Staphylococcus lugdunensisEndocarditis Complicated by Embolism in an 18-Year-Old Woman with Mitral Valve Prolapse

Staphylococcus lugdunensisis a coagulase-negativestaphylococcus(CNS). It is a major cause of prosthetic valve endocarditis; mitral valve prolapse (MVP) has emerged as a prominent predisposing structural cardiac abnormality. We describe a case ofStaphylococcus lugdunensisendocarditis in an 18-year-old woman with preexisting mitral valve prolapse complaining of fever, a one-month history of continuous-remittent fever ( 38.6°C). The transthoracic echocardiogram revealed large vegetation on the anterior mitral valve leaflet flopping from the atrial side to the ventricular side. Five sets of blood cultures were positive for coagulase-negative staphylococci. During hospitalization, after two weeks of antibiotic therapy, the patient complained of sudden pain in her right leg associated with numbness. Lower limb arterial Doppler ultrasound showed an arterial thrombosis of right common iliac artery. Transfemoral iliac embolectomy was promptly performed and on septic embolusS. lugdunensiswith the same antibiotic sensitivity and the same MIC values was again isolated. Our patient underwent cardiac surgery: triangular resection of the A2 with removal of infected tissue including vegetation. Our case is an example of infective endocarditis byS. lugdunensison native mitral valve in a young woman of 18 with anamnesis valve prolapse.

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Can Infectious Endocarditis during Pregnancy Be Cured with Only Drug Treatment?

The Heart Surgery Forum ◽

10.1532/hsf.1226 ◽

2015 ◽

Vol 18 (1) ◽

pp. 033

Author(s):

Serhat Caliskan ◽

Feyzullah Besli ◽

Saim Sag ◽

Fatih Gungoren ◽

Ibrahim Baran

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Prolapse ◽

Treatment Options ◽

Blood Cultures ◽

Normal Vaginal Delivery ◽

Posterior Leaflet ◽

History Of ◽

Current Guidelines

During pregnancy, infective endocarditis (IE) is quite rare but has a high mortality rate in terms of the mother and the fetus. In this article, a 24-year-old patient with a history of mitral valve prolapse (MVP) who was hospitalized due to IE and treated successfully is presented. On echocardiography, severe mitral valve prolapse, severe mitral regurgitation, and vegetation on the posterior leaflet of mitral valve were observed. Streptococcus mitis was subsequently isolated from four sets of blood cultures. The patient was diagnosed with IE. After 6 weeks of antibiotic therapy, the patient was cured completely without surgical treatment. At 40-weeks of pregnancy, the patient gave birth via a normal vaginal delivery. There were no problems with the 3,800-gram baby born. In current guidelines, there is very limited advice on treatment options for patients who develop IE during pregnancy. Therefore, evaluation of patient-based treatment options would be appropriate. In addition, IE prophylaxis for MVP is not recommended in current guidelines. However, in MVP patients with mitral regurgitation, prior to procedures associated with a high risk of infective endocarditis, IE prophylaxis may be rational.

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Corynebacterium propinquum: A Rare Cause of Prosthetic Valve Endocarditis

Case Reports in Medicine ◽

10.1155/2016/1391789 ◽

2016 ◽

Vol 2016 ◽

pp. 1-3 ◽

Cited By ~ 2

Author(s):

Umair Jangda ◽

Ankit Upadhyay ◽

Farshad Bagheri ◽

Nilesh R. Patel ◽

Robert I. Mendelson

Keyword(s):

Rheumatoid Arthritis ◽

Chest Pain ◽

Mitral Valve ◽

Complete Resolution ◽

Prosthetic Valve ◽

Prosthetic Valve Endocarditis ◽

Blood Cultures ◽

History Of ◽

Systemic Infections ◽

Compromised Patients

NondiphtheriaCorynebacteriumspecies are often dismissed as culture contaminants, but they have recently become increasingly recognized as pathologic organisms. We present the case of a 48-year-old male patient on chronic prednisone therapy for rheumatoid arthritis with a history of mitral valve replacement with prosthetic valve. He presented with fever, dizziness, dyspnea on exertion, intermittent chest pain, and palpitations. Transesophageal echocardiography revealed two medium-sized densities along the inner aspect of the sewing ring and one larger density along the atrial surface of the sewing ring consistent with vegetation. Two separate blood cultures grewCorynebacterium propinquum, which were sensitive to ceftriaxone but highly resistant to vancomycin and daptomycin. The patient completed a course of ceftriaxone and repeat TEE study and after 6 weeks demonstrated near complete resolution of the vegetation. To our knowledge, this case represents the first in the literature ofCorynebacterium propinquumcausing prosthetic valve endocarditis. The ability of these organisms to cause deep-seated systemic infections should be recognized, especially in immune-compromised patients.

