often and was associated with higher rates of mortality than NVE. Embolic complications were relatively common and represent important sequelae, especially in the intravenous drug user population. It is also pertinent to aggressively treat older cohorts as they were associated with increased mortality.

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MitraClip-related infective endocarditis in a frail, elderly patient: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa275 ◽

2020 ◽

Vol 4 (5) ◽

pp. 1-4

Author(s):

Kevin Leow ◽

Courtney Isreb ◽

Martin Brown

Keyword(s):

Infective Endocarditis ◽

Mortality Rate ◽

Cognitive Reserve ◽

Surgical Intervention ◽

Oral Antibiotics ◽

Mitral Valve Leaflet ◽

Frail Elderly Patient ◽

Case Summary ◽

History Of ◽

Initial Blood

Abstract Background The incidence of infective endocarditis (IE) following a MitraClip is rare with 17 reported cases in the literature. The reported mortality rate is high, at 41%, despite both medical and surgical therapies. To date, this is the first documented case of IE following a MitraClip procedure in Australia. Case summary An 88-year-old male presented with a 1-week history of confusion and dyspnoea. Clinical examination was significant for a temperature of 37.7°C, a pansystolic murmur and bilateral pitting oedema to mid-shin, but no peripheral stigmata of IE. His history included a MitraClip procedure 11 weeks prior for severe mitral regurgitation. Initial blood cultures grew enterococcus faecalis. A transthoracic echocardiogram did not identify vegetations on the MitraClip. Subsequent transoesophageal echocardiogram (TOE) identified a 4 mm × 2 mm echodensity on the posterior mitral valve leaflet suggestive of IE. He was deemed not suitable for surgical intervention due to poor cognitive reserve and his medical comorbidities, so he commenced intravenous (IV) Ampicillin and Ceftriaxone which was later changed to Benzylpenicillin. Repeat TOE 2 weeks later showed the vegetation to have increased to ∼1 cm in length, so his treatment was reverted to Ampicillin. A further TOE 4 weeks later showed reduction in size to 5 mm × 2 mm. After 6 weeks of IV antibiotics, the patient was discharged on lifelong oral antibiotics. Discussion Infective endocarditis following MitraClip procedure is rare. This disease has a high mortality rate despite optimal medical and surgical therapy. Increased awareness amongst clinicians is important given an increasing volume of MitraClip procedures.

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