scholarly journals Streptococcus gallolyticus endocarditis on a prosthetic tricuspid valve: a case report and review of the literature

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Raz Shapira ◽  
Tamir Weiss ◽  
Elad Goldberg ◽  
Eytan Cohen ◽  
Ilan Krause ◽  
...  

Abstract Background Streptococcus gallolyticus subspecies gallolyticus is a known pathogen that causes infective endocarditis, and most cases involve the left heart valves. We present the first reported case of prosthetic tricuspid valve endocarditis caused by this microorganism. Relevant literature is reviewed. Case presentation A 67-year-old Jewish female with a history of a prosthetic tricuspid valve replacement was admitted to the emergency department because of nonspecific complaints including effort dyspnea, fatigue, and a single episode of transient visual loss and fever. No significant physical findings were observed. Laboratory examinations revealed microangiopathic hemolytic anemia and a few nonspecific abnormalities. Transesophageal echocardiogram demonstrated a vegetation attached to the prosthetic tricuspid valve. The involved tricuspid valve was replaced by a new tissue valve, and Streptococcus gallolyticus subspecies gallolyticus was grown from its culture. Prolonged antibiotic treatment was initiated. Conclusions Based on this report and the reviewed literature, Streptococcus gallolyticus should be considered as a rare but potential causative microorganism in prosthetic right-sided valves endocarditis. The patient’s atypical presentation emphasizes the need for a high index of suspicion for the diagnosis of infective endocarditis.

2021 ◽  
Vol 14 (8) ◽  
pp. e243370
Author(s):  
John Leso ◽  
Majd Al-Ahmad ◽  
Drinnon O Hand

A 34-year-old man with a medical history of injection drug use presented with 2 weeks of weakness, nausea, vomiting and septic shock secondary to infective endocarditis of a native tricuspid valve. On admission, CT chest demonstrated multiple cavitary lesions as well as numerous small infarcts seen on MRI brain concerning for systemic septic emboli. Subsequent transthoracic echo with bubble study revealed a large patent foramen ovale (PFO). The patient later received surgical debulking of his tricuspid valve vegetation with AngioVac. Subsequently, PFO closure was performed with a NobleStitch device. The case presented here demonstrates the importance of having a high index of suspicion with right-sided endocarditis and the development of other systemic signs and symptoms. It also underscores the necessity of a multidisciplinary team of cardiologists, surgeons, infectious disease specialists and intensivists in the treatment of these complicated patients.


2021 ◽  
Vol 14 (8) ◽  
pp. e244312
Author(s):  
Atanu Chandra ◽  
Shrestha Ghosh ◽  
Uddalak Chakraborty ◽  
Debojyoti Ray

Right-sided native valve infective endocarditis is common in patients with congenital or valvular heart disease, intracardiac device, central venous catheter and intravenous drug abuse, usually manifesting in adulthood. However, in the absence of predisposing risk factors and in younger age groups, this disease may pose a diagnostic challenge. We report a case series of three juvenile patients with isolated tricuspid valve infective endocarditis without any risk factors and paucity of cardiovascular findings in two of them, in an attempt to highlight the importance of maintaining a high index of suspicion to arrive a timely diagnosis.


2020 ◽  
Vol 2020 (7) ◽  
Author(s):  
Heerani Woodun ◽  
Sarah Bouayyad ◽  
Sura Sahib ◽  
Nadir Elamin ◽  
Steven Hunter ◽  
...  

Abstract A 29-year-old male, with chronic atopic dermatitis (AD), presented with a 2-week history of fatigue, pyrexia and weight loss. Examination showed eczematous patches with lichenified papules, erosions on the right shin and a new murmur. Blood cultures isolated methicillin-sensitive Staphylococcus aureus. Transthoracic echocardiography showed vegetation on the tricuspid valve (TV) that was adherent to the septal leaflet. He was treated for infective endocarditis, attributed to poorly controlled AD, with intravenous Flucloxacillin. Due to ongoing sepsis and pulmonary septic emboli, Clindamycin was added. He underwent TV repair; the septal leaflet was excised, and the remnant two leaflets were brought together with a ring. His patent foramen ovale was closed. His skin was treated with topical steroids and emollients. Right-sided endocarditis of an intact TV is uncommon in a non-intravenous drug user. Therefore, this novel case portrays the importance of aggressively managing AD as it is a risk factor for significant systemic infections.


