A Case of Infective Endocarditis Due to Oral Streptococci After Perioperative Oral Function Management

ABSTRACT The FimA protein of Streptococcus parasanguis is a virulence factor in the rat model of endocarditis, and immunization with FimA protects rats against homologous bacterial challenge. Because FimA-like proteins are widespread among the oral streptococci, the leading cause of native valve endocarditis, we evaluated the ability of this vaccinogen to protect rats when challenged by other streptococcal species. Here we report that FimA vaccination produced antibodies that cross-reacted with and protected against challenge by the oral streptococci S. mitis, S. mutans, and S. salivarius. FimA thus has promise as a vaccinogen to control infective endocarditis caused by oral streptococci.

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P1802Management and outcomes of infective endocarditis in adults with congenital heart disease

European Heart Journal ◽

10.1093/eurheartj/ehz748.0554 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R Ly ◽

D Lebeaux ◽

F Pontnau ◽

F Compain ◽

B Gaye ◽

...

Keyword(s):

Congenital Heart Disease ◽

Heart Disease ◽

Infective Endocarditis ◽

Congenital Heart ◽

Hospital Death ◽

Oral Streptococci ◽

Mortality And Morbidity ◽

Risk Of Death ◽

Duke Criteria ◽

Increased Risk

Abstract Background Causes, epidemiology and microbiology of infective endocarditis (IE) have evolved in recent decades. Although novel tools for the diagnosis and therapeutic strategies have emerged, mortality and morbidity remain high. These trends may particularly concern the growing population of adults with congenital heart disease (CHD) who are at increased risk for IE. Purpose We aimed to characterize IE in CHD patients and describe management and outcome in this setting. We also sought to determine the risk factors associated with in-hospital death in CHD patients. Methods From January 2000 to June 2018, 666 consecutive episodes of IE in adults were recorded in our center. Among them, 143 concerned CHD, including 5 implantable cardiac electronic devices-lead infections, all managed by an IE team including CHD specialists. Cases were classified according to modified Duke criteria. Results CHD patients were significantly younger (37 years IQR [26–52]), with a more common history of cardiac reoperations (numbers of sternotomies≥2 in 35.7%) and infective endocarditis (19.7%, p<0.01) compared to non-CHD patients. There were more infections of valve-containing prosthetics (44% vs. 30%, p<0.04), and the right heart side (41.5%, p<0.01) in CHD patients. Forty-nine percent of them had a simple CHD, 12.7% a moderate, and 36.4% a complex. A predisposing event could be identified in only 34% of cases. Oral streptococci/Streptococci bovis and Staphylococcus aureus were the most frequently microorganisms isolated (32.4% and 20.4%, respectively). Surgery was performed in 90 episodes (62%), and was selected in emergency (<24h) in 61% (figure 1). In-hospital mortality was 12.7% and was directly related to IE in 10/18 cases. CHD patients had a significant lower risk of death compared to non-CHD patients (OR=0.47, p=0.026, p<0.01), even after adjustment for age, and the infected heart side. On multivariate analysis the complexity of CHD (if simple CHD: OR=0.07 IQR [0.01 to 0.44], p<0.01) and the white blood cell count (OR=1.18 IQR [1.04 to 1.33], p=0.01) were the strongest predictive factors of in-hospital death in the CHD group. Conclusions Mortality associated with IE in CHD patients is lower than in acquired heart disease. The multidisciplinary approach by IE team and CHD specialists may have improved management and outcome in this setting. However, risk for death remains high in complex lesions. Larger prospective studies on IE in adults with CHD are needed to develop guidelines in these complex patients.

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Invasion and Killing of Human Endothelial Cells by Viridans Group Streptococci

Infection and Immunity ◽

10.1128/iai.71.5.2365-2372.2003 ◽

2003 ◽

Vol 71 (5) ◽

pp. 2365-2372 ◽

Cited By ~ 55

Author(s):

Murray W. Stinson ◽

Susan Alder ◽

Sarmishtha Kumar

Keyword(s):

