Staphylococcus saprophyticus causing native valve endocarditis

Coagulase negative staphylococci are a rare cause of native valve endocarditis. Staphylococcus saprophyticus is a coagulase-negative Staphylococcus infrequently reported as a human pathogen, and most of the cases reported are urinary tract infections. We describe a case of native valve endocarditis attributed to this organism. The patient needed valve replacement due to heart failure.     

Left-sided native valve Staphylococcus aureus endocarditis

Despite improved diagnostic tools and expanded treatment options, left-sided native valve endocarditis caused by Staphylococcus aureus infection remains a serious and destructive disease. The high morbidity and mortality, however, can be reduced by early recognition, correct diagnosis, and appropriate treatment. In the following article, we discuss the clinical presentation, diagnostic workup and treatment of infective endocarditis, thereby reviewing the current guidelines. Blood cultures and echocardiography are the cornerstones of diagnosis in identifying infective endocarditis but are no substitute for clinical judgement. The modified Duke criteria may facilitate the diagnostic process, but clinical evaluation remains crucial.     

Isolated native tricuspid valve endocarditis caused by viridans streptococcus

The present report describes a case of native tricuspid valve endocarditis caused by viridans group streptococcus in a 43-year-old man who had recently undergone dental extraction. The patient had no history of intravenous drug use, heart disease or right heart catheterization. Although there have been scattered reports of unusual organisms, to the authors'' knowledge, this is the first case of viridans group streptococcal endocarditis involving only the tricuspid valve after dental manipulation.Key Words: Tricuspid valve endocarditis, Viridans streptococcusIsolated native tricuspid valve endocarditis (TVE) accounts for only 5% to 10% of all cases of infective endocarditis (1,2) and is rarely seen in the absence of intravenous drug use (IDU) or intracardiac catheterization or cardiac anomalies (3,4). The present report describes a case of isolated viridans streptococcal TVE after dental manipulation in a nonintravenous drug user without underlying cardiac disease or central venous catheterization. We are not aware of any cases reported in the English literature of isolated native TVE caused by viridans streptococcal species after dental procedures. The expedient identification of patients with TVE in the absence of predisposing factors can be difficult, and thus delay in diagnosis may delay appropriate therapeutic intervention.     

Clinical profile of Streptococcus agalactiae native valve endocarditis

Background

Streptococcus agalactiae is an unusual pathogen in adults who are not pregnant. S agalactiae endocarditis is a poorly defined entity because it is uncommon; in contrast to other streptococcal endocarditis, it bears a high mortality rate. The aim of this study was to define its clinical, prognostic, and therapeutic profile on the basis of a series of 9 consecutive patients.

Methods

We conducted a prospective and multicenter study of patients with infectious endocarditis in which 310 episodes were included.

Results

S agalactiae grew in 9 patients (3%) who had no valve prosthesis. All patients except 1 had underlying diseases, and all patients had serious complications; the most common complications were major emboli, heart failure, and shock. The valve affected was the mitral valve in 4 patients, the aortic valve in 2 patients, both the mitral and aortic valves in 2 patients, and the tricuspid valve in 1 patient. All episodes were on native valves. Vegetations tended to be large (maximal diameter >10 mm in all patients), very mobile, and pedunculated. An abscess was found in 2 patients, and a perforation of the valve developed in 3 patients. Five patients died (mortality rate, 56%), 3 of whom had received antibiotic therapy alone. The 4 patients who survived underwent combined medical-surgical therapy.

Conclusion

S agalactiae native valve endocarditis is very aggressive, and early surgery should be considered to prevent the destruction of valves and development of serious complications.     

Late prosthetic valve endocarditis caused by Staphylococcus hemolyticus.

We describe a case of late PVE in a 78-year-old man that was caused by Stapylococcus hemolyticus and occurred 5 years after aortic valve replacement. This is the first reported case of PVE due to this organism.     

Isolated native tricuspid valve endocarditis caused by viridans streptococcus.

