1
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Wu DM, Konstantinov IE, Zhu MZ, Ishigami S, Chowdhuri KR, Brizard CP, Buratto E. Surgery for paravalvular abscess in children. JTCVS OPEN 2023; 16:648-655. [PMID: 38204677 PMCID: PMC10775127 DOI: 10.1016/j.xjon.2023.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/14/2023] [Revised: 08/13/2023] [Accepted: 08/28/2023] [Indexed: 01/12/2024]
Abstract
Objective To investigate the outcomes of surgery in children with paravalvular abscess at our institution. Methods A retrospective review of all patients who underwent surgery for paravalvular abscess was performed. Results Between 1989 and 2020, 30 patients underwent surgery for paravalvular abscess, of whom 5 (16.7%) had an intracardiac fistula and 6 (20.0%) had a pseudoaneurysm. Aortic annulus abscesses were most common, occurring in 23 patients (76.7%). Aortic root replacement was performed in 17 patients (56.7%), root reconstruction was performed in 4 (13.3%), and reconstruction of the central fibrous body was required in 5 (16.7%). Postoperatively, 7 patients (23.3%) required extracorporeal membrane oxygenation (ECMO) support, and 1 patient (3.3%) required permanent pacemaker insertion. There were 6 early deaths, 5 of whom were on ECMO, and no late deaths, with a 15-year survival of 79.7% (95% confidence interval [CI], 60.2%-90.3%). Deaths were from sudden cardiac arrest resulting in brain death in 3 patients, inability to wean from ECMO due to severe cardiac dysfunction in 2 patients, and cerebral mycotic aneurysm and hemorrhage in 1 patient. Freedom from reoperation was 40.0% (95% CI, 17.0%-62.3%) at 15 years Reoperation due to recurrence was rare, occurring in only 2 patients (6.7%). Streptococcus pneumoniae (hazard ratio [HR], 9.2; 95% CI, 1.6-51.7) and preoperative shock (HR, 6.4; 95% CI, 1.3-32.0) were associated with mortality. Central fibrous body reconstruction was associated with reoperation (HR, 4.4; 95% CI, 1.2-16.1). Conclusions Although paravalvular abscess in children is associated with high early mortality, hospital survivors have good long-term survival. Reoperation is frequent, but is rarely due to recurrence of endocarditis.
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Affiliation(s)
- Damien M. Wu
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Igor E. Konstantinov
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia
| | - Michael Z.L. Zhu
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Shuta Ishigami
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Kuntal Roy Chowdhuri
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
| | - Christian P. Brizard
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
- Melbourne Children's Centre for Cardiovascular Genomics and Regenerative Medicine, Melbourne, Australia
| | - Edward Buratto
- Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Australia
- Murdoch Children's Research Institute, Melbourne, Australia
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2
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Oh JK, Jung J, Lee SA, Lee S, Lee EJ, Chang E, Kang CK, Choe PG, Kim YJ, Kim NJ, Song JM, Kang DH, Song JK, Oh MD, Park WB, Kim DH. Impact of routine brain imaging on the prognosis of patients with left-sided valve infective endocarditis without neurological manifestations. Int J Cardiol 2023; 389:131175. [PMID: 37442351 DOI: 10.1016/j.ijcard.2023.131175] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/30/2023] [Accepted: 07/10/2023] [Indexed: 07/15/2023]
Abstract
BACKGROUND There are limited data on the impact of routine use of brain magnetic resonance imaging (MRI) on the prognosis of neurologically asymptomatic patients with left-sided infective endocarditis (IE). METHODS Among patients diagnosed with possible or definite IE in two tertiary referral centers between January 2005 and March 2019, we identified 527 left-sided IE patients without neurological symptoms or signs at the time of diagnosis. Patients who underwent brain MRI within 1 week after the IE diagnosis were classified as the routine brain imaging group (n = 216), and the rest were categorized as the control group (n = 311). All-cause mortality at 3 months, attributable mortality (defined as death directly related to IE), and fatal neurological events compared after adjustment using inverse probability of treatment weighting (IPTW). RESULTS During a median follow-up of 57 months, the routine brain imaging group had a similar risk of 3-month all-cause mortality to the control group in the multivariate analysis (hazard ratio [HR], 0.53; 95% confidence interval [CI], 0.24-1.14) and IPTW-adjusted cohort (HR, 0.59; 95% CI, 0.25-1.42). The risks of attributable mortality and fatal neurological events were also similar between the two groups in the multivariable analysis and IPTW-adjusted cohort. In the subgroup analysis, the routine brain imaging group showed more favorable outcomes in cases of large vegetation (> 10 mm) or acute-onset microorganisms. CONCLUSIONS Routine use of brain MRI in left-sided IE patients without neurological manifestations is not associated with improved clinical outcomes. However, routine brain imaging in appropriate clinical settings could improve clinical outcomes.
