scholarly journals An unusual case of Cardiobacterium valvarum causing aortic endograft infection and osteomyelitis

2021 ◽  
Vol 20 (1) ◽  
Author(s):  
Eric G. Hauser ◽  
Imran Nizamuddin ◽  
Brett B. Yarusi ◽  
Karen M. Krueger
Keyword(s):  
Infective Endocarditis ◽  
English Language ◽  
Vertebral Osteomyelitis ◽  
Causative Organism ◽  
Complex Anatomy ◽  
Risk Patients ◽  
History Of ◽  
Disseminated Disease ◽  
Cardiac Manifestations ◽  
Endograft Infection

Abstract Background HACEK (Haemophilus spp., Aggregatibacter spp., Cardiobacterium spp., Eikenella corrodens, and Kingella spp.) group organisms are responsible for 0.8% to 6% of all infective endocarditis cases, with Cardiobacterium spp. being the third most commonly implicated HACEK microorganism. Within this genus is Cardiobacterium valvarum (C. valvarum), a novel organism described in 2004. To date, only 15 cases of C. valvarum infection have been reported in the English-language literature, and have primarily been cases of infective endocarditis in patients with valvular disease. C. valvarum has not been reported to cause infections spreading to the surrounding bone. Case presentation We present a case of a 57-year-old man with a history of aortic dissection followed by aortic endograft replacement who presented with back pain. He was found to have radiographic evidence of an infected aortic endograft, along with vertebral osteomyelitis, discitis, and epidural phlegmon. Blood cultures identified C. valvarum as the causative organism. The patient was treated with ceftriaxone and surgical intervention was deferred due to the patient’s complex anatomy. His course was complicated by septic cerebral emboli resulting in cerebrovascular accident. Conclusions This case report highlights C. valvarum, a rare and emerging HACEK group microorganism that warrants consideration in high-risk patients with evidence of subacute infection and disseminated disease. While C. valvarum classically presents as infective endocarditis, extra-cardiac manifestations have also been described. As demonstrated in this case, endograft involvement and osteomyelitis may occur in rare circumstances.

scholarly journals Quantifying infective endocarditis risk in patients with predisposing cardiac conditions

2017 ◽  
Vol 39 (7) ◽  
pp. 586-595 ◽  
Author(s):  
Martin H Thornhill ◽  
Simon Jones ◽  
Bernard Prendergast ◽  
Larry M Baddour ◽  
John B Chambers ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
High Risk ◽  
Hospital Admissions ◽  
Previous History ◽  
Prosthetic Material ◽  
Moderate Risk ◽  
Prosthetic Valves ◽  
English Population ◽  
Risk Patients ◽  
History Of

Abstract Aims There are scant comparative data quantifying the risk of infective endocarditis (IE) and associated mortality in individuals with predisposing cardiac conditions. Methods and results English hospital admissions for conditions associated with increased IE risk were followed for 5 years to quantify subsequent IE admissions. The 5-year risk of IE or dying during an IE admission was calculated for each condition and compared with the entire English population as a control. Infective endocarditis incidence in the English population was 36.2/million/year. In comparison, patients with a previous history of IE had the highest risk of recurrence or dying during an IE admission [odds ratio (OR) 266 and 215, respectively]. These risks were also high in patients with prosthetic valves (OR 70 and 62) and previous valve repair (OR 77 and 60). Patients with congenital valve anomalies (currently considered ‘moderate risk’) had similar levels of risk (OR 66 and 57) and risks in other ‘moderate-risk’ conditions were not much lower. Congenital heart conditions (CHCs) repaired with prosthetic material (currently considered ‘high risk’ for 6 months following surgery) had lower risk than all ‘moderate-risk’ conditions—even in the first 6 months. Infective endocarditis risk was also significant in patients with cardiovascular implantable electronic devices. Conclusion These data confirm the high IE risk of patients with a history of previous IE, valve replacement, or repair. However, IE risk in some ‘moderate-risk’ patients was similar to that of several ‘high-risk’ conditions and higher than repaired CHC. Guidelines for the risk stratification of conditions predisposing to IE may require re-evaluation.