2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Aria Mahtabfar ◽  
Hamoon Eshraghi ◽  
Melroy D’Souza ◽  
William Berrigan ◽  
Kathleen Casey

Background. Infectious endocarditis (IE) typically occurs in the setting of intravenous drug use, prosthetic heart valves, or rheumatic heart disease. However, there are a few reports of IE occurring in the setting of immunosuppression secondary to cancer and/or chemotherapy. Here, we present a case of a cancer patient who developed anterior spinal artery (ASA) syndrome secondary to a septic embolus from IE. Case Presentation. A 78-year-old male with a history of gastroesophageal cancer treated with chemotherapy and radiation presented to the hospital after a fall at home. He reported experiencing dyspnea and orthopnea for two weeks prior to presentation. In the ED, his vital signs were stable, and his examination was significant for a flaccid paralysis of the right lower extremity. Diagnosis of septic emboli secondary to IE was made after the echocardiogram showed the presence of vegetations on the aortic valve, blood cultures were positive for Streptococcus mitis, and thoracic spine MRI was indicative of an infarction at T10. Discussion. This case highlights the presence of IE in the setting of cancer and chemotherapy. Although cancer is a rare cause of IE, clinicians must maintain a high index of suspicion in order to minimize the sequelae of IE.


2015 ◽  
Vol 7 (2) ◽  
pp. 145-149
Author(s):  
Sri Endah Rahayuningsih ◽  
Rahmat Budi Kuswiyanto ◽  
Herdiana Elizabeth Situmorang ◽  
Evelyn Phangkawira

Almost all patients who develop infective endocarditis (IE) had history of congenital or acquired heart disease.We report a 9 years old boy who was diagnosed as ?-thalassemia major since age 1.5 years, admitted to hospital with chief complaint of difficulty of breathing for 1 week before admission, accompanied by fever. Holosystolic murmur of grade 3/6 was found in the lower left sternal border along with hepatosplenomegaly. Chest x-ray depicted right ventricle enlargement and opaque densities in the middle field of left lung. Blood culture showed growth of Staphylococcus aureus. Echocardiography detected thickening tricuspid valve with oscillating mass in the tricuspid valve, severe pulmonary hypertension, and minimal pericardial effusion. Diagnosis of IE was made. After clinical improvement he was discharged with good condition. The diagnosis of IE in children without heart defects is difficult to establish and right-sided IE is rare in children that a high suspicion index should be considered. DOI: http://dx.doi.org/10.3329/cardio.v7i2.22263 Cardiovasc. j. 2015; 7(2): 145-149


2015 ◽  
Vol 2015 ◽  
pp. 1-4
Author(s):  
Shahzad Khan ◽  
Athanasios Smyrlis ◽  
Dmitry Yaranov ◽  
David Oelberg ◽  
Eric Jimenez

Infective endocarditis (IE) is an infection of the endocardium that involves valves and adjacent mural endocardium or a septal defect. Local complications include severe valvular insufficiency, which may lead to intractable congestive heart failure and myocardial abscesses. If left untreated, IE is generally fatal. Diagnosing IE can be straightforward in patients with the typical oslerian manifestations such as bacteremia, evidence of active valvulitis, peripheral emboli, and immunologic vascular phenomena. In the acute course, however, the classic peripheral stigmata may be few or absent, particularly among intravenous drug abuse (IVDA) patients in whom IE is often due to aS. aureusinfection of right-sided heart valves. We present a complicated case of a very aggressive native aortic valveMSSA(methicillin sensitive Staphylococcus aureus) IE in a young adult male with a past medical history of bicuspid aortic valve and IV drug abuse. His clinical course was complicated by aortic valve destruction and development of third-degree AV block, as well as an aorto-left atrial fistula requiring emergent operation for AV replacement and patch repair. The patient required two reoperations for recurrent endocarditis and its complications.


2021 ◽  
Vol 2 (2) ◽  
pp. 84
Author(s):  
Maulia Prismadani ◽  
Agus Subagjo

Infective endocarditis (IE) is associated with a high rate of mortality and morbidity in patients with anomalies of heart valves. We present a case of a 23-year-old male known to have severe mitral regurgitation (MR) with a history of prolonged fever for 5 months. According to The Modified Duke Criteria, clinical sign and symptoms fulfilled one major criterion (echocardiography finding of vegetation on mitral valve) and three minor (fever of at least 380 Celsius, valvular heart disease as a predisposing heart condition, and positive blood culture for Lactococcus sp. and Pediococcus sp.) considered as definite IE. Fever is one of the most common symptoms of IE (>90% of cases). Patient with prolonged fever and structural abnormality of heart valve should be considered for acute or subacute of IE. Establishing an diagnosis of IE and appropriate antibiotic therapy will improve the patient's clinical condition, and reduce morbidity and mortality.