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Affiliation(s)
- Jin Kyung Oh
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea; Division of Cardiology, Department of Internal Medicine, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, Republic of Korea
| | - Jongtak Jung
- Department of Internal Medicine, Soonchunhyang University Hospital, Seoul, Republic of Korea
| | - Seung-Ah Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Sahmin Lee
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Eun-Jae Lee
- Department of Neurology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Euijin Chang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Chang Kyoung Kang
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Pyoeng Gyun Choe
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yong-Jin Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Nam Joong Kim
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jong-Min Song
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Duk-Hyun Kang
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Jae-Kwan Song
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea
| | - Myoung-Don Oh
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Wan Beom Park
- Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
| | - Dae-Hee Kim
- Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea.
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3
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Erdem S, Patel D, Patel SV, Patel S, Patel S, Kanwar A. Streptococcus pneumoniae Serotype 23B Causing Asymptomatic Sinusitis Complicated by Endocarditis and Meningitis: Sequela of a Non-vaccine Serotype. Cureus 2023; 15:e41892. [PMID: 37581129 PMCID: PMC10423637 DOI: 10.7759/cureus.41892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2023] [Indexed: 08/16/2023] Open
Abstract
We describe a rare case of a Streptococcus pneumoniae (S. pneumoniae) infection causing mitral valve endocarditis and bacterial meningitis in a previously healthy young adult male in his 20s who presented with altered mentation. Though our patient did not endorse any respiratory issues, we suspected the paranasal sinuses to have been the cryptic primary source of disseminated infection into the respiratory system and meninges due to incidental mucosal thickening being found on imaging. Blood and cerebrospinal fluid analyses and cultures revealed the proliferation of S. pneumoniae serotype 23B, despite our patient having previously received appropriate pneumococcal vaccinations in his childhood without delinquency. Ultimately, surgical replacement of the mitral valve, as well as a course of ceftriaxone, was indicated for this patient, in which full resolution of symptoms was achieved upon discharge.
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Affiliation(s)
- Saliha Erdem
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Dhruvil Patel
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Suraj V Patel
- Internal Medicine, Ross University School of Medicine, Miramar, USA
| | - Shlok Patel
- Medical School, University of Michigan, Ann Arbor, USA
| | - Shivam Patel
- Medical School, University of South Florida, Tampa, USA
| | - Amrit Kanwar
- Cardiology, Detroit Medical Center, Detroit, USA
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4
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Kenig A, Oster Y, Cohen-Poradosu R, Reisenberg K, Wieder-Finesod A, Hershman-Sarafov M, Oren I, Weber G, Dagan R, Regev-Yochay G, Strahilevitz J. Characteristics of endovascular pneumococcal infections; a decade of nationwide surveillance study. Eur J Clin Microbiol Infect Dis 2022; 41:1365-1370. [PMID: 36175812 DOI: 10.1007/s10096-022-04500-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 09/19/2022] [Indexed: 11/30/2022]
Abstract
In order to characterize pneumococcal endovascular infection in the post-vaccination era, a retrospective nationwide study based on the Israeli Adult IPD database was conducted. Between 2010 and 2019, 0.6% (23 cases) of IPD cases were of endovascular type, occurring mainly in males (72.3%) with underlying medical conditions (78.2%). Additional pneumococcal source (10 patients) and concomitant infections were not uncommon. Penicillin and ceftriaxone susceptibility rates were 65.2% and 91.3%, respectively; 60.9% of the isolates were not covered by the pneumococcal conjugate vaccine. 21.7% of patients died during hospitalization. In conclusion, pneumococcal endovascular infections still carry significant morbidity and mortality.
