Listeria monocytogenes tricuspid valve endocarditis with septic pulmonary emboli in a liver transplant recipient

Listeria monocytogenes has long been known as a pathogen of immunocompromised hosts, including solid organ and bone marrow transplant recipients. Its principal manifestations include bacteremia and meningitis. Endocarditis due to Listeria is far less common and in general affects the left side of the heart. We here report an unusual case of Listeria tricuspid valve endocarditis and septic pulmonary emboli in a sulfa-intolerant liver transplant recipient with a history of relapsing cytomegalovirus (CMV) hepatitis and an indwelling Hickman catheter. The literature on Listeria endocarditis and infections in transplant recipients is reviewed. The possible relationship between susceptibility to Listeria infection and the discontinuation of trimethoprim-sulfamethoxazole prophylaxis is of interest.     

Transmission of infection to liver transplant recipients from donors with infective endocarditis: lessons learned

Donors not meeting standard criteria, such as those with bacteremia, are now being used in response to the increasing need for organs for transplantation. Recommended strategies to prevent the occurrence of donor‐derived bacteremia include the use of directed antibiotic prophylaxis. However, this approach does not eliminate the risk of infection transmission. Similarly, the management of organ recipients from donors with infective endocarditis (IE) remains uncharacterized. We report 2 cases of donor‐derived bacterial infections in liver transplant recipients despite pathogen‐specific antibiotic prophylaxis. In both instances, the donors had documented IE treated with appropriate antimicrobial therapy and clearance of bacteremia. Recipients had very distinctive clinical outcomes likely related to pathogen virulence and the extent of donor infection. Persistent infection in the transplanted liver should be suspected in organ recipients of a liver from donors with IE, despite the absence of bacteremia at the time of death and organ procurement. For eradication, recipients may require prolonged pathogen‐directed antimicrobial therapy, such as is used for endovascular infections. Prompt recognition of donors with IE, appropriate notification, and prolonged antibiotic prophylaxis are key to reducing the risk of such donor‐derived infections.     

Infective endocarditis in the grown-up congenital heart (GUCH) population

Aims Infective endocarditis accounts for 4% of admissions toa specialized unit for grown-up congenital heart patients. Thisstudy defines lesions susceptible to infection, antecedent events,organisms, outcome and surgical treatment in a group of suchpatients. Methods and results The grown-up congenital heart disease databasewas searched for all patients aged 13 years and above with adequatedocumentation of infective endocarditis retrospectively between1983–1993 and thereafter between 1993–1996. Therewere 185 patients (214 episodes) divided into Group I: 128 patientsunoperated or palliated and Group II: 57 patients after definitiverepair and/or valve repair/replacement. In Group I, the commonestaffected sites were ventricular septal defect in 31 (24%), leftventricular outflow tract in 22 (17%) and mitral valve in 17(13%) and in Group II, left ventricular outflow tract in 20(35%), repaired Fallot in 11 (19%), and atrioventricular defectsin eight (14%). Infective endocarditis was not seen in secundumatrial septal defects before or after closure; in closed ventricularseptal defects and ducts without left-sided valve abnormality;in isolated pulmonary stenosis; in unrepaired Ebstein; or afterFontan-type or Mustard operations. Surgery was performed in39 patients: as an emergency in 17, and for failed medical therapyin 22. Only 87 (41%) of patients had a predisposing event: dentalprocedure or sepsis were the commonest events in Group I (33%)and cardiac surgery in Group II (50%). Streptococci specieswere found in 54% of Group I patients and in 45% of Group II.Staphylococci aureus was commoner in Group II (25%) comparedto Group I (14%). Mean time from the onset of symptoms to diagnosiswas 60 and 29 days in Groups I and II, respectively. Eight (4%)patients died as a result of septicaemia related to emergencyor repeated surgery and Staphylococcus aureus infection. Recurrentattacks occurred in 21 (11%) patients. Conclusion Reparative surgery does not prevent endo-carditisexcept for closure of a ventricular septal defect and duct.Delay in diagnosis is serious since it contributes to mortality,although the overall mortality % is not high. Specific lesionsare not affected so prophylaxis is probably unnecessary in thoseanomalies.     

Simultaneous mold infections in an orthotopic heart transplant recipient

Abstract: Simultaneous mold infections in heart transplant recipients have not been previously reported. Here we describe early onset post‐transplant pulmonary aspergillosis and cutaneous zygomycosis in a 46‐year‐old heart transplant recipient who was also treated with basiliximab. Along with surgical debridement, medical treatment of his cutaneous abdominal wall zygomycosis at the former left ventricular assist device driveline site with liposomal amphotericin B and voriconazole also led to cure of his pulmonary aspergillosis.     