The present report describes a case of native tricuspid valve endocarditis caused by viridans group streptococcus in a 43-year-old man who had recently undergone dental extraction. The patient had no history of intravenous drug use, heart disease or right heart catheterization. Although there have been scattered reports of unusual organisms, to the authors' knowledge, this is the first case of viridans group streptococcal endocarditis involving only the tricuspid valve after dental manipulation.     

Emergence of coagulase-negative staphylococci as a cause of native valve endocarditis.

BACKGROUND: Coagulase-negative staphylococci (CoNS) are an infrequent cause of native valve endocarditis (NVE), and our understanding of NVE caused by CoNS is incomplete. METHOD: The International Collaboration on Endocarditis-Prospective Cohort Study includes patients with endocarditis from 61 centers in 28 countries. Patients with definite cases of NVE caused by CoNS who were enrolled during the period June 2000-August 2006 were compared with patients with definite cases of NVE caused by Staphylococcus aureus and patients with NVE caused by viridans group streptococci. Multivariable logistic regression was used to determine factors associated with death in patients with NVE caused by CoNS. RESULTS: Of 1635 patients with definite NVE and no history of injection drug use, 128 (7.8%) had NVE due to CoNS. Health care-associated infection occurred in 63 patients (49%) with NVE caused by CoNS. Comorbidities, long-term intravascular catheter use, and history of recent invasive procedures were similar among patients with NVE caused by CoNS and among patients with NVE caused by S. aureus. Surgical treatment for endocarditis occurred more frequently in patients with NVE due to CoNS (76 patients [60%]) than in patients with NVE due to S. aureus (150 [33%]; P=.01) or in patients with NVE due to viridans group streptococci (149 [44%]; P=.01). Despite the high rate of surgical procedures among patients with NVE due to CoNS, the mortality rates among patients with NVE due to CoNS and among patients with NVE due to S. aureus were similar (32 patients [25%] and 124 patients [27%], respectively; P=.44); the mortality rate among patients with NVE due to CoNS was higher than that among patients with NVE due to viridans group streptococci (24 [7.0%]; P=.01). Persistent bacteremia (odds ratio, 2.65; 95% confidence interval, 1.08-6.51), congestive heart failure (odds ratio, 3.35; 95% confidence interval, 1.57-7.12), and chronic illness (odds ratio, 2.86; 95% confidence interval, 1.34-6.06) were independently associated with death in patients with NVE due to CoNS (c index, 0.73). CONCLUSIONS: CoNS have emerged as an important cause of NVE in both community and health care settings. Despite high rates of surgical therapy, NVE caused by CoNS is associated with poor outcomes.     

Prognostic value of serial C-reactive protein measurements in left-sided native valve endocarditis

BACKGROUND: The clinical course of left-sided native valve infective endocarditis varies from uncomplicated disease to fulminant infection. Although several factors are known to affect clinical outcome, it is difficult to predict morbidity and mortality in individual patients. The objective of this study was to determine the value of serial C-reactive protein (CRP) measurements as a predictor of clinical outcome. METHODS: One hundred twenty-three consecutive patients who fulfilled the Duke criteria for definite left-sided native valve infective endocarditis were prospectively enrolled. Poor outcome was defined as serious infectious complications or death. Patients were followed up for 12 weeks after the end of antimicrobial therapy. Multivariate analysis was used to examine the relative importance of the CRP level as a predictor of poor outcome after adjusting for age, abscess, multivalvular involvement, and Staphylococcus aureus infection. RESULTS: After 1 week of therapy, the adjusted odds ratio for poor outcome was 10.3 (95% confidence interval, 2.2-49.4) for patients with CRP levels in the highest tertile (>122 mg/L [to convert to nanomoles per liter, multiply by 9.524]) vs the lowest tertile (1-69 mg/L). A low percentage decline during the first week of treatment was statistically significantly associated with a higher risk of poor outcome (logistic regression coefficient, 1.1; P = .009). At no point in time did CRP level predict the need for cardiac surgery. CONCLUSION: High CRP level after 1 week of treatment and a slow percentage decline in CRP level during the first week of treatment are indicators of poor clinical outcome.     