PLoS ONE ◽  
2010 ◽  
Vol 5 (1) ◽  
pp. e8939 ◽  
Author(s):  
Marie Benoit ◽  
Franck Thuny ◽  
Yannick Le Priol ◽  
Hubert Lepidi ◽  
Sonia Bastonero ◽  
...  

2019 ◽  
Vol 16 (3) ◽  
pp. 63-68
Author(s):  
Cristina Dumitrescu ◽  
Alin Badea ◽  
Ioana Păltineanu ◽  
Dan Mitrea ◽  
Radu Mihăilescu ◽  
...  

AbstractInfective endocarditis is an infection of the endocardial surface of the heart. Usually, it affects one or more heart valves or an intracardiac device. Neurologic events (silent or symptomatic) account for 20 to 40% of all patients with infective endocarditis.We are presenting the case of a 57 -year-old man with cardiovascular risk factors admitted to our clinic for aphasia. His medical history included a recent stroke and small fiber neuropathy with a gradual onset for the past six months. Despite extensive investigations, no cause for strokes and neuropathy could be found. To identify a potential source of embolism, a transoesophageal echocardiography was performed. It revealed vegetation attached to both aortic and mitral valves. Blood cultures were positive for Streptococcus gallolyticus. The patient underwent emergency aortic and mitral valve replacement and a 6-week course of antibiotic treatment with ceftriaxone and gentamicin with the improvement of both aphasia and peripheral neuropathy.Central nervous system complications such as encephalopathy, seizures, stroke or severe cerebral hemorrhage are commonly described in infective endocarditis, but peripheral nervous system involvement is rarely reported in the literature. Although no cause for neuropathy has been found, it is difficult to asses whether it was a complication of the infective endocarditis.


2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
B Hammad ◽  
R Abayazeed ◽  
A Elbadry ◽  
N Hisham ◽  
E Elsharkawy

Abstract Background Right sided infective endocarditis (IE) accounts for 5-10% of IE cases, systemic embolization is uncommon and if present it is linked to the presence of shunt or concomitant left sided IE. Clinical presentation A 35-years old gentleman with history of heroin intravenous drug abuse (IV), presented with a history of unexplained fever for two weeks along with exertional dyspnea, productive cough, chest pain and severe left hypochondria pain. On examination he had a blood pressure of 130/80 mmHg, a heart rate of 130 bpm, a temperature of 40oC, elevated jugular venous pressure and a harsh pansystolic murmur over the lower left sternal border. Laboratory results revealed anaemia, leukocytosis elevated ESR and CRP and blood cultures were positive for methicillin-resistant staphylococcus aureus (MRSA), electrocardiography showed sinus tachycardia and abdomen computed tomography scan revealed multiple splenic infarctions. Methods and results 2D&3DTrans-Thoracic Echocardiography (TTE) revealed the presence of an echogenic elongated highly mobile mass measures 2.0 cm in maximum dimension attached to the atrial surface of the anterior tricuspid valve leaflet a long with severe valvular regurgitation. Patent foramen ovale (PFO) was visualized by Color Doppler and right to left shunt was confirmed by contrast study with a complete opacification of the left side. The left ventricle dimensions were normal , there was an evidence of hyokinesis of inter-ventricular septum (IVS) and inferior wall and function was reduced, estimated LVEF = 45%. Hence, coronary angiography was done and revealed normal coronaries. 3D Trans-esophageal Echocardiography(TEE) was done for better visualization of the interatrial septum (IAS), vegetation and to rule out complications. The study confirmed the presence of PFO, there was no concomitant IAS defects, the vegetation is highly mobile and facing the IAS. Accordingly, patient was diagnosed with tricuspid infective endocarditis complicated with paradoxical embolization, anti-biotics were commenced and patient underwent successful tricuspid valve replacement and PFO closure. Discussion Tricuspid valve endocarditis has been linked to IV drug abuse and staphylococcus aureus has been recognized as the most commonly implicated organism. While systemic emboli are rare in right sided IE, our patient represent this uncommon complication. He had multiple splenic infractions and TTE contrast study showed PFO with a high degree of right to left shunt. Coronary embolization was a suspect in our patient as well given the presence of regional wall motion abnormalities involving the left ventricle inferior wall and IVS. Conclusion Echocardiography is a crucial imaging modality in patient with long standing fever and history of IV drug abuse to rule out infective endocarditis. 3D-TEE is of added value along with TTE in better definition of vegetations and detection of infective endocarditis complication. Abstract P1299 Figure. Tricuspid valve infective endocarditis


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