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Successful Resolution of Early-Onset Prosthetic Valve Endocarditis Associated With Extended Spectrum β-Lactamases Producing Escherichia coli With Medical Management

Journal of Investigative Medicine High Impact Case Reports ◽

10.1177/2324709620965337 ◽

2020 ◽

Vol 8 ◽

pp. 232470962096533

Author(s):

Umaima Dhamrah ◽

Keely Johnson ◽

Aisha Amin ◽

Maurice Policar

Keyword(s):

Escherichia Coli ◽

Mitral Valve ◽

Prosthetic Valve ◽

Prosthetic Valve Endocarditis ◽

Blood Cultures ◽

Extended Spectrum ◽

Successful Resolution ◽

History Of ◽

Valve Placement

A 74-year-old male with a recent bioprosthetic mitral valve placement presented with dyspnea, chills, and palpitations. Blood cultures on admission grew extended spectrum β-lactamase Escherichia coli. Transthoracic echocardiogram and transesophageal echocardiography were negative for valvular vegetations, but given the recent history of mitral valve replacement and difficulty visualizing valvular vegetations in prosthetic valve, we initiated treatment of our patient with antibiotics for 6 weeks. Repeat blood cultures showed clearance of the organism and on follow-up, and the patient had no signs of recurrence of infection.

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Incidence of Mitral Valve Prolapse in Adolescent Scoliosis and Thoracic Hypokyphosis

PEDIATRICS ◽

10.1542/peds.70.3.451 ◽

1982 ◽

Vol 70 (3) ◽

pp. 451-454

Author(s):

Stephen S. Hirschfeld ◽

Charles Rudner ◽

Clyde L. Nash ◽

Eliezer Nussbaum ◽

Eleanor M. Brower

Keyword(s):

Family History ◽

Mitral Valve ◽

Mitral Valve Prolapse ◽

Soft Tissue Defect ◽

Skeletal Abnormality ◽

Degree Relative ◽

Familial History ◽

High Incidence ◽

History Of ◽

Echocardiographic Evidence

Seventy-four patients with adolescent scoliosis underwent cardiac examination and M-mode echocardiography to detect the presence of mitral valve prolapse (MVP). Twenty-one (28%) had echocardiographic evidence of MVP, whereas 18 had auscultatory findings of a nonejection click or late systolic murmur. A subset of 41 patients had a family history of scoliosis and 37% had MVP. The incidence of MVP increased to 41% when a first degree relative, such as a sibling, parent, or offspring, had scoliosis. Thirty-six patients with scoliosis had additional thoracic hypokyphosis (straight back) and 13 (36%) had MVP. The incidence of MVP was 48% when the scoliosis and hypokyphosis were hereditary and increased to 53% when a familial history of skeletal abnormality was present. This study indicates a high incidence of MVP in patients with scoliosis and hypokyphosis, especially when the skeletal abnormality is familial. It suggests that the cardiac and skeletal systems may be affected by a generalized soft-tissue defect.

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Abstract 494: Mitral to Meninges: Aspergillus Endocarditis With Septic Emboli

Circulation Research ◽

10.1161/res.127.suppl_1.494 ◽

2020 ◽

Vol 127 (Suppl_1) ◽

Author(s):

Christopher T Smith ◽

Dantwan Smith ◽

Waqaar Arshad

Keyword(s):