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

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.

scholarly journals Atypical symptoms with typical signs in a patient with Propionibacterium acnes related mitral valve endocarditis

2021 ◽  
Vol 9 (6) ◽  
pp. 1790
Author(s):  
Rashid Hameed ◽  
Noshine Irrum ◽  
Pankaj Saxena ◽  
Muntaser D. Musameh
Keyword(s):  
Infective Endocarditis ◽  
Propionibacterium Acnes ◽  
Medical Condition ◽  
Previous History ◽  
Causative Organism ◽  
Atypical Symptoms ◽  
Prosthetic Valves ◽  
History Of ◽  
Atypical Presentations ◽  
High Level

Infective endocarditis (IE) is a serious medical condition associated with an increase in morbidity and mortality if not treated promptly and adequately. The clinical outcome depends on the early diagnosis and aggressiveness of the causative organism. Patients usually present with typical features suggestive of Infective endocarditis but in some circumstances the presentations are atypical, and if not diagnosed and treated, may lead to serious consequences. We present a case of atypical presentations of infective endocarditis caused by Propionibacterium acnes organism with no classical features of endocarditis and had symptoms suggestive of urinary tract infection. The diagnosis of IE can be very difficult in patients with atypical clinical presentation, particularly caused by low-pathogenicity organisms. Appropriate clinical assessment and high level of suspicious especially in the patients with previous history of infective endocarditis or having prosthetic valves in situ is crucial.

scholarly journals Streptococcus oralis MitraClip endocarditis following a dental procedure: a case report

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Aikaterini Papamanoli ◽  
Tahmid Rahman ◽  
Andreas P. Kalogeropoulos ◽  
Zeena Lobo ◽  
Paul Diggs ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Hemodynamic Instability ◽  
Blood Cultures ◽  
Causative Organism ◽  
Surgical Risk ◽  
Continue Medical ◽  
Streptococcus Oralis ◽  
Dental Procedures ◽  
Risk Patients

Abstract Background Transcatheter edge-to-edge mitral valve repair using the MitraClip device is increasingly used for high surgical risk patients with severe mitral regurgitation (MR). Previous guidelines for infective endocarditis prophylaxis prior to dental procedures focused on high-risk patients, but without explicit recommendation for MitraClip recipients. We believe this could be the first reported case to identify Streptococcus oralis as the causative organism. Case presentation An 87-year-old male with severe MR treated with two MitraClip devices three months prior to index admission, presented with worsening malaise and intermittent chills on a background of multiple comorbid conditions. The patient had dental work a month prior to presentation, including a root canal procedure, without antibiotic prophylaxis. Vitals were significant for fever and hypotension. On physical examination, there was a holosystolic murmur at the apex radiating to the axilla, bilateral pitting edema in the lower extremities, and elevated jugular venous pulsation. A transthoracic echocardiogram showed severe MR with a possible echodensity on the mitral valve, prompting a transesophageal echocardiogram, which demonstrated a pedunculated, mobile mass on the posterior leaflet of the mitral valve. Five blood cultures grew gram positive cocci in pairs and chains, later identified as Streptococcus oralis, with minimum inhibitory concentration to penicillin 0.06 mg/L. Initial empiric antibiotics were switched to ceftriaxone 2 gr daily and subsequent blood cultures remained negative. However, the patient developed pulmonary edema and worsening hemodynamic instability requiring vasopressors. As surgical risk for re-operation was considered prohibitive, the decision was made to continue medical management and comfort-directed care. The patient died a week later. Conclusions Despite low incidence, infective endocarditis should be included in the differential among MitraClip recipients. The explicit inclusion of this growing patient population in the group requiring prophylaxis prior to dental procedures in the 2020 ACC/AHA valvular heart disease guidelines is an important step forward.

