Infective endocarditis by a rare and fastidious agent: Abiotrophia defectiva

2021 ◽  
Vol 14 (6) ◽  
pp. e241964
Author(s):  
Ana Margarida Mosca ◽  
Fenando Mané ◽  
Carla Marques Pires ◽  
Paulo Medeiros
Keyword(s):  
Infective Endocarditis ◽  
Aortic Valve ◽  
Blood Cultures ◽  
Surgical Aortic Valve Replacement ◽  
Delay In Diagnosis ◽  
Severe Aortic Regurgitation ◽  
Appropriate Treatment ◽  
Abiotrophia Defectiva ◽  
High Level ◽  
Prompt Diagnosis

Abiotrophia defectiva is a nutritional variant streptococcus, with affinity for endovascular structures that cannot be cultured on non-supplemented media, leading to a delay in diagnosis. This case describes a 36-year-old woman with a previously known bicuspid aortic valve that presented with asthenia, myalgias and anorexia with 2-month onset. On admission, we documented fever and a systolic murmur. Transthoracic echocardiography revealed an oscillating mass attached to the aortic valve. The patient was admitted with a possible diagnosis of infective endocarditis. Later, blood cultures were positive for A. defectiva. Due to severe aortic regurgitation and congestive heart failure, she underwent surgical aortic valve replacement. After 6 weeks of antimicrobial therapy, the patient experienced full recovery. Despite of its rarity, A. defectiva endocarditis is associated with significant morbidity with mortality and physicians must have a high level of suspicion to ensure a prompt diagnosis and provide the appropriate treatment.

scholarly journals Infective Endocarditis Complicated with Progressive Heart Failure due to β-Lactamase-Producing Cardiobacterium hominis

2000 ◽  
Vol 38 (5) ◽  
pp. 2015-2017 ◽  
Author(s):  
Po-Liang Lu ◽  
Po-Ren Hsueh ◽  
Chien-Ching Hung ◽  
Lee-Jene Teng ◽  
Tsrang-Neng Jang ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Blood Isolate ◽  
Severe Aortic Regurgitation ◽  
Progressive Heart Failure ◽  
Resistance To Penicillin ◽  
High Level ◽  
Level Resistance

We describe a 66-year-old woman with infective endocarditis due toCardiobacterium hominis whose condition, complicated by severe aortic regurgitation and congestive heart failure, necessitated aortic valve replacement despite treatment with ceftriaxone followed by ciprofloxacin. The blood isolate of C. hominis produced β-lactamase and exhibited high-level resistance to penicillin (MIC, ≧256 μg/ml) and reduced susceptibility to vancomycin (MIC, 8 μg/ml).

scholarly journals Aggregatibacter aphrophilus aortic valve infective endocarditis

Infectio ◽  
2017 ◽  
Vol 21 (2) ◽  
Author(s):  
Ana Luísa Broa ◽  
Inês Cruz ◽  
Carlos Cotrim ◽  
José Diogo
Keyword(s):  
Infective Endocarditis ◽  
Aortic Valve ◽  
Final Diagnosis ◽  
Blood Cultures ◽  
Lumbar Pain ◽  
Medical Procedures ◽  
Transthoracic Echocardiogram ◽  
Severe Aortic Regurgitation ◽  
Aggregatibacter Aphrophilus ◽  
Serious Infections

Nowadays, infective endocarditis remains a major cause of morbidity and mortality worldwide and there are concerns related to the increased number of infections associated with virulent agents and medical procedures. We present a case of a homeless man with unknown medical history, admitted for lumbar pain who became confused, hypotensive and tachycardic, evolving to severe sepsis. His initial investigation was also suggestive of acute myocardial infarction but the transthoracic echocardiogram revealed massive aortic valve vegetation with perivalvular abscess leading to severe aortic regurgitation. The patient died with the final diagnosis of infective endocarditis. Later on the blood cultures was identified Aggregatibacter aphrophilus, an HACEK group agent. This case confirms that, albeit the general favorable outcomes, there are cases of serious infections, especially if the diagnosis and treatment were late.

scholarly journals Aortic valve replacement due to granulomatosis with polyangiitis: a case series

2020 ◽  
Vol 4 (5) ◽  
pp. 1-6
Author(s):  
Gilles Uijtterhaegen ◽  
Laura De Donder ◽  
Eline Ameloot ◽  
Kristof Lefebvre ◽  
Jo Van Dorpe ◽  
...  
Keyword(s):  
Heart Disease ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Valve Replacement ◽  
Valvular Heart Disease ◽  
Granulomatosis With Polyangiitis ◽  
Surrounding Tissue ◽  
Valve Regurgitation ◽  
Aortic Valve Regurgitation ◽  
Severe Aortic Regurgitation

Abstract Background Granulomatosis with polyangiitis (GPA), formerly known as Wegener’s granulomatosis, is a systemic inflammatory process predominantly affecting upper and lower respiratory tract and kidneys. Valvular heart disease is a rare manifestation of GPA. Case summary We report two cases of acute valvular heart disease mimicking acute endocarditis caused by GPA. Both patients were middle-aged females with acute aortic valve regurgitation suggestive of possible infective endocarditis. In their recent medical history, atypical otitis and sinusitis were noted. The first patient was admitted with heart failure and the second patient because of persisting fever. Echocardiogram revealed severe aortic regurgitation with an additional structure on two cusps, suggestive of infective endocarditis in both patients. Urgent surgical replacement was performed; however, intraoperative findings did not show infective endocarditis, but severe inflammatory changes of the valve and surrounding tissue. In both patients, the valve was replaced by a prosthetic valve. Microscopic examination of the valve/myocardial biopsy showed diffuse acute and chronic inflammation with necrosis and necrotizing granulomas, compatible with GPA after infectious causes were excluded. Disease remission was obtained in both patients, in one patient with Rituximab and in the other with Glucocorticoids and Cyclophosphamide. Both had an uneventful follow-up. Discussion Granulomatosis with polyangiitis can be a rare cause of acute aortic valve regurgitation mimicking infective endocarditis with the need for surgical valve replacement. Atypical ear, nose, and throat symptoms can be a first sign of GPA. Symptom recognition is important for early diagnosis and appropriate treatment to prevent further progression of the disease.

