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

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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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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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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Prosthetic valve endocarditis caused by multidrug-resistant Candida albicans in a patient with myelodysplasia syndrome: A case report and literature review

Current Medical Mycology ◽

10.18502/cmm.4.3.171 ◽

2018 ◽

Cited By ~ 1

Author(s):

Firoozeh Kermani ◽

Tahereh Shokohi ◽

Mahdi Abastabar ◽

Lotfollah Davoodi ◽

Shervin Ziabakhsh Tabari ◽

...

Keyword(s):

Candida Albicans ◽

Case Report ◽

Valve Replacement ◽

Prosthetic Valve ◽

Prosthetic Valve Endocarditis ◽

Multidrug Resistant ◽

Immunosuppressed Patients ◽

History Of ◽

Cardiac Valve Replacement

Background and Purpose: Candida endocarditis is an infrequent disease with a high mortality rate, which commonly occurs in immunosuppressed patients with cardiac valve replacement. We reported a 70-year-old woman diagnosed with Candida prosthetic valve endocarditis (PVE). This study also involved a review of all published cases of Candida PVE from 1970. Case report: Herein, we reported a 70-year-old woman with the history of severe mitral stenosis and myelodysplasia syndrome. She underwent mitral valve replacement for two times. The blood cultures were positive, and phenotypic identification of the isolates at the species level was performed based on microscopic and macroscopic characteristics. In the second prosthetic valve replacement, huge fungal white and creamy vegetation was observed which was identified as Candida albicans based on the conventional and molecular methods. Despite the administration of antifungal treatments, the patient passed away probably due to the multidrug-resistant Candida PVE. Conclusion: As PVE is a late consequence of prosthetic valve replacement, extended follow-up visits, early diagnosis, repeating valve replacement surgeries, and timely selective antifungal treatments are warranted.

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Corynebacterium CDC group G native and prosthetic valve endocarditis

Infectious Disease Reports ◽

10.4081/idr.2015.5881 ◽

2015 ◽

Vol 7 (3) ◽

Author(s):

Adil Sattar ◽

Siegfried Yu ◽

Janak Koirala

Keyword(s):

Mitral Valve ◽

Prosthetic Valve ◽

Prosthetic Valve Endocarditis ◽

Mitral Valve Regurgitation ◽

Venous Access ◽

High Grade Fever ◽

Access Port ◽

First Case ◽

Life Threatening ◽

History Of

We report the first case of native and recurrent prosthetic valve endocarditis with <em>Corynebacterium</em> CDC group G, a rarely reported cause of infective endocarditis (IE). Previously, there have been only two cases reported for prosthetic valve IE caused by these organisms. A 69-year-old female with a known history of mitral valve regurgitation presented with a 3-day history of high-grade fever, pleuritic chest pain and cough. Echocardiography confirmed findings of mitral valve thickening consistent with endocarditis, which subsequently progressed to become large and mobile vegetations. Both sets of blood cultures taken on admission were positive for <em>Corynebacterium</em> CDC group G. Despite removal of a long-term venous access port, the patient’s presumed source of line associated bacteremia, mitral valve replacement, and aggressive antibiotic therapy, the patient had recurrence of vegetations on the prosthetic valve. She underwent replacement of her prosthetic mitral valve in the subsequent 2 weeks, before she progressed to disseminated intravascular coagulation and expired. Although they are typically considered contaminants, corynebacteria, in the appropriate clinical setting, should be recognized, identified, and treated as potentially life-threatening infections, particularly in the case of line-associated bacteremias, and native and prosthetic valve endocarditis.

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

Case Reports in Infectious Diseases ◽

10.1155/2013/730924 ◽

2013 ◽

Vol 2013 ◽

pp. 1-4

Author(s):

Rosaria Pecoraro ◽

Antonino Tuttolomondo ◽

Gaspare Parrinello ◽

Antonio Pinto ◽

Giuseppe Licata

Keyword(s):

Mitral Valve ◽

Mitral Valve Prolapse ◽

Common Iliac Artery ◽

Antibiotic Sensitivity ◽

Prosthetic Valve Endocarditis ◽

Blood Cultures ◽

Coagulase Negative Staphylococci ◽

Staphylococcus Lugdunensis ◽

Mitral Valve Leaflet ◽

History Of

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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P1458 Recurrent endocarditis on mitral valve prosthesis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.885 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

S Suma ◽

C Spaziani ◽

T Manca ◽

A Ramelli ◽

A Vezzani ◽

...

Keyword(s):