scholarly journals 122. Dalbavancin Use in Patients with Substance Use Disorders

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S189-S190
Author(s):  
Amber C Streifel ◽  
Jina Makadia ◽  
Strnad Luke ◽  
Alyse Douglass ◽  
Heather Mayer ◽  
...  
Keyword(s):  
Substance Use ◽  
High Risk ◽  
Clinical Outcomes ◽  
Discharge Planning ◽  
Treatment Options ◽  
Vertebral Osteomyelitis ◽  
Causative Organism ◽  
Icd 10 ◽  
History Of ◽  
Severe Infections

Abstract Background Dalbavancin, a lipoglycopeptide antibiotic, has an extended half-life that allows for weekly dosing and is an alternative to daily intravenous (IV) antibiotics. The dosing interval has the potential to expand treatment options for more severe infections in patients with substance use disorder (SUD), houselessness, and other complex social determinants of health where treatment of severe infections with long courses of IV antibiotics can have a high risk of failure. Questions remain regarding clinical outcomes for this indication and patient population. Methods We conducted a retrospective review of dalbavancin use for any patient with documented SUD either by ICD-10 or in chart notes. We identified all patients > 18 years who received > 1 dose of dalbavancin via medication records. Results 53 patients with documented SUD received dalbavancin as part of their treatment regimen (Table 1). The most common indication was osteomyelitis, including 14 cases of vertebral osteomyelitis (Table 2). The most common causative organism was Staphylococcus aureus, 23 (43%) cases due to MRSA and 10 (18%) due to MSSA. The majority of patients (41,77%) had a documented history of IV drug use (IDU) and 19% had alcohol use disorder. A structured, RN-lead multi-disciplinary discharge planning conference to discuss antibiotic options, risk factors for outpatient parenteral antibiotic therapy, and PICC safety in the community was held for 17 (32%). Concern about outpatient PICC safety in patients with history of IDU, unsafe home environment, and prior non-adherence to outpatient antibiotics were common reasons for choosing dalbavancin. Ten (19%) patients were lost to follow-up. The 30 and 90-day readmission rates were 13% and 19% respectively but were due to relapse or recurrence of infection in only 3 (6%) at 30 days and 2 (4%) additional at 90 days. There was only one death at 90 days ant it was unrelated to infection. (Table 3) Table 2. Dalbavancin Use Conclusion Dalbavancin was well tolerated and = a viable alternative for patients with SUD who often have social factors and preferences that make continuation of outpatient IV therapy high risk or impractical. Further data on clinical outcomes in complex infections is needed. Disclosures All Authors: No reported disclosures

Pathogen influence on epidemiology, diagnostic evaluation and management of infective endocarditis

Heart ◽  
2020 ◽  
Vol 106 (24) ◽  
pp. 1878-1882
Author(s):  
Khawaja M Talha ◽  
Daniel C DeSimone ◽  
M Rizwan Sohail ◽  
Larry M Baddour
Keyword(s):  
At Risk ◽  
Infective Endocarditis ◽  
Clinical Course ◽  
Prosthetic Valve Endocarditis ◽  
Target Population ◽  
Significant Shift ◽  
The Past ◽  
Risk Patients ◽  
History Of ◽  
Viridans Group Streptococci

Infective endocarditis (IE) is uncommon and has, in the past, been most often caused by viridans group streptococci (VGS). Due to the indolent nature of these organisms, the phrase ‘subacute bacterial endocarditis’, so-called ‘SBE’, was routinely used as it characterised the clinical course of most patients that extended for weeks to months. However, in more recent years, there has been a significant shift in the microbiology of IE with the emergence of staphylococci as the most frequent pathogens, and for IE due to Staphylococcus aureus, the clinical course is acute and can be associated with sepsis. Moreover, increases in IE due to enterococci have occurred and have been characterised by treatment-related complications and worse outcomes. These changes in pathogen distribution have been attributed to a diversification in the target population at risk of IE. While prosthetic valve endocarditis and history of IE remain at highest risk of IE, the rise in prevalence of injection drug use, intracardiac device implantations and other healthcare exposures have heavily contributed to the existing pool of at-risk patients. This review focuses on common IE pathogens and their impact on the clinical profile of IE.

