Two Case Reports of Group B Streptococcal Infective Endocarditis Complicated by Embolism

Rationale: Linezolid (LNZ) induced Cutaneous Adverse Drug Reactions (CADRs) have rare atypical presentation. Till date, there are very few published case reports on LNZ induced CADRs among the multidrug-resistant patients suffering from Infective Endocarditis (MDR IE). Here, we present a rare case report of LNZ induced CARs in a MDR IE patient. Case report: A 24-year-old female patient was admitted to the hospital with chief complaints of fever (101°C) associated with rigors, chills, and shortness of breath (grade IV) for the past 4 days. She was diagnosed with MDR IE, having a prior history of rheumatic heart disease. She was prescribed LNZ 600mg IV BD for MDR IE, against Staphylococcus coagulase-negative. The patient experienced flares of cutaneous reactions with multiple hyper-pigmented maculopapular lesions all over the body after one week of LNZ therapy. Upon causality assessment, she was found to be suffering from LNZ induced CADRs. LNZ dose was tapered gradually and discontinued. The patient was prescribed corticosteroids along with other supportive care. Her reactions completely subsided and infection got controlled following 1 month of therapy. Conclusion: Healthcare professionals should be vigilant for rare CADRs, while monitoring the patients on LNZ therapy especially in MDR patients as they are exposed to multiple drugs. Moreover, strengthened spontaneous reporting is required for better quantification.

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Association between acute ischemic stroke etiology and macroscopic aspect of retrieved clots: is a clot’s color a warning light for underlying pathologies?

Journal of NeuroInterventional Surgery ◽

10.1136/neurintsurg-2019-014905 ◽

2019 ◽

Vol 11 (12) ◽

pp. 1197-1200 ◽

Cited By ~ 2

Author(s):

Alessandro Sgreccia ◽

Zoé Duchmann ◽

Jean Philippe Desilles ◽

Bertrand Lapergue ◽

Julien Labreuche ◽

...

Keyword(s):

Atrial Fibrillation ◽

Ischemic Stroke ◽

Infective Endocarditis ◽

Acute Ischemic Stroke ◽

Mechanical Thrombectomy ◽

Case Reports ◽

Patient Characteristics ◽

Study Groups ◽

Double Blind ◽

Stroke Etiology

BackgroundFew case reports have considered the chromatic aspect of retrieved clots and the possible association with their underlying etiology.ObjectiveThe aim of our study was to analyze the frequency of the TOAST ischemic stroke typical (atrial fibrillation, dissection, atheroma) and atypical (infective endocarditis, cancer-related, valve-related thrombi) etiologies depending on the chromatic aspect of retrieved clots.MethodsA total of 255 anonymized and standardized clot photos of consecutive patients treated by mechanical thrombectomy for acute ischemic stroke were included. A double-blind evaluation was performed by two senior interventional neuroradiologists, who classified the visual aspects of the clots into two main patterns: red/black or white. Main patient characteristics, distribution of underlying stroke etiologies, and outcomes were compared between the two study groups.ResultsThe inter-reader agreement for clot colors was excellent (k=0.78). Two hundred and thirty-three patients were classified as having red/black clots and 22 as having white clots. A statistically significant association (p=0.001) between atypical etiologies and white clots was observed.ConclusionsWhite clots were significantly associated with atypical etiologies in this cohort,in particular, with infectious endocarditis.

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More than Garden Variety: Massive Vegetations from Infective Endocarditis

Pathogens ◽

10.3390/pathogens9120998 ◽

2020 ◽

Vol 9 (12) ◽

pp. 998

Author(s):

Christopher Radcliffe ◽

Joyce Oen-Hsiao ◽

Matthew Grant

Keyword(s):

Heart Failure ◽

Infective Endocarditis ◽

Methicillin Resistant Staphylococcus Aureus ◽

Surgical Intervention ◽

Case Reports ◽

Source Control ◽

Valvular Regurgitation ◽

Vancomycin Therapy ◽

Staphylococcus Aureus Bacteremia ◽

History Of

Infective endocarditis classically involves non-sterile vegetations on valvular surfaces in the heart. Feared complications include embolization and acute heart failure. Surgical intervention achieves source control and alleviates valvular regurgitation in complicated cases. Vegetations >1 cm are often intervened upon, making massive vegetations uncommon in modern practice. We report the case of a 39-year-old female with history of intravenous drug abuse who presented with a serpiginous vegetation on the native tricuspid valve and methicillin-resistant Staphylococcus aureus bacteremia. The vegetation grew to 5.6 cm by hospital day two, and she successfully underwent a tricuspid valvectomy. Six weeks of intravenous vancomycin therapy were completed without adverse events. To better characterize other dramatic presentations of infective endocarditis, we performed a systematic literature review and summarized all case reports involving ≥4 cm vegetations.

