Endocarditis caused by Lactococcus cremoris

We describe a case of subacute endocarditis due to Lactococcus cremoris associated with consumption of unpasteurized milk. Treatment with amoxicillin-clavulanic acid and subsequently penicillin resulted in prompt sterilization of this patient's bloodstream and full recovery.     

Endocarditis caused by Stenotrophomonas maltophilia

Stenotrophomonas maltophilia is frequently isolated from hospital environments. In recent years, it has been reported that this bacterium is causing hospital infections at increasing rates and is gaining importance because of its multiple resistance. Although it has been related to several infections, endocarditis caused by S. maltophilia is rarely encountered. In this case study, endocarditis in a 40-y-old man with a history of aortic valve replacement is presented. Blood cultures revealed S. maltophilia to be the aetiological agent, which showed multiresistance to various antibiotics. Ticarcillin-clavulanate and trimethoprim-sulfamethoxazole were used in the treatment.     

Endocarditis caused by Gemella haemolysans

Summary Gemella haemolysans, a coccus related to theStreptococcaceae, was isolated from the blood of a patient with endocarditis. The patient was successfully treated with a combination of penicillin G and tobramycin, followed by clindamycin. The taxonomy of this organism, especially its relationship toStreptococcus morbillorum is discussed and previously reported cases ofGemella infections are reviewed.

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Endokarditis durch Gemella haemolysans

Zusammenfassung Aus Blutkulturen einer Patientin mit einer Endokarditis wurde einGemella haemolysans-Stamm angezüchtet, ein zu denStreptococcaceae gehöriges Bakterium. Die Patientin konnte mit einer Kombination von Penicillin G und Tobramycin sowie anschließender Clindamycin-Therapie erfolgreich behandelt werden. Die Taxonomie des Erregers, insbesondere seine Verwandtschaft zuStreptococcus morbillorum, wird diskutiert und eine Übersicht über kürzlich beschriebeneGemella-Infektionen gegeben.

     

Endocarditis caused by coagulase-negative staphylococci

Summary Sixteen patients with coagulase-negative staphylococcal endocarditis were treated at the University of Minnesota Hospitals between January 1970 and September 1977. In six patients, endocarditis developed after prosthetic valve surgery; among the other ten patients (the medical group), eight had known antecedent valvular disease. The skin was thought to be the source of infection in eight patients, suggesting that prompt treatment of skin infections and avoidance of injections in patients with valvular disease are important measures in the prevention of this disease. Patients with prosthetic valve endocarditis were infected with antibiotic-resistant organisms and had a higher mortality than those in the medical group (83% versus 20%). Bacterial isolates from three patients with prosthetic valve endocarditis were resistant to methicillin, and two of these three isolates also were resistant to cephalothin by quantitative susceptibility testing. The only patient with prosthetic valve endocarditis to survive was operated upon early in the course of his illness. Thes observation, coupled with the high mortality in this series and in others, has prompted us to advocate early surgery in prosthetic valve endocarditis.

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Endokarditis durch koagulase-negative Staphylokokken

Zusammenfassung Zwischen Januar 1970 und September 1977 kamen in der Klinik der Universität Minnesota 16 Patienten mit einer durch koagulase-negative Staphylokokken verursachten Endokarditis zur Behandlung. Sechs dieser Patienten hatten zuvor künstliche Herzklappen erhalten. Bei acht der übrigen 10 Patienten, (der nicht-chirurgischen Gruppe), waren Herzklappendefekte bekannt. Als Infektionsquelle ist bei acht Patienten die Haut anzuschuldigen. Prompte Behandlung von Hautinfektionen und Vermeidung von Injektionen sind deshalb als wesentliche Maßnahmen zur Verhütung von Endokarditiden bei Patienten mit Herzklappendefekten anzusehen. Antibiotika-resistente Staphylokokken und eine Mortalitat von 83% wurden in der post-chirurgischen Patientengruppe beobachtet im Gegensatz zu der nicht-chirurgischen Gruppe, die eine Mortalitat von 20% aufwies. Von drei Endokarditis-Patienten mit Herzklappen-Prothesen wurden Staphylokokken gezüchtet, die resistent gegen Methicillin waren. In zwei dieser Fälle wurden die Erreger darüber hinaus mittels quantitativer Resistenzprüfung als Cephalothin-resistent erkannt. Der einzige überlebende Endokarditis-Patient mit Herzklappen-Prothese war im Frühstadium seiner Endokarditis in chirurgische Behandlung übergeben worden. Diese Tatsache, verbunden mit der hohen Endokarditis-Mortalität bei Patienten mit Herzklappen-Prothesen, läßt frühestmögliche Herzoperation bei beginnender Endokarditis geraten erscheinen.

     

Endocarditis caused by Haemophilus aegyptius

Endocarditis due to Haemophilus is uncommon. This is the first reported case caused by Haemophilus aegyptius. The course of the disease was complicated by pericarditis, congestive heart failure, and myocardial abscess formation. Surgical removal of the damaged aortic valve was not beneficial. The biologic properties of the organism included urea degradation, absence of indole metabolism, and absence of the enzyme ornithine decarboxylase.     

Endocarditis caused by Actinobacillus actinomycetemcomitans

The HACEK group endocarditis are infrequent in general population. They usually develop subacute endocarditis with large vegetations, peripheral emboli, heart failure, requiring frequent valvular replacement. We report a clinical case of endocarditis caused by Actinobacillus actinomycetemcomitans (AA), without the typical findings of the HACEK group endocarditis and with a successful evolution with medical treatment.     

Endocarditis caused by Candida parapsilosis.

The authors report a case of endocarditis caused by Candida parapsilosis. To the best of our knowledge, a case has not been described previously in Japan in the English literature. A battery of 8 peroxidase-labeled lectins was tested on sections of paraffin-embedded tissue to determine which lectin could be used in the microscopic diagnosis of C. parapsilosis. One lectin, from Archis hypoaea (PNA) was found to react with C. parapsilosis. On the other hand, C. albicans, Aspergillus, Mucor, and Cryptococcus did not react with A. hypoaea (PNA). On fluorescence microscopic study, C. parapsilosis was not fluorescent, but other fungi were fluorescent when exposed to ultraviolet illumination. Therefore, we propose new procedures for identification of C. parapsilosis in tissue sections using lectin histochemistry and fluorescence microscopy.     

Endocarditis caused by Salmonella enteritidis.

A case of endocarditis caused by Salmonella enteritidis is reported in a 20-year-old African woman. This is only the fourth published case. The development of this rare infection in the patient reported here probably resulted from a reduction in immunity caused by pregnancy and a past splenectomy.     

Endocarditis caused by Abiotrophia species.

Two cases of endocarditis with nutritionally variant streptococci are presented. Such strains have recently been included in the new genus Abiotrophia. A total of 12 additional Abiotrophia strains, including the type strains of Abiotrophia defectiva and Abiotrophia adiacens, were characterized in order to comment on their microbiological characteristics.     

Endocarditis caused by Salmonella enteritidis.

A case of endocarditis caused by Salmonella enteritidis is reported in a 20-year-old African woman. This is only the fourth published case. The development of this rare infection in the patient reported here probably resulted from a reduction in immunity caused by pregnancy and a past splenectomy.