Legionella micdadei prosthetic valve endocarditis

Summary Legionella usually causes pneumonia, but occasionally is in the differential diagnosis of culture negative endocarditis which sometimes involves prosthetic heart valves.Legionella prosthetic valve endocarditis is nearly always due toLegionella pneumophila and its clinical presentation is indistinguishable from other causes of prosthetic valve endocarditis. Diagnosis ofLegionella prosthetic valve endocarditis is by recovery of the organism from the blood, demonstration or isolation of the organism from the prosthetic heart valve, or by persistently highLegionella titers which are extremely elevated in prosthetic valve endocarditis compared toLegionella pneumonia. We believe this is the first case reported of prosthetic valve endocarditis caused byLegionella micdadei, and the first case ofLegionella prosthetic valve endocarditis with microscopic hematuria.

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Klappenprothesenendokarditis durchLegionella micdadei

Zusammenfassung Gelegentlich muß der PneumonieerregerLegionella in der Differentialdiagnose der kulturnegativen Endokarditis berücksichtigt werden, die manchmal auch Klappenprothesen befällt. Die Klappenprothesenendokarditis wird bei Legionellenätiologie fast ausschließlich durchLegionella pneumophila verursacht; in ihrem klinischen Erscheinungsbild ist sie von Klappenprothesenendokarditiden anderer Genese nicht zu unterscheiden. Die Diagnose wird durch Erregernachweis im But, in der entfernten Klappe oder durch sehr hoheLegionella-Titer nachgewiesen, die im Vergleich zur Legionellenpneumonie extrem stark erhöht sind. Wir gehen davon aus, daß unsere Fallmitteilung die erste Publikation einer Klappenprothesenendokarditis durchLegionella micdadei und der erste Fall mit Mikrohämaturie ist.

     

Mycobacterium neoaurum causing prosthetic valve endocarditis: a case report and review of the literature

Mycobacterium neoaurum is a rare cause of bacteremia, and infection usually occurs in an immunocompromised host in the setting of an indwelling catheter. Prosthetic valve endocarditis due to non-tuberculous mycobacteria typically carries a dismal prognosis; we report a case of M. neoaurum prosthetic valve endocarditis with favorable response to antimicrobial therapy without surgical intervention.     

Stenotrophomonas maltophilia endocarditis of prosthetic aortic valve: report of a case and review of literature

Stenotrophomonas Maltophilia (previously known as Xanthomonas maltophilia and Pseudomonas maltophilia ) is an aerobic, nonfermenting, gram-negative bacillus, which has emerged as a serious nosocomial pathogen in patients with compromised immunity. It is a rare cause of endocarditis with only 20 cases previously reported in medical literature. The risk factors associated with S maltophilia endocarditis include intravenous drug abuse, dental treatment, previous cardiac surgery, and infected intravascular devices. S maltophilia is resistant to multiple antibiotics, which leads to frequent therapeutic failures. Although the optimal antibiotic treatment for S maltophilia endocarditis remains unknown, most of the patients received 2 or more antibiotics. We report a case of S maltophilia endocarditis of prosthetic aortic valve, associated with a painless aortic dissection, that responded well to a combination of ciprofloxacin and chloramphenicol. The literature is reviewed to elaborate the disease characteristics, the treatments used, and the prognosis of the S maltophilia endocarditis.     

Propionibacterium acnes endocarditis in a native valve complicated by intraventricular abscess: a case report and review.

Propionibacterium acnes is a constituent of the normal skin flora. It has been described as causing infection on prosthetic valves but very rarely on native valves. We describe a case of aggressive P. acnes endocarditis in a healthy 36-y-old man which infected a native aortic valve and was complicated by an aortic root abscess and review the literature.     

Early prosthetic valve endocarditis due to Acinetobacter baumannii: a case report and brief review of the literature

Acinetobacter is a highly resistant microorganism, commonly isolated in intensive and post-operative care units. Although rarely reported, it may constitute 1 of the several causes of early prosthetic valve endocarditis. A diffuse, red maculopapular rash may be encountered in patients with Acinetobacter endocarditis. Here we present a case of early prosthetic valve endocarditis due to Acinetobacter baumannii and accompanied by a cutaneous eruption.     