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Mitral valve repair for infective endocarditis: Kobe experience

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320947586 ◽

2020 ◽

Vol 28 (7) ◽

pp. 384-389

Author(s):

Yukikatsu Okada ◽

Takeo Nakai ◽

Takashi Muro ◽

Hisato Ito ◽

Yu Shomura

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Event Free Survival ◽

Valve Repair ◽

Free Survival ◽

Autologous Pericardium ◽

Ring Annuloplasty ◽

Group A ◽

Group B

Objectives We retrospectively analyzed our experience of mitral valve repair for native mitral valve endocarditis in a single institution. Methods From January 1991 to October 2011, 171 consecutive patients underwent surgery for infective endocarditis. Of these, 147 (86%) had mitral valve repair. At the time of surgery, 98 patients had healed (group A) and 49 had active infective endocarditis (group B). Repair procedures included resection of all infected tissue and thick restricted post-infection tissue, leaflet and annulus reconstruction with treated autologous pericardium, chordal reconstruction with polytetrafluoroethylene sutures, and ring annuloplasty if necessary. Fifty-two (35%) patients required concomitant procedures. The study endpoints were overall survival, freedom from reoperation, and freedom from valve-related events. The median follow-up was 78 months. Results There was one hospital death (hospital mortality 0.7%). Survival at 10 years was 88.5% ± 3.5% with no significant difference between the two groups ( p = 0.052). Early reoperation was required in 4 patients in group B due to persistent infection or procedure failure. Freedom from reoperation at 5 years was 99% ± 1.0% in group A and 89.6 ± 4.0% in group B ( p = 0.024). Event-free survival at 10 years was 79.3% ± 4.8% (group A: 83.4% ± 5.9%, group B: 72.6% ± 6.9%, p = 0.010). Conclusions Mitral valve repair was highly successful using autologous pericardium, chordal reconstruction, and ring annuloplasty if required. Long-term results were acceptable in terms survival, freedom from reoperation, and event-free survival. Mitral valve repair is recommended for mitral infective endocarditis in most patients.

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Endovascular intervention for acute stroke due to infective endocarditis

Neurosurgical FOCUS ◽

10.3171/2011.11.focus11263 ◽

2012 ◽

Vol 32 (2) ◽

pp. E1 ◽

Cited By ~ 21

Author(s):

Haitham Dababneh ◽

V. Shushrutha Hedna ◽

Jenna Ford ◽

Ziad Taimeh ◽

Keith Peters ◽

...

Keyword(s):

Infective Endocarditis ◽

Acute Stroke ◽

Case Reports ◽

Case Series ◽

Standard Of Care ◽

Clinical Decision ◽

Neurological Complications ◽

Endovascular Interventions ◽

First Case ◽

Risk Of Hemorrhage

The overall incidence of neurological complications due to infective endocarditis is as high as 40%, with embolic infarcts more common than hemorrhagic strokes. The standard of care for typical strokes does not apply to infective endocarditis because there is a substantial risk of hemorrhage with thrombolysis. In the last decade there have been multiple case reports of intravenous and intraarterial thrombolysis with successful outcomes for acute strokes with related infective endocarditis, but successful endovascular interventions for acute strokes associated with infective endocarditis are rarely reported. To the authors' knowledge, this report is the first case in the literature to use a mechanical retrieval device in successful vegetation retrieval in an infective endocarditis acute stroke. Although an interventional approach for treatment of acute stroke related to infective endocarditis is a promising option, it is controversial and a cautious clinical decision should be made on a case-by-case basis. The authors conclude that this approach can be tested in a case series with matched controls, because this condition is rare and a randomized clinical trial is not a realistic option.

