Polymicrobial native valve endocarditis due to Bacillus cereus and Cardiobacterium hominis

We present a case of polymicrobial subacute bacterial endocarditis and bacteremia with Bacillus cereus and Cardiobacterium hominis in a 72-year-old man with pre-existing mitral valve disease and prior mitral valve repair who presented with renal failure and glomerulonephritis. Bacillus is often a contaminant in blood cultures but has been rarely implicated in patients with invasive infections such as endocarditis. Intravenous drug use, prosthetic heart valves, valvular heart disease and venous catheters are the most frequently described risk factors for Bacillus bacteremia and endocarditis in the medical literature. Management is challenging as Bacillus is resistant to penicillin and cephalosporin antibiotics due to production of beta-lactamase. Polymicrobial endocarditis is uncommon and when it occurs typically involves Staphylococcal species. To our knowledge, this is the first reported case of polymicrobial endocarditis in which both Bacillus and a HACEK organism are implicated.

Download Full-text

Bacillus cereus Subacute Native Valve Infective Endocarditis and Its Multiple Complications

Case Reports in Cardiology ◽

10.1155/2020/8826956 ◽

2020 ◽

Vol 2020 ◽

pp. 1-4

Author(s):

Jemimah Nallarajah ◽

M. I. Mujahieth

Keyword(s):

Infective Endocarditis ◽

Bacillus Cereus ◽

Heart Valves ◽

Rare Event ◽

Antineutrophil Cytoplasmic Antibody ◽

Prosthetic Heart Valves ◽

Drug Abusers ◽

Sri Lankan ◽

Native Valve ◽

Glomerular Nephritis

Bacillus cereus causing infective endocarditis (IE) in a native valve is an extremely rare event, but it is reported mostly in intravenous drug abusers and other risk factors as immunosuppression, malignancy, and valvular heart disease including prosthetic heart valves. We report a case of B.cereus native mitral valve infective endocarditis in a 58-year-old Sri Lankan male who is not a drug abuser who presented with painless hematuria with reduced urine output. During hospital stay, he developed frequent episodes of brief focal seizures. He had undergone multiple investigations that revealed splenic abscesses, cerebral vasculitis, and glomerular nephritis with positive rheumatoid factor, cytoplasmic antineutrophil cytoplasmic antibody (C-ANCA), and cryoglobulin. The appropriate antibiotic was the prime therapeutic intervention which carried an excellent prognosis. This case highlights an unusual organism in the blood culture that caused IE warranting thorough physical examination and investigations.

Download Full-text

Characterization and outcome of invasive infections due to Paecilomyces variotii: analysis of patients from the FungiScope® registry and literature reports

Journal of Antimicrobial Chemotherapy ◽

10.1093/jac/dkaa481 ◽

2020 ◽

Author(s):

Rosanne Sprute ◽

Jon Salmanton-García ◽

Ertan Sal ◽

Xhorxha Malaj ◽

Iker Falces-Romero ◽

...

Keyword(s):

Amphotericin B ◽

Heart Valves ◽

Favourable Outcome ◽

Molecular Techniques ◽

Major Surgery ◽

Prosthetic Heart Valves ◽

Paecilomyces Variotii ◽

Invasive Infections ◽

Oncological Diseases

Abstract Objectives To provide a basis for clinical management decisions in Paecilomyces variotii infection. Methods Unpublished cases of invasive P. variotii infection from the FungiScope® registry and all cases reported in the literature were analysed. Results We identified 59 cases with P. variotii infection. Main baseline factors were presence of indwelling devices in 29 cases (49.2%), particularly peritoneal catheters (33.9%) and prosthetic heart valves (10.2%), haematological or oncological diseases in 19 (32.2%), major surgery in 11 (18.6%), and diabetes mellitus in 10 cases (16.9%). The most prevalent infection sites were peritoneum (n = 20, 33.3%) and lungs (n = 16, 27.1%). Pain and fever were frequent (n = 35, 59.3% and n = 33, 55.9%, respectively). Diagnosis was established by culture in 58 cases (98.3%). P. variotii caused breakthrough infection in 8 patients. Systemic antifungals were given in 52 patients (88.1%). Amphotericin B was administered in 39, itraconazole in 15, and posaconazole in 8 patients. Clinical isolates were frequently resistant to voriconazole, whereas the above-mentioned antifungals showed good in vitro activity. Infections of the blood and CNS caused high mortality. Overall mortality was 28.8% and death was attributed to P. variotii in 10 cases. Conclusions P. variotii causes life-threatening infections, especially in immunocompromised and critically ill patients with indwelling devices. Patients undergoing peritoneal dialysis are at particular risk. Multidisciplinary management is paramount, including molecular techniques for diagnosis and treatment with efficacious systemic antifungals. Amphotericin B, itraconazole and posaconazole are regarded as treatments of choice. Combination with flucytosine may be considered. Surgical debridement and removal of indwelling devices facilitate favourable outcome.