Mitral Valve ◽

Fungal Infections ◽

Early Recognition ◽

Elevated Serum ◽

Blood Cultures ◽

Septic Emboli ◽

Chronic Pancreatitis Patient ◽

Fungal Endocarditis ◽

Tertiary Center ◽

History Of

Introduction: Fungal endocarditis comprises less than 2% of infective endocarditis, with Aspergillus causing less than 28% of fungal endocarditis. Fungal endocarditis should be suspected in immunocompromised patients with persistent fevers, negative blood cultures, and vegetation on echocardiography. Invasive Aspergillus can affect any organ, but typically begins in the respiratory tract. Mortality rates climb to 90% with signs of hematogenous spread, such as cerebral abscesses. Case Presentation: Patient is a 53-year-old female with a past medical history of Sweet syndrome and chronic pancreatitis. Patient was admitted for persistent fevers and confusion. Patient was tachycardic but normotensive with a temperature of 102.5 F. Labs included significantly elevated serum LDH and Beta-D-Glucan. Blood cultures remained negative. Lumbar puncture cultures were negative; CSF cytology revealed pleocytosis with positive Aspergillus galactomannan serum antigen. Head MRI revealed multiple peripherally enhancing supratentorial lesions and intracranial abscesses (largest 8.4 mm) with ventriculitis of lateral ventricles, right greater than left. Transesophageal Echocardiogram (TEE) revealed mitral valve vegetation at A2 segment, no surrounding perivalvular abscess, minimal mitral regurgitation (MR). Management: Antibiotics were discontinued and patient was counseled on avoiding glucocorticoids. Patient was transferred to large tertiary center for Neurosurgery evaluation but was not candidate for biopsy/aspiration of the ring-enhancing lesions per Neurosurgery. Cardiothoracic Surgery was also consulted and patient was not a candidate for mitral valve replacement due to small size of vegetation without abscess and only mild MR. Voriconazole was continued and patient ultimately demonstrated a slow improvement in her strength and mental status over the next 6 months. Discussion: Mitral endocarditis from Aspergillus is rare but has a very high mortality rate. This case illustrates the importance of early recognition of systemic fungal infections in the setting of immunosuppression. Glucocorticoids and broad-spectrum antibiotics placed this patient at elevated risk for invasive Aspergillosis, which led to mitral endocarditis and subsequent cerebral abscesses from septic emboli.

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Predictors of sudden cardiac arrest in adolescents with mitral valve prolapse: an analysis of the nationwide inpatient sample

European Heart Journal ◽

10.1093/ehjci/ehaa946.2007 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

B Narasimhan ◽

L Wu ◽

C.H Lucas ◽

K Bhatia ◽

A Shah ◽

...

Keyword(s):

Cardiac Arrest ◽

Family History ◽

Sudden Cardiac Death ◽

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Prolapse ◽

Cardiac Death ◽

Sudden Cardiac Arrest ◽

Adolescent Patients ◽

History Of

Abstract Background Mitral valve prolapse (MVP) is the most commonly encountered valvular pathology seen in 2–3% of the general population. Though traditionally regarded as a benign pathology, recent literature suggests that sudden cardiac death is significantly more common in these patients with estimates of 0.2–0.4%/year. The exact underlying mechanism of these higher rates of SCD remain poorly understood. In this study, we aim to identify predictors of sudden cardiac arrest (SCA) in an adolescent population. Methods We conducted a retrospective study using the AHRQ-HCUP National Inpatient Sample 2016-2017 for the years 2016-17. All patients (≤18 years) admitted with Mitral valve prolapse were identified using ICD-10 codes and further sub stratified based on presence or absence of sudden cardiac arrest (SCA). Baseline characteristics were obtained and multivariate regression analysis was utilized to identify potential predictors of SCA. Independent risk factors for in-hospital mortality were identified using a proportional hazards model. Complications were defined as per the Agency for Health Care Research and Quality guideline. Results We screened a total of 71,473,874 admissions in the NIS database to identify a total of 1,372 adolescent patients admitted with MVP in the years 2016–17. These patients were then sub-categorized based on presence or absence of SCA during the hospitalization. Our findings revealed that patients with SCA were generally slightly older (15y vs 13y, p=0.036, OR-1.1, p=0.007) and more likely female (83.3% vs 13%, p=0.227, OR – 3.55, p=0.57)). Interestingly, patients in the SCA cohort were noted to have almost 4 fold higher rates of Mitral regurgitation (66.6% vs 18.35%, p=0.008, OR-8.89, p=0.005) as well as family history of SCD (16.7% vs 4.1%, p=0.145, OR-4.65, p=0.14). Conclusions Presence of Mitral regurgitation and a family history of sudden cardiac death are associated with significantly higher rates of SCA in adolescent patients with mitral valve prolapse. Predictors of SCA in Adolescent MVP Funding Acknowledgement Type of funding source: None

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Pooled analysis of 1270 infective endocarditis cases in Turkey

The Journal of Infection in Developing Countries ◽

10.3855/jidc.10056 ◽

2019 ◽

Vol 13 (02) ◽

pp. 93-100 ◽

Cited By ~ 1

Author(s):

Arman Vahabi ◽

Funda Gül ◽

Sabina Garakhanova ◽

Hilal Sipahi ◽

Oğuz Reşat Sipahi

Keyword(s):