Robotic mitral valve repair in infective endocarditis

Background

Robotic mitral surgery is the most common robotic cardiac procedures. However, in mitral endocarditis the repair become more challenging especially in minimally approach. We applied robotic surgery in mitral endocarditis repair and reviewed our surgical methods and results.

Patients

From January 2012 to December 2013, 12 patients with mitral endocarditis in National Taiwan University Hospital were operated via robotic assisted repair. Age of them was among 21 to 65 years old, mean 43.

Results

The vegetation involves anterior leaflet in 3, posterior leaflet in 8 and commissural leaflet in 4. Mean cardiopulmonary bypass time is 124 minutes and cross clamp time is 89 minutes. There was no stroke and no operation death. Mitral valve repair technique including anterior leaflet patch augmentation in 2, direct closure of rupture hole on anterior leaflet in one, plication commissural leaflet in 2, and artificial chordae in 10. There was no mitral regurgitation detected immediately after weaning of cardiopulmonary bypass. All of them got free-from-regurgitation or -stenosis rate was 100% at one-year follow.

Conclusions

Although mitral infective endocarditis is complex and difficult to repair, robotic mitral repair in infective endocarditis is feasible. Even in the complex repair group, the cardiopulmonary bypass time is not prolonged and the result is good.     

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.     

Pregnant intravenous drug user tricuspid valve infective endocarditis treated with a successful simultaneous valve replacement and Cesarean section

A 30‐year‐old female patient known to be an intravenous drug user (IVDU) was admitted to Bajcsy‐Zsilinszky Hospital Cardiology Intensive Care Unit at 29‐week gestation with severe sepsis and right heart failure. She had methicillin‐sensitive Staphylococcus aureus on blood culture. Echocardiography confirmed the diagnosis of tricuspid valve infective endocarditis (IE). She had acute deterioration and hemodynamic instability for which an emergency tricuspid valve replacement (TVR) with a simultaneous Cesarean section (CS) was performed simultaneously. Medical management is the standard treatment in IE of IVDU pregnant patients, but in case of life‐threatening complications, emergency TVR and CS are to be considered. This is the first reported case of IVDU IE treated with simultaneous TVR and CS.     

Ruptured mitral valve aneurysm: A devastating complication of aortic valve endocarditis

Mitral valve aneurysm is a rare clinical entity that is mostly resulted from infective endocarditis, in particular, aortic valve endocarditis. Once mitral valve aneurysm ruptures and severe mitral regurgitation and hemodynamic instability develop, prompt surgery should be considered. Here we report a patient with ruptured mitral valve aneurysm associated with native aortic valve endocarditis that was improved after a successful mitral and aortic valve replacement surgery associated with antibiotic therapy for 6 weeks.     

Native valve endocarditis due to Candida albicans in two children: Two new case reports

Candida endocarditis (CE) is a rare and serious complication of candidemia. Using current diagnostic tools a confirmed diagnosis is often delayed and outcomes remain poor. The majority of new cases occur following cardiac valvular surgery, and/or in patients with the following risk factors: intravenous drug use, cancer chemotherapy, prolonged presence of central venous catheters, and prior history of bacterial endocarditis. It is not a common complication in non‐neutropenic patients particularly with the absence of a prosthetic valve, and very few reports in the literature are available. Attempting to add to the limited data, 211 candidemia episodes from 172 nonneutropenic pediatric cases between January 2008 and December 2017 were evaluated. All patients were considered asymptomatic for underlying heart disease. However, 2 (0.9%) patients with a central venous catheter were determined as having endocarditis following echocardiography.     

Clinical outcomes in patients with native valve infective endocarditis and diabetes mellitus

BACKGROUNDThere is a lack of data on the clinical outcomes in patients with native valve infective endocarditis (NVIE) and diabetes mellitus (DM).AIMTo investigate (1) trends in the prevalence of DM among patients with NVIE; and (2) the impact of DM on NVIE outcomes. METHODSWe identified 76385 with NVIE from the 2004 to 2014 National Inpatient Sample, of which 22284 (28%) had DM. We assessed trends in DM from 2004 to 2014 using the Cochrane Armitage test. We compared baseline comorbidities, microorganisms, and in-patients procedures between those with vs without DM. Propensity match analysis and multivariate logistic regression were used to investigate study outcomes in in-hospital mortality, stroke, acute heart failure, cardiogenic shock, septic shock, and atrioventricular block.RESULTSCrude rates of DM increased from in 22% in 2004 to 30% in 2014. There were significant differences in demographics, comorbidities and NVIE risk factors between the two groups. Staphylococcus aureus was the most common organism identified with higher rates in patients with DM (33.1% vs 35.6%; P < 0.0001). After propensity matching, in-hospital mortality (11.1% vs 11.9%; P < 0.0001), stroke (2.3% vs 3.0%; P < 0.0001), acute heart failure (4.6% vs 6.5%; P = 0.001), cardiogenic shock (1.5% vs 1.9%; P < 0.0001), septic shock (7.2% vs 9.6%; P < 0.0001), and atrioventricular block (1.5% vs 2.4%; P < 0.0001), were significantly higher in patients with DM. Independent predictors of mortality in NVIE patients with DM include hemodialysis, congestive heart failure, atrial fibrillation, staphylococcus aureus, and older age.CONCLUSIONThere is an increasing prevalence of DM in NVIE and it is associated with poorer outcomes. Further studies are crucial to identify the clinical, and sociodemographic contributors to this trend and develop strategies to mitigate its attendant risk.     