Antibiotic Therapy Did Not Prevent the Rupture of Mycotic Aneurysm of the Superior Mesenteric Artery

2015 ◽  
Vol 18 (3) ◽  
pp. 088
Author(s):  
Ye-tao Li ◽  
Xiao-bin Liu ◽  
Tao Wang
Keyword(s):  
Abdominal Pain ◽  
Infective Endocarditis ◽  
Aortic Valve ◽  
Superior Mesenteric Artery ◽  
Mesenteric Artery ◽  
Mycotic Aneurysm ◽  
Acute Abdominal Pain ◽  
Rare Complication ◽  
Emergency Operation ◽  
History Of

<p class="p1"><span class="s1">Mycotic aneurysm of the superior mesenteric artery (SMA) is a rare complication of infective endocarditis. We report a case with infective endocarditis involving the aortic valve complicated by multiple septic embolisms. The patient was treated with antibiotics for 6 weeks. During preparation for surgical treatment, the patient developed acute abdominal pain and was diagnosed with a ruptured SMA aneurysm, which was successfully treated with an emergency operation of aneurysm ligation. The aortic valve was replaced 17 days later and the patient recovered uneventfully. In conclusion, we present a rare case with infective endocarditis (IE) complicated by SMA aneurysm. Antibiotic treatment did not prevent the rupture of SMA aneurysm. Abdominal pain in a patient with a recent history of IE should be excluded with ruptured aneurysm.</span></p>

The Nonviolent Struggle for Indian Freedom, 1905-19

2018 ◽  
Author(s):  
David Hardiman
Keyword(s):  
English Language ◽  
Second World War ◽  
World War ◽  
Passive Resistance ◽  
Civil Resistance ◽  
Political Concept ◽  
History Of ◽  
Second World ◽  
Moral Stance

Much of the recent surge in writing about the practice of nonviolent forms of resistance has focused on movements that occurred after the end of the Second World War, many of which have been extremely successful. Although the fact that such a method of civil resistance was developed in its modern form by Indians is acknowledged in this writing, there has not until now been an authoritative history of the role of Indians in the evolution of the phenomenon.The book argues that while nonviolence is associated above all with the towering figure of Mahatma Gandhi, 'passive resistance' was already being practiced as a form of civil protest by nationalists in British-ruled India, though there was no principled commitment to nonviolence as such. The emphasis was on efficacy, rather than the ethics of such protest. It was Gandhi, first in South Africa and then in India, who evolved a technique that he called 'satyagraha'. He envisaged this as primarily a moral stance, though it had a highly practical impact. From 1915 onwards, he sought to root his practice in terms of the concept of ahimsa, a Sanskrit term that he translated as ‘nonviolence’. His endeavors saw 'nonviolence' forged as both a new word in the English language, and as a new political concept. This book conveys in vivid detail exactly what such nonviolence entailed, and the formidable difficulties that the pioneers of such resistance encountered in the years 1905-19.

Repainting the Little Red Schoolhouse

2002 ◽  
Author(s):  
John G. Rodden
Keyword(s):  
Educational Reform ◽  
English Language ◽  
Nation Building ◽  
German Education ◽  
Language Study ◽  
History Of

This is the first English-language study of GDR education and the first book, in any language, to trace the history of Eastern German education from 1945 through the 1990s. Rodden fully relates the GDR's attempt to create a new Marxist nation by means of educational reform, and looks not only at the changing institution of education but at something the Germans call Bildung--the formation of character and the cultivation of body and spirit. The sociology of nation-building is also addressed.

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