Infective endocarditis of the tricuspid valve caused by Staphylococcus aureus after ear piercing

Right-sided endocarditis usually involves the tricuspid valve, predominantly in intravenous drug abusers, in patients with anti-arrhythmic devices or central venous lines, and in patients with skin or genitourinary infection and with congenital heart disease 1. We describe a case of a 15-y-old patient, who had tricuspid valve endocarditis in a morphologically normal valve after having his ear pierced, without history of parenteral drug addiction and vascular catheter use. Progression of vegetation size and development of tricuspid valve regurgitation in spite of the intensive antibiotic treatment eventually required surgical intervention.     

Mitral valve endocarditis resulting from coagulase-negative Staphylococcus after stent implantation in a saphenous vein graft

Valvular endocarditis after percutaneous coronary intervention is unusual. We report a new case of mitral valve endocarditis after stent implantation to a saphenous vein graft.     

Aerococcus viridans native valve endocarditis

Aerococcus viridans is an infrequent human pathogen and few cases of infective endocarditis have been reported. A case involving a 69-year-old man with colon cancer and hemicolectomy 14 years previously, without recurrence, is reported. A diagnosis of native mitral valve endocarditis was established on the basis of clinical presentation, characteristic echocardiographic findings and pathological specimen examination after urgent valve replacement. A viridans endocarditis appears to be particularly virulent, requiring a surgical approach in four of 10 cases reported and death in one of nine. Given the aggressive nature of A viridans endocarditis and the variable time to diagnosis (a few days to seven months), prompt recognition of symptoms and echocardiography, in addition to blood cultures, should be performed when symptoms persist.     

Prosthetic valve endocarditis caused by corynebacterium pilosum

Summary A case of prosthetic valve endocarditis caused byCorynebacterium pilosum in a 79-year-old woman developed eighty years after aortic valve replacement with bovine pericardium bioprosthesis is described. In spite of the antibiotic therapy she presented an unfavourable course that led to her death.

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Klappenprothesen-Endokarditis durch Corynebacterium pilosum

Zusammenfassung Bei einer 79 Jahre alten Frau trat acht Jahre nach Aortenklappenersatz mit einer Bioprothese aus Perikard vom Rind eine Klappenprothesen-Endokarditis auf, als deren UrsacheCorynebacterium pilosum identifiziert wurde. Trotz Antibiotikatherapie kam es zu einem letalen Verlauf der Erkrankung.

     

Prosthetic valve endocarditis caused by Trichosporon cutaneum

We report, to our knowledge, the first case of Trichosporon cutaneum endocarditis which developed in a 58-year-old woman 14 months after mitral valve replacement. The patient had not had antibiotic therapy. She was treated with an oral antifungal agent, ketoconazol, and prosthetic valve replacement. The initial outcome was favorable, but she died 5 months later of aortic valve endocarditis. Fungal infection was documented by isolation of the fungus from blood cultures, by anatomical and pathological examination and by the changes in serology.     

Prosthetic valve endocarditis caused by Trichosporon beigelii

A case of Trichosporon beigelii prosthetic valve endocarditis is described. Prosthetic valve endocarditis developed in the patient, a 58-year-old woman with a history of rheumatic heart disease, 10 months after mitral valve surgery. A large left atrial fungus ball was present. Cultures of blood and valvular tissue were positive for T. beigelii. The organism was sensitive to amphotericin B, 5-fluorocytosine, ketoconazole, and miconazole.     

Prosthetic valve endocarditis caused by Veillonella parvula

Veillonella species is a rare cause of endocarditis. We report a case of a 49-year-old man with Veillonella parvula prosthetic valve endocarditis who presented with acute cardiac failure due to valvular dehiscence. His clinical course was complicated by cortical blindness and limb paresis as a result of cerebral embolism. The endocarditis was successfully treated with urgent valve replacement surgery and a prolonged course of metronidazole.