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Affiliation(s)
- Ariel Kenig
- Department of Medicine, Hadassah Hebrew University Medical Center, Jerusalem, Israel.,Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
| | - Yonatan Oster
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel.,Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Ein Kerem, 91120, Jerusalem, Israel
| | | | - Klaris Reisenberg
- Infectious Disease Unit, Soroka University Medical Center, Beer Sheva, Israel
| | - Anat Wieder-Finesod
- Infectious Disease Unit, Sheba Medical Center, Ramat Gan, Israel.,Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Ilana Oren
- Infectious Disease Unit, Rambam Medical Center, Haifa, Israel
| | - Gabriel Weber
- Infectious Disease Unit, Carmel Medical Center, Haifa, Israel.,Faculty of Medicine Technion, Israel Institute of Technology, Haifa, Israel
| | - Ron Dagan
- Faculty of Health Science, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - Gili Regev-Yochay
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.,Infection Prevention & Control Unit, Sheba Medical Center, Ramat Gan, Israel
| | - Jacob Strahilevitz
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel. .,Department of Clinical Microbiology and Infectious Diseases, Hadassah Hebrew University Medical Center, Ein Kerem, 91120, Jerusalem, Israel.
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5
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Asai N, Mikamo H. Recent Topics of Pneumococcal Vaccination: Indication of Pneumococcal Vaccine for Individuals at a Risk of Pneumococcal Disease in Adults. Microorganisms 2021; 9:2342. [PMID: 34835468 PMCID: PMC8623678 DOI: 10.3390/microorganisms9112342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 11/05/2021] [Accepted: 11/06/2021] [Indexed: 11/16/2022] Open
Abstract
Pneumococcal disease is one of the most common and severe vaccine-preventable diseases (VPDs). Despite the advances in antimicrobial treatment, pneumococcal disease still remains a global burden and exhibits a high mortality rate among people of all ages worldwide. The immunization program of the pneumococcal conjugate vaccine (PCV) in children has decreased pneumococcal disease incidence in several countries. However, there are several problems regarding the pneumococcal vaccine, such as indications for immunocompetent persons with underlying medical conditions with a risk of pneumococcal disease, the balance of utility and cost, i.e., cost-effectiveness, vaccine coverage rate, serotype replacement, and adverse events. Especially for individuals aged 19-64 at risk of pneumococcal disease, physicians and vaccine providers should make a rational decision whether the patients should be vaccinated or not, since there is insufficient evidence supporting it. We describe this review regarding topics and problems regarding pneumococcal vaccination from the clinician's point of view.
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Affiliation(s)
- Nobuhiro Asai
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Nagakute 480-1195, Japan;
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Nagakute 480-1195, Japan
- Department of Pathology, University of Michigan, Ann Arbor, MI 48109, USA
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University Hospital, Nagakute 480-1195, Japan;
- Department of Infection Control and Prevention, Aichi Medical University Hospital, Nagakute 480-1195, Japan
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6
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Manasrah N, Moses R, Al Sbihi AF, Hafeez W, Hakim A. Isolated Native Tricuspid Valve Endocarditis in an HIV Patient due to Streptococcus Pneumoniae: A Rare Clinical Phenomenon. Cureus 2020; 12:e10780. [PMID: 33154848 PMCID: PMC7606189 DOI: 10.7759/cureus.10780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Streptococcus pneumonia is an important cause of septicemia. Other sites of infection include meningitis, septic arthritis, and endocarditis. Pneumococcal endocarditis is rare and has a poor prognosis. We report a case of a 47-year-old female patient with HIV who developed isolated native tricuspid valve endocarditis secondary to streptococcus pneumonia, which is considered to be a very rare presentation in our patient due to the absence of common risk factors such as intravenous drug use, heart disease, or right heart catheterization.
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7
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Nakamura S, Hanayama N, Matushita H, Sakaki K. Detachment of a prosthetic valve due to infective endocarditis caused by Streptococcus pneumoniae. Clin Case Rep 2020; 8:1357-1360. [PMID: 32884753 PMCID: PMC7455410 DOI: 10.1002/ccr3.2749] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2019] [Revised: 12/24/2019] [Accepted: 01/21/2020] [Indexed: 12/04/2022] Open
Abstract
The incidence of infective endocarditis (IE) due to S pneumoniae has decreased, thanks to antibiotics. However, when it does occur, it can be lethal. The present case provides a reminder of the potential lethality of this postoperative infection.