Salvage heart transplantation for Mycoplasma hominis prosthetic valve endocarditis: A case report and review of the literature

Heart transplantation (HT) has been rarely performed in patients with infective endocarditis (IE) and is considered a “last resort” procedure. Orthotropic HT with bicaval technique was performed in a man with culture‐negative endocarditis. Mycoplasma hominis was later detected using 16S ribosomal DNA PCR from surgically removed valve tissue. Literature review and previous results are summarized. HT may be considered as salvage treatment in selected patients with intractable IE. In cases when there is no growth in culture, 16S ribosomal DNA PCR sequencing can be used to identify the pathogen in excised valvular tissue. Mycoplasma spp. is extremely uncommon and difficult to diagnose cause of infective endocarditis (IE). There are no proposed or defined criteria for heart transplantation (HT) in patients with refractory IE, and HT has been rarely performed in this setting. We report a case of M hominis prosthetic valve endocarditis diagnosed by 16S ribosomal DNA PCR in a patient who underwent a salvage HT. We reviewed in the literature other cases of IE caused by Mycoplasma spp.     

Legionella endocarditis: A case report and review

BackgroundLegionella is a well known but infrequent cause of bacterial endocarditis.MethodsWe report a case of endocarditis caused by Legionella spp. We reviewed previously reported cases in PubMed, Google Scholar and in references included in previous reports, and summarized relevant clinical data.ResultsA 63-year-old man with a history of aortic valve replacement developed persistent fever and monoarthritis. Transesophageal echocardiography showed perivalvular abscess. He died during surgery. Blood and valve cultures were negative. Legionella spp. was demonstrated with 16S-rRNA PCR from the resected material. Twenty cases of Legionella endocarditis have been reported. Harboring a prosthetic valve was the main risk factor. Prognosis was favorable, both for patients treated with or without surgical valve replacement. Overall mortality was <10%.ConclusionsLegionella is an infrequent cause of endocarditis. It frequently requires surgical treatment. Prognosis is good. Molecular techniques are likely to become the gold standard for diagnosis.     

Pasteurella multocida aortic valve endocarditis: case report and literature review

Pasteurella multocida is a rare cause of infective endocarditis that occurs mostly in immunocompromised patients and is therefore associated with a high mortality rate. The case is reported of a 48-year-old male patient with liver cirrhosis, who developed aortic valve endocarditis caused by P. multocida. The infection was detected by blood cultures. The patient presented with generalized symptoms and initial neurologic symptoms suggestive of meningitis. Transthoracic echocardiography conducted after the discovery of a diastolic murmur revealed a large vegetation on the aortic valve, and notable insufficiency. These findings were confirmed at surgery, where-upon the patient underwent aortic valve replacement using a bioprosthetic valve. Subsequently he developed a recurrent episode of endocarditis that was successfully treated with antibiotic therapy. Other similar cases reported in the literature are reviewed.     

Pichia ohmeri prosthetic valve endocarditis and review of the literature

Fungal prosthetic valve endocarditis (PVE) is a serious complication of valve replacement surgery. We report the first case of documented Pichia ohmeri PVE in an immunocompetent man who was successfully treated with valve replacement and antifungal therapy with amphotericin B.     

Staphylococcus capitis prosthetic valve endocarditis: report of two rare cases and review of literature

Staphylococcus epidermidis is the most common organism associated with prosthetic valve endocarditis. Staphylococcus capitis, a coagulase-negative Staphylococcus, is a rare cause of endocarditis. We report two cases of S.capitis prosthetic valve endocarditis, both involving prosthetic aortic valve and complicated by aortic root abscess. We also review the literature for this rare condition caused by this rare organism.     

Mitral valve endocarditis in hypertrophic cardiomyopathy: case report and literature review

Mitral endocarditis complicating hypertrophic cardiomyopathy occurs predominantly on the left ventricular aspect of the anterior mitral valve leaflet in the presence of outflow tract obstruction. It is a rare condition and the estimated cumulative 10 year probability of developing endocarditis in patients with obstruction is < 5%. Combined mitral valve replacement and septal myectomy has been reported in this setting. A case of community acquired Staphylococcus aureus mitral valve endocarditis is reported in a previously asymptomatic young man with hypertrophic obstructive cardiomyopathy. The potential treatment options are discussed.     

Rothia dentocariosa endocarditis complicated by brain abscess

A 27-year-old woman is described with Rothia dentocariosa endocarditis, the fourth such case described in the literature. Her course was complicated by brain abscess, which was treated successfully with antibiotics. It is believed this represents the first case of R. dentocariosa with central nervous system involvement.     