Endothelial Cells ◽

Infective Endocarditis ◽

Culture Medium ◽

Umbilical Vein ◽

Bovine Liver ◽

Surface Proteins ◽

Oral Streptococci ◽

Bovine Liver Catalase ◽

Umbilical Vein Endothelial Cells ◽

Viridans Group Streptococci

ABSTRACT Colonization of the cardiovascular endothelium by viridans group streptococci can result in infective endocarditis and possibly atherosclerosis; however, the mechanisms of pathogenesis are poorly understood. We investigated the ability of selected oral streptococci to infect monolayers of human umbilical vein endothelial cells (HUVEC) in 50% human plasma and to produce cytotoxicity. Planktonic Streptococcus gordonii CH1 killed HUVEC over a 5-h period by peroxidogenesis (alpha-hemolysin) and by acidogenesis but not by production of protein exotoxins. HUVEC were protected fully by addition of supplemental buffers and bovine liver catalase to the culture medium. Streptococci were also found to invade HUVEC by an endocytic mechanism that was dependent on polymerization of actin microfilaments and on a functional cytoskeleton, as indicated by inhibition with cytochalasin D and nocodazole. Electron microscopy revealed streptococci attached to HUVEC surfaces via numerous fibrillar structures and bacteria in membrane-encased cytoplasmic vacuoles. Following invasion by S. gordonii CH1, HUVEC monolayers showed 63% cell lysis over 4 h, releasing 64% of the total intracellular bacteria into the culture medium; however, the bacteria did not multiply during this time. The ability to invade HUVEC was exhibited by selected strains of S. gordonii, S. sanguis, S. mutans, S. mitis, and S. oralis but only weakly by S. salivarius. Comparison of isogenic pairs of S. gordonii revealed a requirement for several surface proteins for maximum host cell invasion: glucosyltransferase, the sialic acid-binding protein Hsa, and the hydrophobicity/coaggregation proteins CshA and CshB. Deletion of genes for the antigen I/II adhesins, SspA and SspB, did not affect invasion. We hypothesize that peroxidogenesis and invasion of the cardiovascular endothelium by viridans group streptococci are integral events in the pathogenesis of infective endocarditis and atherosclerosis.

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Isolation and characterization of Streptococcus mutans in heart valve and dental plaque specimens from a patient with infective endocarditis

Journal of Medical Microbiology ◽

10.1099/jmm.0.46609-0 ◽

2006 ◽

Vol 55 (8) ◽

pp. 1135-1140 ◽

Cited By ~ 63

Author(s):

Ryota Nomura ◽

Kazuhiko Nakano ◽

Hirotoshi Nemoto ◽

Kazuyo Fujita ◽

Satoko Inagaki ◽

...

Keyword(s):

Infective Endocarditis ◽

Dental Caries ◽

Oral Cavity ◽

Streptococcus Mutans ◽

Heart Valve ◽

Dental Plaque ◽

Biochemical Properties ◽

Oral Streptococci ◽

Isolation And Characterization

Streptococcus mutans, known to be an aetiologic agent of dental caries, also causes infective endocarditis (IE), although a comparison of isolates from the oral cavity and infected heart valve of the same patient has not been reported. In the present study, infected heart valve and dental plaque samples from a patient with IE were analysed. Broad-range PCR with DNA sequencing revealed that 50 clones from the dental plaque isolates were composed of oral streptococci and periodontopathic bacteria, whereas only Streptococcus mutans was detected in 50 clones from the heart valve. Eighteen strains of Streptococcus mutans were isolated from dental plaque and seven from the heart valve, and the biochemical properties of each were in accordance with those of Streptococcus mutans. DNA fingerprinting analysis revealed that all the oral isolates of Streptococcus mutans had similar patterns, which were different from those of the isolates from the infected heart valve. Western blotting using glucosyltransferase (GTF)-specific antiserum showed that the seven strains from the heart valve lacked the three types of intact GTF. In addition, the sucrose-dependent adhesion rates of these isolates were significantly lower than those of the oral isolates (P<0.001). Furthermore, the isolates from the heart valve were less susceptible to erythromycin and kanamycin. These results indicate that the properties of the Streptococcus mutans strains isolated from the infected valve were different from those of typical oral strains, which may be related to the effects of IE.

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Virulence factors in streptococcal infective endocarditis

Microbiology Australia ◽

10.1071/ma05114 ◽

2005 ◽

Vol 26 (3) ◽

pp. 114

Author(s):

Derek W S Harty

Keyword(s):

Infective Endocarditis ◽

Heart Valves ◽

Blood Stream ◽

Mutans Streptococci ◽

Oral Streptococci ◽

Streptococcus Anginosus ◽

Streptococcus Oralis ◽

Causative Agents ◽

Life Threatening ◽

Micro Organisms

Infective endocarditis (IE) is a life threatening, endovascular infection occurring when bacteria enter the blood stream and adhere to heart valves. Mortality rates remain in the range of 11-27%. The most common infecting micro-organisms are now the staphylococci (44%) although streptococci (31%) and particularly the oral streptococci (21%) are still major causative agents. Many different oral streptococci have been isolated from IE cases, the most common being Streptococcus sanguinis, Streptococcus oralis, Streptococcus gordonii, Streptococcus mitis, Streptococcus anginosus group and mutans streptococci.