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Affiliation(s)
- Saori Nakamura
- Department of Cardiothoracic SurgeryKanto Rosai HospitalKanagawaJapan
- Department of CardiologyTokyo Metropolitan Tama Medical CenterTokyoJapan
| | - Naoji Hanayama
- Department of Cardiothoracic SurgeryKanto Rosai HospitalKanagawaJapan
| | - Hiroshi Matushita
- Department of Cardiothoracic SurgeryKanto Rosai HospitalKanagawaJapan
| | - Kenjiro Sakaki
- Department of Cardiothoracic SurgeryKanto Rosai HospitalKanagawaJapan
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8
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Miyaue N, Yamanishi Y, Tada S, Ando R, Yabe H, Nagai M. Acromioclavicular joint arthritis as the first manifestation of Austrian syndrome. J Infect Chemother 2020; 26:124-127. [DOI: 10.1016/j.jiac.2019.06.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Revised: 06/05/2019] [Accepted: 06/20/2019] [Indexed: 10/26/2022]
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9
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Périer A, Puyade M, Revest M, Tattevin P, Bernard L, Lemaignen A, Boutoille D, Allal J, Roblot F, Rammaert B. Prognosis of Streptococcus pneumoniae endocarditis in France, a multicenter observational study (2000-2015). Int J Cardiol 2019; 288:102-106. [PMID: 31056415 DOI: 10.1016/j.ijcard.2019.04.048] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 03/18/2019] [Accepted: 04/16/2019] [Indexed: 12/14/2022]
Abstract
BACKGROUND Streptococcus pneumoniae is responsible for <2% of infective endocarditis (IE). The aim of this study was to assess the prognosis of pneumococcal IE. METHODS This multicentric observational retrospective study included adult patients presenting with definite S. pneumoniae IE according to modified Dukes criteria from four French university hospitals over a 15-year period, January 2000-December 2015. Survival rate at 90 days and 2 years after diagnosis, appropriateness of antibiotherapy, and pneumococcal vaccination status were determined. Risk factors for mortality were studied by univariate analysis. RESULTS Of 3886 patients admitted with IE during the study period, 50 (1.3%) had pneumococcal IE, mostly males (n = 38, 76%), with a mean age of 60 ± 14 years. Predisposing conditions for IE or for invasive pneumococcal disease (IPD) involved 24% and 78% of the cases, respectively. Only 2 patients were vaccinated against pneumococcus before IE and 13 (26%) after IE. Antimicrobial strategy was in accordance with the 2015 ESC Guidelines in 28%. Cardiac surgery was performed in 56%, and was associated with better survival (p = 0.012). In the 40 patients followed until 2 years, the survival rate was 67%, deaths occurring mostly before 90 days. Age ≥ 65 was a risk factor for mortality (p = 0.011). CONCLUSION Pneumococcal IE remains rare but with a poor prognosis. Resort to surgery is yet to be determined. Predisposing conditions for IPD are the main factors leading to pneumococcal IE. They could be prevented by vaccine coverage improvement.
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Affiliation(s)
- Amandine Périer
- Université de Poitiers, Poitiers, France; CHU de Poitiers, Service de Médecine Interne, Poitiers, France
| | - Mathieu Puyade
- Université de Poitiers, Poitiers, France; CHU de Poitiers, Service de Médecine Interne, Poitiers, France
| | - Matthieu Revest
- Université de Rennes, Rennes, France; CHU de Pontchaillou, Service de Maladies Infectieuses, Rennes, France
| | - Pierre Tattevin
- Université de Rennes, Rennes, France; CHU de Pontchaillou, Service de Maladies Infectieuses, Rennes, France
| | - Louis Bernard
- Université de Tours, Tours, France; CHRU de Tours, Hôpital Bretonneau, Service de Médecine Interne et Maladies Infectieuses, Tours, France
| | - Adrien Lemaignen
- Université de Tours, Tours, France; CHRU de Tours, Hôpital Bretonneau, Service de Médecine Interne et Maladies Infectieuses, Tours, France
| | - David Boutoille
- Université de Nantes, Nantes, France; CHU de Nantes, Service de Maladies Infectieuses, Nantes, France
| | - Joseph Allal
- Université de Poitiers, Poitiers, France; CHU de Poitiers, Service de Cardiologie, Poitiers, France
| | - France Roblot
- Université de Poitiers, Poitiers, France; CHU de Poitiers, Service de maladies infectieuses et tropicales, Poitiers, France; Inserm U1070, Poitiers, France
| | - Blandine Rammaert
- Université de Poitiers, Poitiers, France; CHU de Poitiers, Service de maladies infectieuses et tropicales, Poitiers, France; Inserm U1070, Poitiers, France.
