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

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.

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

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

scholarly journals P1459 Flu-like syndrome complicated in a rare form of infective endocarditis

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
D Kristo ◽  
J Nacher Jimenez ◽  
J Moya Nur ◽  
J Roda ◽  
B Seidelberger ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Blood Culture ◽  
Ct Scan ◽  
Healthy Woman ◽  
Clinical Severity ◽  
Posterior Leaflet ◽  
Haemophilus Parainfluenzae ◽  
History Of ◽  
The Right

Abstract Background The HACEK group of organisms are one of the infrequent causes of infective endocarditis (IE)(5% of cases in adults).Cultures require long incubation time and clinical presentation may be insidious,delaying final diagnosis.We report a case of subacute atypical presentation of native mitral valve Haemophilus parainfluenzae IE A 33 yo female with no history of cardiac disease was presented in our hospital with malaise,weakness &high fever till 39oC for at about two weeks.The patient was treated with levofloxacin and discharged. The 1st blood culture was negative.After 25 days the patient was presented with prolonged fever,neurological signs of TIA(motor aphasia and septic embolic episode of 2nd level on the right hand&foot).Physical exam normal,no cardiac murmurs. ECG:normal. Echo:TTE-mitral valve with thickened leaflet, presence of structures suggestive for vegetations (15x19 mm) at the posterior leaflet, perforation of the posterior leaflet causing an IM mild-moderate.TEE-mitral valve with small posterior leaflet, big anterior leaflet with mobile vegetations of coral-forms with diameter maximum 20x10 mm,located at A3 scallop of mitral valve at posteromedial commissural,with a perforation at this level causing moderate IM.No other pathological findings.Cranial CT scan-no data of any acute intracranial abnormality.Body CT scan-a low uptake area of the renal parenchyma related to acute pyelonephritis/infarction.Blood tests-elevated CRP & thrombocytopenia.Blood culture(2nd one): Haemophilus parainfluenzae.Treatment-The patient went on ceftriaxone and underwent a surgical mitral valve repair with mitral annuloplasty and patch placement because of the size of the vegetation and the embolic risk.We also respect the desire of the patient to be pregnant.The patient improved, no fever. Follow-up:CRP normal.TTE echo showed no evidence of the previously detected vegetation with a residual mild MR.The patient was discharged home followed up after 6 weeks with full recovery. Discussion We present the case of a young healthy woman without any diseases,admitted with the symptoms of a simple flu-like syndrome with a negative blood culture, but complicated later in one of the rarest forms of IE with Haemophilus parainfluenzae. HACEK organisms are most often associated with IE, although rare, can be extremely serious because of the tendency of big size vegetation and embolic episodes,but outcomes generally are successful if the organism is identified early and treated appropriately.The treatment of a HACEK infection is based on the location of the infection,clinical severity and available susceptibility data.According to the ESC recommendations Ceftriaxone or ampicillin/sulbactam is the therapy of choice for patients with HACEK endocarditis in both native and prosthetic-valve endocarditis.Fluoroquinolones may be considered as alternative therapy.Regardless of the agent chosen,treatment should last 4– 6 weeks,depending upon the type of valve involved Abstract P1459 Figure.

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

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.

scholarly journals Recurrent Mitral Valve Endocarditis Caused byStreptococcus pneumoniaein a Splenectomized Host

2013 ◽  
Vol 2013 ◽  
pp. 1-4
Author(s):  
Shikha Shrestha ◽  
JayaKrishna Chintanaboina ◽  
Samir Pancholy
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Treatment Options ◽  
Laboratory Data ◽  
Pneumococcal Vaccination ◽  
Uneventful Recovery ◽  
First Episode ◽  
Severe Mitral Regurgitation ◽  
High Grade Fever ◽  
History Of

A 72-year-old male with a remote history of splenectomy and two previous episodes of pneumococcal endocarditis of mitral valve presented with high-grade fever and confusion for 3 days. Nine months priorly, patient underwent mitral valve repair when he had the first episode of pneumococcal mitral valve endocarditis. He received pneumococcal vaccination two years ago. On examination during this admission, he was found to be febrile (104.3 F) and confused and had a grade 2/6 systolic murmur at the apex without any radiation. Laboratory data was significant for a white blood cell count of 22,000/mm3(normal: 4000–11000/mm3). Blood cultures (4/4 bottles) grew penicillin-sensitiveStreptococcus pneumoniae. Transesophageal echocardiogram revealed small vegetation on the posterior mitral leaflet without any evidence of abscess and severe mitral regurgitation. Patient clinically responded to intravenous ceftriaxone. However, due to recurrent pneumococcal mitral valve endocarditis and severe mitral regurgitation, the patient underwent mitral valve replacement. Patient had an uneventful recovery and was discharged home. Pneumococcal endocarditis itself is being uncommon in this current, penicillin, era; our case highlights the recurrent nature of pneumococcal endocarditis in a splenectomized host and the importance of pursuing aggressive treatment options in this clinical scenario.