Heart Failure ◽

Staphylococcus Aureus ◽

Mitral Valve ◽

Antibiotic Therapy ◽

Blood Cultures ◽

Valve Prosthesis ◽

Mitral Valve Prosthesis ◽

Mitral Prosthesis ◽

History Of

Abstract Patient Presentation and initial work up A 72 years old man with history of hypertension was admitted to our hospital due to acute pulmonary oedema. He had no fever at that time and he had an history of known mitral valve prolapse but with no reported mitral valve regurgitation (MR). Transthoracic Echocardiogram (TTE) was performed and it showed a severe MR. Transesophageal echocardiogram (TOE) showed prolapse of the posterior leaflet of the mitral valve with suspicion of cordal rupture and the presence of an aneurysm of the anterior mitral valve leaflet with perforation of it (panel A and B). Diagnosis and Management Diagnosis of severe MR as the result of previous endocarditis was made. Blood cultures were negative, as well as there were no signs of active endocarditis. However, since there were heart failure and signs of uncontrolled infection, the patient underwent surgical mitral valve replacement (MVR) with bioprosthesis. Moreover, it was started antibiotic therapy with vancomycin, rifampin and ceftriaxone, which was continued for two weeks and then stopped since the microbiological culture of the valve was negative. Follow-up After two months he was re-admitted to the hospital due to a new onset of breathlessness. TTE showed a dehiscence of the mitral prosthetic valve in the inferolateral zone with rocking movement, subvalvular pseudoaneurysm and moderate paravalvular leak (panel C and D). Blood cultures were positive for Staphylococcus Aureus. Consequently, the patient underwent a new surgical MVR. Furthermore, six weeks of antibiotic therapy were carried out with daptomycin and rifampin. However, after another three months, he was admitted once again to the hospital for heart failure with a new evidence of abruption of the mitral prosthesis, again in the inferolateral region and, this time, with the evidence of a vegetation on the atrial side of the prosthesis (panel E and F). Again, blood cultures were positive for Staphylococcus Aureus, and the patient underwent the third surgical intervention of MVR. Another six weeks of antibiotic therapy with daptomycin and rifampin were performed. The patient was then discharged and he is now strictly followed clinically. Conclusion In conclusion, we reported the case of a recurrent relapse of endocarditis on mitral valve prosthesis due to Staphylococcus Aureus infection. Interestingly, the mitral prosthesis was involved always in the same zone (inferolateral area) with abruption of the prosthesis and significant paravalvular regurgitation. At the second relapse there was also a vegetation on it and both times blood cultures were positive. Moreover, antibiotic therapy was conducted for six weeks both times, but the recurrence of endocarditis showed us that he was a sensitive patient and that in cases of relapses like this it should be performed a more careful clinical follow up, involving frequent laboratory tests and clinical and echocardiographic evaluations. Abstract P1458 Figure.

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A rare case of prosthetic valve endocarditis caused by extended-spectrum β-Lactamase producing Escherichia coli

Journal of Global Infectious Diseases ◽

10.4103/0974-777x.77310 ◽

2011 ◽

Vol 3 (1) ◽

pp. 99 ◽

Cited By ~ 5

Author(s):

HarshitH Modi ◽

SneshaH Modi ◽

BazghaRehan Siddiqui ◽

JohnM Andreoni

Keyword(s):

Escherichia Coli ◽

Rare Case ◽

Prosthetic Valve ◽

Prosthetic Valve Endocarditis ◽

Extended Spectrum

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1646 Complicated aortic prosthetic valve endocarditis

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jez319.1036 ◽

2020 ◽

Vol 21 (Supplement_1) ◽

Author(s):

M Do Lago Palacio Estrela ◽

M G Paiva ◽

R L Ferreira ◽

A S L Gazola ◽

P S C Pedreira ◽

...

Keyword(s):

Mitral Valve ◽

Prosthetic Valve ◽

Prolonged Mechanical Ventilation ◽

Prosthetic Valve Endocarditis ◽

Blood Cultures ◽

Oral Antibiotic ◽

Heart Team ◽

Mechanical Prosthesis ◽

Aortic Prosthesis ◽

18F Fdg

Abstract Introduction Prosthetic valve endocarditis (PVE) occurs in 1 to 3% of cases at 1 year and 3 to 9% at 5 years postoperative (PO) with 40% mortality. Clinical complications, uncontrolled infection and agents such as staphylococci and fungi indicate the need for surgery. Recent trial with stable patients (26.7% PVE), oral antibiotic therapy (ATB) proved to be as effect as intravenous antibiotic. However, in complicated cases, prolonged clinical treatment still an exception. Case Report ANFJ, male, 45 years old, aortic valve replacement by mechanical prosthesis in 2015, was hospitalized in Jun/18 with right front-temporal-parietal cerebral hemorrhage and sub febrile for 1 week. Transthoracic echocardiogram (TTE) showed pseudoaneurysm of the mitral valve anterior leaflet with 4+ regurgitation and aortic metallic prosthesis without dysfunction, but transesophageal echocardiogram (TEE) disclosed periprosthetic abscess. Empirical ATB was started until blood cultures yielded S. Agalactiae. After 3 weeks with ceftriaxone, patient persisted sub febrile, high CRP, pulmonary congestion and a new TEE showed mobile aortic prosthesis, fistula and periaortic regurgitation 4+. Urgent surgery was carried out at the same day for abscess drainage and replacement of prosthetic valve by biological aortic prosthesis but without mitral valve approach. Immediate PO underwent with hemodynamic instability, prolonged mechanical ventilation, pleural empyema, acute renal failure requiring dialysis and persistence of fever. Two weeks after surgery, TTE demonstrated new periprosthetic abscess with multiple collections along the ascending aorta. Reassessed by heart team and reoperation was contraindicated due to poor clinical conditions. Patient received parenteral broad-spectrum antibiotic evolving with clinical stabilization, normalization of inflammatory tests becoming afebrile. Aortic angiotomography in Aug/18 showed a periaortic collection of 3.0X2.0X1.9cm and contrast extravasation. New TEE in Aug/18 showed periprosthetic abscess and discrete aortic-right atrium fistula (2+). Maintained ATB until D42, persisting afebrile, negative blood cultures, normal leucogram and CRP. Considered inoperable, he was discharged on Sep/18. After 30 days, patient was stable, negative blood cultures however with worsening ESR (2 -> 99mm/h) and CRP (0.5 -> 15mg/dl). He performed ETT and 18F-FDG PET/CT on Nov/18 with persistence of abscess, fistula and high increase 18F-FDG uptake. Heart team again opted for prolonged oral ATB with amoxicillin 3.0gr/day. Re-evaluated on Dec/18 with laboratory normalization and good clinical evolution until last appointment on April/19 under oral antibiotic. Conclusion Reoperation of PVE improves prognosis, however in some cases where surgical risk is prohibitive, prolonged ATB may be the only option to control infecction or as a bridge for eventual heart transplantation. Abstract 1646 Figure.

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