Aortic valve aneurysm after acute endocarditis

Endocarditis at the aortic level is usually characterized by the presence of a vegetation or an abscess on echocardiography. This paper reports on what is believed by the authors to be the first case of endocarditis presenting as an aneurysmal deformation of one aortic cusp without a vegetation.     

Echocardiographic study of patients with congenital heart disease and infective endocarditis

BACKGROUND: Infective endocarditis (IE) occurs with significant frequency in patients with congenital heart disease. The complications leading to increased morbidity and mortality may be detected by echocardiographic examination. This study was undertaken in order to identify echocardiographic findings that influence the outcome of patients with congenital heart disease and IE. METHODS: Twenty-five patients with an average age of 28 years were selected and divided into two groups according to evolution. Group I included patients who survived the infectious process, while Group II included patients who died during hospitalization or after release. RESULTS: Aortic valve disease was the most frequent anomaly. The clinical finding of most relevance for evolution during hospitalization was heart failure. Acute kidney failure and multiple organ failure from sepsis were the most common complications in patients who died. Echocardiograms established the diagnosis in all cases. Transesophageal studies revealed all periaortic abscesses. CONCLUSIONS: Echocardiography makes it possible to identify and evaluate complications associated with elevated morbidity and mortality in patients with congenital heart disease and IE.     

Cavitary pneumonia due to Rhodococcus equi in a heart transplant recipient

Abstract: Rhodococcus equi is an uncommon human pathogen that usually affects immunocompromised patients. We present a case of a 68-year-old male heart transplant recipient, who developed rhodococcal pneumonia with secondary bacteremia 10 months post-transplant. The patient was a retired carpenter who was involved in breeding of horses. He responded completely to the treatment with vancomycin and imipenem/cilastin, followed by oral ciprofloxacin and minocycline for total treatment duration of 5 months. This case highlights the association between an animal exposure and infection with a unique opportunistic pathogen.     

Pseudomonas aeruginosa endocarditis in renal transplant recipients

Infective endocarditis (IE) is a serious and life-threatening disease. Transplant recipients are at increased risk of acquiring serious infections. The most common organisms causing IE in solid organ transplant recipients are reported to be gram positive. IE due to Gram-negative organism has rarely been reported. We report 2 cases of renal transplant recipients who met the Duke's criteria for IE due to Pseudomonas aeruginosa.     

A case of Verruconis gallopava infection in a heart transplant recipient successfully treated with posaconazole

Verruconis gallopava is an environmental dematiaceous fungus that is recognized increasingly as a cause of human disease, especially for immunocompromised persons. Infection can range from superficial and localized lesions to pulmonary involvement and disseminated disease, including central nervous system abscesses. Optimal therapy is undefined. We report a patient post cardiac transplant who had pulmonary infection with V gallopava and was treated successfully with posaconazole.     

Thrombus causing fatal left ventricular outflow tract obstruction in a heart transplant patient

A 60 year male, orthotopic heart transplant recipient developed a fatal left ventricular outflow obstruction secondary to thrombus at 38 months post transplant. Although he had episodes of mild to moderate rejection at 2 and 16 months post transplant, subsequent biopsies were negative and annual cardiac catheterizations showed mild left ventricular hypokinesis and normal coronary arteries. This case represents a catastrophic complication of transplant rejection and illustrates the problems with identifying rejection using current diagnostic methods.     

Pericarditis in infective endocarditis

Three patients with infective endocarditis who presented withsevere precordial pain and pericardial rubs are described inwhom sterile pericardial and pleural effusions were found. Thepericardial pain disappeared and the effusions regressed withsuccessful antibiotic treatment. A similar mechanism to thepostmyocardial infarction syndrome is suggested.     

Right‐sided endocarditis: eustachian valve and coronary sinus involvement

Infective endocarditis in patients with intravenous drug use commonly involves right‐sided heart valves. Eustachian valve (EV) endocarditis is not commonly seen given the valve's infrequent presence. Involvement of the coronary sinus (CS) with endocarditis is also an unusual finding. We present a case with echocardiographic findings consistent with EV endocarditis along with CS involvement, which appropriately responded to antibiotics.