scholarly journals P627 Step by step valve destruction in infective endocarditis with no apparent vegetations

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
M Skafar ◽  
A Ovsenik ◽  
J Toplisek ◽  
B Berlot ◽  
M Bervar
Keyword(s):  
Heart Failure ◽  
Staphylococcus Aureus ◽  
Congestive Heart Failure ◽  
Infective Endocarditis ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Antibiotic Therapy ◽  
Systolic Dysfunction ◽  
Illustrative Case ◽  
Posterior Leaflet

Abstract Background Infective endocarditis can present without evident vegetation, diagnosis is challenging and prognosis very poor. We present an illustrative case where natural evolution of the mitral valve destruction with no evident vegetations was followed with frequent consecutive transthoracic (TTE) and transesophageal echocardiography (TOE). Case presentation 71-year old male with known dilated cardiomyopathy presented with dyspnoea, ankle swelling and severe kidney failure with hyperkalemia. During short hospitalization he was recompensated with haemodialysis, parenteral diuretics and inotropes. TTE showed dilated left ventricle with severe systolic dysfunction and no evidence of valvular disease. Few days after discharge he was readmitted with malaise and febrile state with no obvious site of infection. Blood cultures were positive for Staphylococcus aureus and antibiotic therapy was initiated immediately. Weekly TTEs and TOEs were performed (Figure 1, column A-D): Week 1: TTE was performed due to congestive heart failure. There was no suspicion on disease and TTE showed no obvious mitral valve pathology. Week 3: Second TTE showed only light thickening of posterior mitral leaflet with mild mitral regurgitation. Week 4: Follow-up TOE was performed showing posterior leaflet discontinuity with small eccentric regurgitation jet and no vegetation. Week 6: Symptoms of congestive heart failure persisted despite antibiotic treatment. A progressive destruction of posterior leaflet with evident perforation of P1 scallop and consequent severe mitral regurgitation. Patient was referred for urgent mitral valve replacement. Conclusions Staphylococcus aureus is a destructive pathogen and can cause severe destruction of native valve even without obvious vegetations. This case presents echocardiographic features of natural course of infective endocarditis on mitral valve. Despite antibiotic therapy progressive valve destruction is possible. Abstract P627 Figure.

scholarly journals Normal Procalcitonin, CRP and Negative Blood Cultures in Infective Endocarditis with a Massive Residual Vegetation. A Case Report

2021 ◽  
Author(s):  
D Farandzha ◽  
P Shikerova ◽  
G Lazarova ◽  
D Hazarbasanov
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Bacterial Infections ◽  
Blood Cultures ◽  
Optimal Time ◽  
High Morbidity ◽  
Mitral Valve Leaflet ◽  
Randomized Controlled Clinical Trials

Abstract Background Infective endocarditis (IE) is a serious infection with high morbidity and mortality that involves the endocardial lining of the heart. Most cases of IE are due to bacteria although other atypical microorganisms can also be involved. Procalcitonin (PCT) is a biomarker that is used in the diagnosis of bacterial infections. Case summary We present the case of a 54-year-old patient with bacterial endocarditis who has been regularly visiting his cardiologist for follow-up on a mitral valve prolapse and moderate mitral regurgitation (MR) for the last 11 years. During his last visit transthoracic echocardiography (TTE) showed a previously non-existent structure on the posterior mitral valve leaflet (PMVL) with severe MR. Blood cultures were positive for Streptococcus viridans. On admission he had elevated levels of PCT and C-reactive protein (CRP) which returned to normal values after 4 weeks of intravenous antibiotic therapy. His follow-up blood cultures, taken after normalization of PCT, did not show bacterial growth; however, on TTE he had severe mitral regurgitation and a persistent vegetation which had slightly increased in size after completion of the full antibiotic course. He was referred for mitral valve replacement (MVR) surgery. Discussion Normalization of procalcitonin levels may correlate with negative blood cultures in cases of IE with residual vegetations. The optimal time for surgery in such patients is difficult to define but even in circumstances with less infective organisms such as S. viridans and late in the course of the disease residual vegetations remain a serious risk factor for embolic events. Randomized controlled clinical trials are needed in order to have better recommendations with solid evidence regarding prophylaxis and treatment in IE.

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