Infective Endocarditis ◽

Prosthetic Valve Endocarditis ◽

Pooled Analysis ◽

Etiologic Agent ◽

National Database ◽

Coagulase Negative Staphylococci ◽

History Of ◽

National Databases ◽

Culture Negative ◽

Overall Mortality

Introduction: Despite developments in medicine, infective endocarditis (IE) is still associated with significant morbidity and mortality. In this study it was aimed to systematically review the infective endocarditis literature published or presented from Turkey. Methods: To find the published series, one national database (Ulakbim), and three international databases (Scopus, Pubmed and Sci-e) were searched between 31 October-3 November 2014. also, abstracts of congresses by three national congresses were searched for studies regarding infective endocarditis. Results: Data for 1270 patients (38.3% female, mean age 46.2, 28% prosthetic valve endocarditis) with a diagnosis of infective endocarditis were obtained from 21 reports (18 published articles and three congress abstracts). Of the 18 articles, four were in peer-reviewed medical journals indexed in national databases and 14 were in international databases. There was an underlying heart disease in 51.9% and history of dental procedure was 6.7%. Fever, heart murmur and fatigue were present in 94%, 71.4% and 69% respectively. most commonly involved site was mitral valve (43.3%), followed by aortic (33.8%) and tricuspid valve (6.4%). Staphylococcus aureus, coagulase-negative staphylococci and enterococci comprised the 22.8%, 9.7% and 7.5% of the cases while 31.1% were culture-negative. Overall mortality was 23.4%. When we compared series related to years 2008 and before and 2009 and after, the mortality rates were (24.1%-224/931) vs (20.1%-32/159), respectively (p = 0,31). Conclusion: Infective endocarditis is still associated with significant mortality. S. aureus seems to be the most common etiologic agent. There was a slight decrease in the recent years in mortality.

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Prosthetic valve endocarditis presenting as meningoencephalitis complicated by pseudo-aneurysms in a remote Aboriginal healthcare setting in Australia: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytab265 ◽

2021 ◽

Vol 5 (8) ◽

Author(s):

Anna Louise Watson ◽

Gregory Rice ◽

Tony Hieu Vo ◽

Nadarajah Kangaharan

Keyword(s):

Prosthetic Valve ◽

Prosthetic Valve Endocarditis ◽

Healthcare Setting ◽

Blood Cultures ◽

Fatal Complication ◽

Optimal Care ◽

Australian Aboriginal ◽

Valvular Surgery ◽

Case Summary ◽

History Of

Abstract Background The Australian Aboriginal population has a high burden of cardiac conditions predisposing patients to infective endocarditis. Pseudo-aneurysms are a rare and potentially fatal complication of both prior valvular surgery and endocarditis. Case summary A 31-year-old female with a history of bicuspid aortic valve requiring valve replacement presented with meningoencephalitis. Transoesophageal echo and positive blood cultures for Staphylococcus aureus confirmed prosthetic valve endocarditis (PVE). Aortic root mycotic pseudo-aneurysms developed during antimicrobial therapy and two large pseudo-aneurysms remain post-redo valve, root and arch replacement. Discussion Complications associated with PVE are common, especially due to S. aureus. Redo cardiac surgery is high risk, percutaneous treatments may be technically difficult due to altered post-operative anatomy, and medication adherence issues and lack of healthcare engagement further compromise optimal care in this patient population.

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Splenic rupture as the presenting symptom in infective endocarditis: a rare and dangerous complication

BMJ Case Reports ◽

10.1136/bcr-2021-244191 ◽

2021 ◽

Vol 14 (9) ◽

pp. e244191

Author(s):

Gautam Sen ◽

Susan Lewis

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Splenic Rupture ◽

Rare Complication ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Emergency Laparotomy ◽

Mitral Valve Leaflet ◽

Risk Patients ◽

History Of

Infective endocarditis remains a dangerous condition and carries a mortality risk of approximately 20%. Splenic rupture is a rare complication of endocarditis. A 60-year-old woman with a history of atrial fibrillation, mitral valve repair and severe mitral regurgitation was admitted with a fall and abdominal pain. Emergency laparotomy was performed leading to a diagnosis of splenic rupture, for which splenectomy was performed. Four months later, the patient represented with symptoms of a transient ischaemic attack. Transthoracic and transoesophageal echocardiogram confirmed a large vegetation on the anterior mitral valve leaflet. Treatment with antibiotics and re-do mitral valve surgery was performed. The cause of the initial splenic rupture was felt to have been secondary to undiagnosed infective endocarditis. It is imperative to consider endocarditis in a case of spontaneous splenic rupture particularly in high-risk patients such as those with previous valve surgery.

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