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Group B Streptococcal Infective Endocarditis

Archives of Internal Medicine ◽

10.1001/archinte.1985.00360040117026 ◽

1985 ◽

Vol 145 (4) ◽

pp. 693 ◽

Cited By ~ 14

Author(s):

Richard J. Backes

Keyword(s):

Infective Endocarditis ◽

Group B

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Group B Streptococcal Infective Endocarditis

Archives of Internal Medicine ◽

10.1001/archinte.1985.00360120142039 ◽

1985 ◽

Vol 145 (12) ◽

pp. 2270 ◽

Cited By ~ 1

Author(s):

Pere Domingo

Keyword(s):

Infective Endocarditis ◽

Group B

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Group B streptococcal spondylodiscitis in adults: 2 case reports

Joint Bone Spine ◽

10.1016/j.jbspin.2003.05.001 ◽

2004 ◽

Vol 71 (4) ◽

pp. 338-343 ◽

Cited By ~ 21

Author(s):

Javier Narváez ◽

Cesar Pérez-Vega ◽

Francisco J Castro-Bohorquez ◽

Jaime Vilaseca-Momplet

Keyword(s):

Case Reports ◽

Group B

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Group B Streptococcus Meningitis Following Elective Termination of Pregnancy: Two Case Reports

Infectious Diseases in Obstetrics and Gynecology ◽

10.1155/s1064744995000172 ◽

1995 ◽

Vol 2 (6) ◽

pp. 275-278 ◽

Cited By ~ 1

Author(s):

Mark A. Walker ◽

S. Gene McNeeley

Keyword(s):

Case Reports ◽

Group B Streptococcus ◽

Altered Mental Status ◽

Csf Analysis ◽

Elective Abortion ◽

Serious Infections ◽

Physical Examinations ◽

Group B ◽

Elective Termination ◽

Prompt Diagnosis

Background: Although maternal group B streptococcus (GBS) infections are common, serious infections are rare with prompt diagnosis and treatment. We present 2 cases of GBS meningitis occurring 3 and 10 days after elective abortion. In the first patient, GBS meningitis was definitely related to the elective termination. In the second patient, however, no evidence for a causal relationship could be established and can only be presumed.Case: The patients presented to the emergency department with headache, altered mental status, and fever. Their physical examinations were consistent with meningitis and confirmed by cerebrospinal fluid (CSF) analysis. One patient recovered completely and the other developed severe bilateral hearing loss.Conclusion: GBS meningitis is rare, occurring in men and women. When associated with pregnancy, most cases present within 48–72 h of delivery or abortion.

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Staphylococcus lugdunensisEndocarditis in a 35-Year-Old Woman in Her 24th Week of Pregnancy

Case Reports in Obstetrics and Gynecology ◽

10.1155/2016/7030382 ◽

2016 ◽

Vol 2016 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Mounir Khafaga ◽

Karl-Patrik Kresoja ◽

Berndt Urlesberger ◽

Igor Knez ◽

Philipp Klaritsch ◽

...

Keyword(s):

Infective Endocarditis ◽

Therapeutic Strategy ◽

Single Case ◽

Case Reports ◽

Staphylococcus Lugdunensis ◽

Case Presentation ◽

Maternal Fetal Medicine ◽

Published Report ◽

Original Case ◽

Considerable Morbidity

Background. Infective endocarditis is associated with considerable morbidity and mortality. Guidelines addressing prophylaxis and management of infective endocarditis do not extensively deal with concomitant pregnancy, and case reports on infective endocarditis are scarce. This is the first published report of infective endocarditis byStaphylococcus lugdunensisin a pregnant woman.Case Presentation. We report a single case of a 35-year-old woman in her 24th week of pregnancy who was admitted to our intensive care unit with fever and suspected infectious endocarditis. Blood culture detectedStaphylococcus lugdunensis. A vegetation and severe mitral regurgitation due to complete destruction of the valve confirmed the diagnosis. An interdisciplinary panel of cardiologists, maternal-fetal medicine specialists, cardiac and plastic surgeons, infectiologists, anesthesiologists, and neonatologists was formed to determine the best therapeutic strategy.Conclusions. Timing and indications for surgical intervention to prevent embolic complications in infective endocarditis remain controversial. This original case report illustrates how managing infective endocarditis byStaphylococcus lugdunensisparticularly in the 24th week of pregnancy can represent a therapeutic challenge to a broad section of specialties across medicine. Critical cases like this require a thorough weighing of risks and benefits followed by swift action to protect the mother and her unborn child.

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