Download Full-text

Stuck Mitral Valve with Thromboembolic Stroke Managed with Anticoagulation and Mechanical Thrombectomy

Cardiology and Angiology An International Journal ◽

10.9734/ca/2020/v9i230130 ◽

2020 ◽

pp. 10-15

Author(s):

Akshat Jain ◽

Gurkirat Singh ◽

Aniruddha Kaushik ◽

Rahul Singla ◽

Narendra Omprakash Bansal

Keyword(s):

Mitral Valve ◽

Heart Valves ◽

Mechanical Valve ◽

Developed Countries ◽

Prosthetic Heart Valves ◽

Valve Prosthesis ◽

Short Term ◽

Adequate Knowledge ◽

Mitral Valve Prosthesis ◽

Valve Thrombosis

Heart valve replacements are commonly performed these days in India with mitral valve replacement being most common of all. Thromboemboli are a major source of morbidity in patients with prosthetic heart valves. The incidence of clinically recognizable events ranges from 0.6% to 2.3% per patient-year. Mechanical valve thrombosis is another common complication, incidence of which is estimated at 0.3% to 1.3% per patient-year in developed countries, but as high as 6% per patient-year in developing countries. Management of either complication in these patients requires adequate knowledge and clinical experience. We here describe a rare case of a patient who came to us with both complication of stuck mitral valve prosthesis and embolic stroke simultaneously. We here discuss the approach, monitoring and management of these patients, the clinical difficulties we faced in our case, immediate and short term prognosis of our patient.

Download Full-text

Six-Year Experience with CarboMedics Prosthetic Heart Valves

Asian Cardiovascular and Thoracic Annals ◽

10.1177/021849239600400306 ◽

1996 ◽

Vol 4 (3) ◽

pp. 152-156 ◽

Cited By ~ 1

Author(s):

Zhu Ping ◽

Long Guo Cui ◽

Li Zhong Xue ◽

Feng Shu Sheng ◽

Meng Hua ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Heart Valves ◽

Prosthetic Heart Valve ◽

Functional Class ◽

Prosthetic Heart Valves ◽

Class Iii ◽

Mechanical Prosthesis ◽

Actuarial Survival

Between July 1989 and July 1995, 89 CarboMedics prosthetic heart valves were implanted in 70 patients (38 males, 32 females) ranging in age from 13 to 54 years (mean 33 years). Forty-one of these patients underwent mitral valve replacement, 10 had aortic valve replacement, and 19 had double aortic and mitral valve replacement. Early mortality was 4.9%, 0%, and 15.8% respectively in these groups. Mean follow-up time was 3.4 years and was 95.4% complete (3 lost). There were 5 late deaths (7.7%); 1 in the mitral group, 1 in the aortic group, and 3 who had double valve replacements. Three of these late deaths were considered valve-related. The 5-year actuarial survival rates, hospital mortality excluded, were 97% for mitral, 88% for aortic, and 88% for double valve replacement. Preoperatively, 80% of the patients were in New York Heart Association functional class III or IV, whereas postoperatively, 99.5% of the patients were in class I or II. No structural failures were observed. There was 1 case of systemic embolism and 1 case of valve thrombosis, neither of these patients were taking anticoagulants. Hemorrhage was the most frequent complication; 1 of 4 events was fatal. A less intensive warfarin regimen and improvement in hepatic function may reduce hemorrhagic risk while maintaining thromboembolic protection. On the basis of this experience, the CarboMedics prosthetic heart valve appears to be an excellent mechanical prosthesis for cardiac valve replacement, in terms of hemodynamic performance and low thrombogenicity, in patients receiving anticoagulants.

Download Full-text

Managing Pregnancy with Post Mitral Valve Replacement Presenting Late

Nepal Journal of Obstetrics and Gynaecology ◽

10.3126/njog.v8i1.8866 ◽

2013 ◽

Vol 8 (1) ◽

pp. 50-52

Author(s):

Basanta Lamichhane ◽

N Paradhan ◽

SJ Rawal ◽

A Singh ◽

SR Bhandari ◽

...