Infective endocarditis complicated by abscess and perforation of mitral valve--a case report

A case of a 47-year-old male admitted to our department due to acute myocardial infarction, treated effectively with primary angioplasty, is presented. Three weeks earlier the patient was admitted to another hospital with a suspicion of infective endocarditis. Echocardiography performed in our department after the patient recovered from acute phase of MI revealed the presence of mitral valve abscess which caused valve perforation. The patient was transferred to another institution for cardiac surgery.     

Staphylococcus lugdunensis native tricuspid valve endocarditis: a case report and review of literature

Coagulase negative staphylococci are skin commensals and are generally disregarded as contaminants in clinical specimens. Repeated isolation of coagulase negative staphylococci in blood cultures should warrant a species identification to recognize unusually virulent organisms that demand aggressive treatment, such as Staphylococcus lugdunensis. Staphylococcus lugdunensis is known to cause a wide variety of infections, including a predominant left-sided endocarditis. We report a rare case of native tricuspid valve Staphylococcus lugdunensis endocarditis in a non-intravenous drug user and include a brief literature review.     

L. micdadei PVE successfully treated with levofloxacin/valve replacement: case report and review of the literature

Prosthetic valve endocarditis (PVE) due to Legionella micdadei was diagnosed in a man a year after valve replacement with a bovine xenograft. He did not have pneumonia. The microbiologic diagnosis was established after valvectomy, which was necessitated by failure of empiric antibiotics to eradicate the infection. The fastidious organism grew only on buffered charcoal yeast extract agar and was confirmed as L. micdadei by gene sequence analysis. We believe this to be the first culture-proven case of L. micdadei PVE reported in the literature.     

Fatal Burkholderia cepacia early prosthetic valve endocarditis: a very rare case and a review of the literature

A 58-year-old woman who underwent mitral valve replacement and tricuspid valve repair developed severe acute systemic illness four weeks after surgery. Serial blood cultures grew Burkholderia cepacia at four to five days after incubation. Transthoracic echocardiography had confirmed a diagnosis of prosthetic valve endocarditis. The patient did not respond to empirical or culture-sensitive antibiotic therapy of endocarditis. Trimethoprim-sulfamethoxazole (TMP-SMX) therapy was only commenced at three weeks after the start of fever because of delayed presentation. Every effort should be made to identify this organism in the laboratory. When clinically indicated, early presumptive antibiotic therapy with TMP-SMX should be started.     

Treatment of complicated prosthetic aortic valve endocarditis with annular abscess formation by homograft aortic root replacement

The outcome of 30 consecutive patients with active aortic prosthetic valve endocarditis and root abscesses treated by the technique of homograft aortic root replacement with reimplantation of the coronary arteries is detailed. The principles of this technique are the removal of all abscesses and infected areas likely to drain into the infected mediastinum, excision of infected tissues down to healthy noninfected tissue and replacement with an antibiotic-impregnated homograft aortic root. All patients had evidence of progressive cardiac failure and ongoing sepsis. Mean patient age (+/- SD) at the time of operation was 42 +/- 18 years. The mean number of previous aortic valve replacements per patient was 1.6 +/- 0.7; 14 patients (47%) had undergone greater than or equal to 2 previous replacements. At operation, aortic root abscesses were found in all patients; abscess extension to adjacent structures and partial valve dehiscence had occurred in 23. In-hospital death occurred in 9 (30%) of the 30 patients. The 21 hospital survivors have been followed up for a mean of 66 +/- 42 months (range 9 to 144). Overall, 17 (81%) of the 21 hospital survivors have remained free of major adverse events (recurrence of endocarditis, need for reoperation or death). The results of our study suggest that homograft aortic root replacement should be considered favorably in the treatment of patients with aortic prosthetic valve endocarditis and root abscesses.     

Hemolytic anemia in native valve infective endocarditis: a case report and literature review

Hemolytic anemia is a rare manifestation of infective endocarditis. A 19-year-old man with a small ventricular septal defect developed right-sided infective endocarditis with huge vegetations involving the tricuspid valve, the ventricular septal defect, and the pulmonary valve. Intravascular hemolysis was suggested by the presence of numerous fragmented erythrocytes, giant platelets and polychromasia of the red blood cells. The direct Coombs test was positive, and there were spherocytes and splenomegaly, findings that suggested an immune-mediated mechanism also played a role in the hemolysis. The hematological picture persisted despite antibiotic therapy and recovered only after surgical removal of the vegetations, tricuspid and pulmonary valvectomy, and patch closure of the ventricular septal defect.