Infective endocarditis

2020 ◽  
pp. 163-176
Author(s):  
Salim Jivanji ◽  
Rubya Adamji ◽  
Michael Rigby
Keyword(s):  
Infective Endocarditis ◽  
Aortic Valve ◽  
Oral Hygiene ◽  
Aortic Valve Disease ◽  
Dental Hygiene ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Blood Cultures ◽  
Valve Disease ◽  
Symptoms And Signs

A young patient with previously repaired mixed aortic valve disease presented to his local hospital with symptoms and signs consistent with infective endocarditis. Following confirmation of Streptococcus viridans in his blood cultures, he underwent initial antibiotic treatment, followed by surgical resection of his right ventricular outflow tract vegetation. This chapter examines the difficulty in making a diagnosis of infective endocarditis, the devastating nature of its course, and the challenges in managing this condition. Finally, it explores the association of infective endocarditis with poor dental hygiene, the importance of promoting effective oral hygiene, and the evolving evidence in the use of antibiotic prophylaxis.

scholarly journals Sutureless and rapid deployment bioprosthetic valves: new perspectives.

2021 ◽  
Author(s):  
Antonio Piperata ◽  
Tomaso Bottio ◽  
Martina Avesani ◽  
Gino Gerosa
Keyword(s):  
Infective Endocarditis ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Bioprosthetic Valve ◽  
Surgical Aortic Valve Replacement ◽  
Valve Prostheses ◽  
Rapid Deployment ◽  
Bioprosthetic Valves

We carefully read the recent paper by Hammond et al. (1) on the use of sutureless bioprosthetic valve for homograft failure in the setting of infective endocarditis (IE). This article is the latest demonstration that new sutureless and rapid deployment (RD) valve prostheses are safe and easy-to-use devices for surgical aortic valve replacement, and indicates their suitability for different scenarios and peculiar surgical situations as infective endocarditis (IE).

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 caused by Capnocytophaga canimorsus; a case report

2019 ◽  
Vol 19 (1) ◽  
Author(s):  
Jun Sakai ◽  
Kazuhito Imanaka ◽  
Masahiro Kodana ◽  
Kana Ohgane ◽  
Susumu Sekine ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Aortic Valve ◽  
Dna Sequencing ◽  
Extended Period ◽  
Visual Disturbance ◽  
Drug Susceptibility ◽  
Blood Cultures ◽  
Capnocytophaga Canimorsus ◽  
Adequate Treatment ◽  
Disk Diffusion Test

Abstract Background Capnocytophaga canimorsus is a gram-negative bacterium and an oral commensal in dogs and cats, but occasionally causes serious infections in humans. Septicemia is one of the most fulminant forms, but diagnosis of C. canimorsus infection is often difficult mainly because of its very slow growth. C. canimorsus infective endocarditis (IE) is rare and is poorly understood. Since quite a few strains produce β-lactamase, antimicrobial susceptibility is pivotal information for adequate treatment. We herein report a case with C. canimorsus IE and the results of drug susceptibility test. Case presentation A 46-year-old man had a dog bite in his left hand 3 months previously. The patient was referred to our hospital for fever (body temperature > 38 °C), visual disturbance, and dyspnea. Echocardiography showed aortic valve regurgitation and vegetation on the leaflets. IE was diagnosed, and we initially administered cefazolin and gentamycin assuming frequently encountered microorganisms and the patient underwent aortic valve replacement. C. canimorsus was detected in the aortic valve lesion and blood cultures. It was also identified by 16S ribosome DNA sequencing. Ceftriaxone were started and continued because disk diffusion test revealed the isolate was negative for β-lactamase and this case had cerebral symptoms. The patient successfully completed antibiotic treatment following surgery. Conclusions We diagnosed C. canimorsus sepsis and IE by extended-period blood cultures and 16S ribosome DNA sequencing by polymerase chain reaction, and successfully identified its drug susceptibility.

An Unusual Complication of Infective Endocarditis Involving Bicuspid Aortic Valve

2021 ◽  
Vol 6 (3) ◽  
pp. 01-04
Author(s):  
Arnab Chaudhury
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Aortic Valve ◽  
Bicuspid Aortic Valve ◽  
Unusual Complication ◽  
Severe Mitral Regurgitation ◽  
Mitral Leaflet ◽  
Colour Doppler ◽  
Aneurysmal Dilatation ◽  
Severe Aortic Regurgitation

Bicuspid aortic valve is commonly associated with infective endocarditis with serious peri annular complications. We report a case of 37-year-old male patient presented with infective endocarditis involving bicuspid aortic valve with leaflet perforation and severe aortic regurgitation. Mitral valve was involved secondary to aortic valve endocarditis as a kissing lesion with severe mitral regurgitation. Anterior mitral leaflet (AML) had aneurysmal dilatation with mobile vegetations inside it. In colour Doppler, AML aneurysm was looking like a fireball inside the left atrium. Patient was treated with antibiotics and referred to surgery for aortic and mitral valve replacement.

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