Keyword(s):

Mitral Valve ◽

Valve Replacement ◽

Mitral Valve Replacement ◽

Heart Valves ◽

Prosthetic Heart Valves ◽

Healthy Baby ◽

Obstetrics And Gynaecology ◽

Healthy Female ◽

Ultimate Outcome ◽

Uneventful Pregnancy

With the increased awareness and emphasis of institutional delivery, there has been an increase in trend of cases of valvular heart disease with pregnancy being reported to tertiary centers. Though rare, cases like post mitral valve replacement (MVR) with pregnancy are often a challenge in terms of management with an outcome of uneventful pregnancy and healthy baby. The management of women with prosthetic heart valves during pregnancy poses a particular challenge as there are no available controlled clinical trials to provide guidelines for effective antithrombotic therapy. Here we present a case of post MVR with pregnancy with an ultimate outcome of a healthy female and uneventful vaginal delivery. Nepal Journal of Obstetrics and Gynaecology / Vol 8 / No. 1 / Issue 15 / Jan- June, 2013 / 50-52 DOI: http://dx.doi.org/10.3126/njog.v8i1.8866

Download Full-text

Analysis of the Genotype and Virulence of Staphylococcus epidermidis Isolates from Patients with Infective Endocarditis

Infection and Immunity ◽

10.1128/iai.00606-08 ◽

2008 ◽

Vol 76 (11) ◽

pp. 5127-5132 ◽

Cited By ~ 25

Author(s):

Alastair B. Monk ◽

Sam Boundy ◽

Vivian H. Chu ◽

Jill C. Bettinger ◽

Jaime R. Robles ◽

...

Keyword(s):

Staphylococcus Epidermidis ◽

Heart Valves ◽

Prosthetic Valve Endocarditis ◽

Bloodstream Infections ◽

Prosthetic Heart Valves ◽

Native Valve ◽

Prosthetic Devices ◽

C Elegans ◽

Prosthetic Valves ◽

Kaplan Meier

ABSTRACT Staphylococcus epidermidis is one of the most common causes of infections of prosthetic heart valves (prosthetic valve endocarditis [PVE]) and an increasingly common cause of infections of native heart valves (native valve endocarditis [NVE]). While S. epidermidis typically causes indolent infections of prosthetic devices, including prosthetic valves and intravascular catheters, S. epidermidis NVE is a virulent infection associated with valve destruction and high mortality. In order to see if the differences in the course of infection were due to characteristics of the infecting organisms, we examined 31 S. epidermidis NVE and 65 PVE isolates, as well as 21 isolates from blood cultures (representing bloodstream infections [BSI]) and 28 isolates from nasal specimens or cultures considered to indicate skin carriage. Multilocus sequence typing showed both NVE and PVE isolates to have more unique sequence types (types not shared by the other groups; 74 and 71%, respectively) than either BSI isolates (10%) or skin isolates (42%). Thirty NVE, 16 PVE, and a total of 9 of the nasal, skin, and BSI isolates were tested for virulence in Caenorhabditis elegans. Twenty-one (70%) of the 30 NVE isolates killed at least 50% of the worms by day 5, compared to 1 (6%) of 16 PVE isolates and 1 (11%) of 9 nasal, skin, or BSI isolates. In addition, the C. elegans survival rate as assessed by log rank analyses of Kaplan-Meier survival curves was significantly lower for NVE isolates than for each other group of isolates (P < 0.0001). There was no correlation between the production of poly-β(1-6)-N-acetylglucosamine exopolysaccharide and virulence in worms. This study is the first analysis suggesting that S. epidermidis isolates from patients with NVE constitute a more virulent subset within this species.

Download Full-text

The Effect of Dipyridamole and RA 233 on Human Platelet Function in Vitro

Thrombosis and Haemostasis ◽

10.1055/s-0038-1648112 ◽

1973 ◽

Vol 29 (03) ◽

pp. 694-700 ◽

Cited By ~ 4

Author(s):

Paul L. Rifkin ◽

Marjorie B. Zucker

Keyword(s):

Mechanism Of Action ◽

Human Blood ◽

Glass Bead ◽

Heart Valves ◽

Human Platelet ◽

Drug Effects ◽

Simple Relation ◽

Prosthetic Heart Valves ◽

Induced Aggregation

SummaryDipyridamole (Persantin) is reported to prolong platelet survival and inhibit embolism in patients with prosthetic heart valves, but its mechanism of action is unknown. Fifty jxM dipyridamole failed to reduce the high percentage of platelets retained when heparinized human blood was passed through a glass bead column, but prolonged the inhibition of retention caused by disturbing blood in vitro. Possibly the prostheses act like disturbance. Although RA 233 was as effective as dipyridamole in inhibiting the return of retention, it was less effective in preventing the uptake of adenosine into erythrocytes, and more active in inhibiting ADP-induced aggregation and release. Thus there is no simple relation between these drug effects.

Download Full-text