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1077. Heart Transplantation as Salvage Treatment for Intractable Infective Endocarditis

Open Forum Infectious Diseases ◽

10.1093/ofid/ofy210.914 ◽

2018 ◽

Vol 5 (suppl_1) ◽

pp. S322-S322

Author(s):

Pierre Tattevin ◽

Patricia Muñoz ◽

Asuncion Moreno ◽

Guillaume Hékimian ◽

François Delahaye ◽

...

Keyword(s):

Cardiac Surgery ◽

Infective Endocarditis ◽

Heart Transplantation ◽

Acute Phase ◽

The United States ◽

Left Ventricular ◽

Salvage Treatment ◽

Oral Streptococci ◽

Duke Criteria

Abstract Background Infective endocarditis (IE) remains a severe disease with contemporary in-hospital mortality rates of 20%. Although valvular replacement is performed in 50% of patients during the acute phase, heart transplantation remains the last resort in selected patients with extensive perivalvular lesions or end-stage cardiac failure. Methods Cases were identified through the International Collaboration on Endocarditis (ICE) network. All patients who underwent heart transplantation during the acute phase of IE, with at least three months follow-up, were enrolled. Data were extracted from medical charts on a standardized questionnaire. Only patients who fulfilled Duke criteria for definite IE were enrolled. Results Between 1991 and 2017, 19 patients (6 women, 13 men), with a median age of 52 years (interquartile range, 41–61) underwent heart transplantation for IE refractory to optimized medical treatment and/or other cardiac surgery in Spain (n = 9), France (n = 6), and Colombia, Croatia, Switzerland, and the United States (one patient each). IE affected prosthetic (n = 10), native valves (n = 9), primarily aortic (56%), and mitral (28%). Pathogens were oral streptococci (n = 7), Staphylococcus aureus (n = 5, including two methicillin-resistant), Enterococcus faecalis (n = 2), and Mycoplasma hominis, Haemophilus para-influenzae, Candida albicans (one patient each). Two cases were not documented. Main cardiac lesions were vegetations (n = 17), severe regurgitation (n = 15), peri-annular abscesses (n = 9), prosthetic valve desinsertion (n = 4), and intra-cardiac fistula (n = 1). Seventeen patients underwent cardiac surgery at least once before transplantation, and four patients were on circulatory assistance (left ventricular assist-device, or extra-corporeal membrane oxygenation, two patients each). Median delay between first cardiac surgery and transplantation was 28 days (IQR, 18–71). Six patients died (32%), including four during the first month post-transplant. Thirteen patients survived, with a median follow-up of 44 months post-transplantation (IQR, 13–88). Conclusion Heart transplantation may be considered as salvage treatment in highly selected patients with intractable infective endocarditis. Disclosures All authors: No reported disclosures.

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Incidence and mortality of infective endocarditis caused by oral streptococci in the last three decades at a referral center in Spain

Revista Española de Cardiología (English Edition) ◽

10.1016/j.rec.2021.09.013 ◽

2021 ◽

Author(s):

Paula Anguita ◽

Juan C. Castillo ◽

José López-Aguilera ◽

Manuela Herrera ◽

Manuel Pan ◽

...

Keyword(s):

Infective Endocarditis ◽

Oral Streptococci ◽

Referral Center ◽

Incidence And Mortality

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Antibiotic prophylaxis and prevention of infective endocarditis

ESC CardioMed ◽

10.1093/med/9780198784906.003.0399 ◽

2018 ◽

pp. 1736-1738

Author(s):

Bruno Hoen ◽

Xavier Duval

Keyword(s):

Infective Endocarditis ◽

High Risk ◽

Antibiotic Prophylaxis ◽

Oral Streptococci ◽

Efficacy And Safety ◽

Native Valve ◽

Oral Flora ◽

Cardiac Implantable Electronic Devices ◽

Dental Procedures ◽

Healthcare Associated

Prevention of infective endocarditis has historically focused on oral health because oral streptococci are part of oral flora and once caused most cases of native valve infective endocarditis. Because no randomized clinical trial has ever been conducted to confirm the efficacy and safety of antibiotic prophylaxis of infective endocarditis, it is likely that the debate on indications for antibiotic prophylaxis of infective endocarditis will continue in the coming years. In the meantime, it is reasonable to propose antibiotic prophylaxis to patients at high risk of infective endocarditis before they undergo high-risk dental procedures. Prevention of healthcare-associated infective endocarditis should also be targeted through prevention of healthcare-acquired bacteraemia, and antibiotic prophylaxis before the implantation of cardiac implantable electronic devices. Other prevention options include preservation of good oral hygiene. In the future, prevention of Staphylococcus aureus endocarditis might rely on vaccines, with candidate S. aureus vaccines currently being evaluated in humans.

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