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10
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Sarda C, Magrini G, Pelenghi S, Turco A, Seminari E. Mitral Valve Infective Endocarditis due to Streptococcus pyogenes: A Case Report. Cureus 2019; 11:e4461. [PMID: 31249739 PMCID: PMC6579330 DOI: 10.7759/cureus.4461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Infective endocarditis (IE) due to group A β-hemolytic streptococcus (Streptococcus pyogenes) has rarely been reported in the literature. We herein report a Streptococcus pyogenes native mitral valve endocarditis in a young patient and a review of the literature. The patient had a native mitral valve endocarditis with vegetation; his hemodynamic stability and a short course of antibiotic treatment prevented urgent surgery on the mitral valve. He was previously treated with cefixime and azithromycin for four days and then, upon hospital admission, with vancomycin plus amoxicillin-clavulanate. After the diagnosis of IE due to Streptococcus pyogenes, treatment with gentamicin (3 mg/kg daily) and ampicillin (12 g/day) was implemented. The patient underwent weekly echocardiographic evaluations during antibiotic treatment to document the resolution of the vegetations. He was discharged to home in good clinical conditions after a four-week course of antibiotic treatment.
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Affiliation(s)
- Cristina Sarda
- Infectious Diseases, Fondazione IRCCS Policlinico San Matteo, Pavia, ITA
| | - Giulia Magrini
- Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia , ITA
| | - Sfefano Pelenghi
- Cardiac Surgery, Fondazione IRCCS Policlinico San Matteo, Pavia, ITA
| | - Annalisa Turco
- Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, ITA
| | - Elena Seminari
- Infectious Diseses, Fondazione IRCCS Policlinico San Matteo, Pavia, ITA
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11
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Bindroo S, Akhter S, Thakur K, Geller C. Austrian Triad Complicated by Septic Arthritis and Aortic Root Abscess. Cureus 2018; 10:e3018. [PMID: 30254807 PMCID: PMC6150766 DOI: 10.7759/cureus.3018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 07/20/2018] [Indexed: 11/05/2022] Open
Abstract
Austrian syndrome is a very rare manifestation of invasive Streptococcus pneumoniae infection comprising a triad of pneumonia, meningitis, and endocarditis, also known as Osler's triad. We herein report a rare case of Austrian syndrome further complicated by septic arthritis.
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Affiliation(s)
- Sandiya Bindroo
- Internal Medicine, Crozer Chester Medical Center, Upland, USA
| | - Shafinaz Akhter
- Infectious Disease, Penn Medicine Chester County Hospital, Mount Laurel, USA
| | - Kshitij Thakur
- Internal Medicine, University of Kentucky College of Medicine, Kentucky, USA
| | - Charles Geller
- Cardiothoracic Surgery, Crozer Chester Medical Center, Upland, USA
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12
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Georgiadou SP, Manoulakas E, Makaritsis KP, Dalekos GN. A chronic alcoholic man with high fever, neck rigidity and loss of consciousness: remember the Austrian syndrome a commonly unrecognised invasive pneumococcus triad. BMJ Case Rep 2018; 2018:bcr-2018-225010. [PMID: 29848535 DOI: 10.1136/bcr-2018-225010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Austrian syndrome is a rare medical condition characterised by the triad of pneumonia, meningitis and endocarditis due to Streptococcus pneumoniae Native aortic valve insufficiency is the most common cause of cardiac failure in these patients, requiring valve replacement. We report a 52-year-old chronic alcoholic man who presented with fever, neck rigidity and loss of consciousness. Lumbar puncture revealed central nervous system infection while chest X-ray showed pneumonia. Blood and cerebrospinal fluid cultures revealed S. pneumonia Transoesophageal echocardiography revealed aortic endocarditis with severe valve insufficiency. The patient underwent aortic valve replacement and was finally discharged after completion of 6 weeks intravenous antibiotic treatment. Nowadays, Austrian syndrome is seen infrequently in the antibiotic era. However, clinicians should be aware of this syndrome as its early recognition and prompt combined medical and surgical treatment could reduce morbidity and mortality due to this potentially catastrophic clinical entity.
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Affiliation(s)
- Sarah P Georgiadou
- Department of Medicine and Research Laboratory of Internal Medicine, School of Medicine, University of Thessaly, Larissa, Thessaly, Greece
| | - Efstratios Manoulakas
- Department of Medicine and Research Laboratory of Internal Medicine, School of Medicine, University of Thessaly, Larissa, Thessaly, Greece
| | - Konstantinos P Makaritsis
- Department of Medicine and Research Laboratory of Internal Medicine, School of Medicine, University of Thessaly, Larissa, Thessaly, Greece
| | - George N Dalekos
- Department of Medicine and Research Laboratory of Internal Medicine, School of Medicine, University of Thessaly, Larissa, Thessaly, Greece
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13
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Abstract
Sixty years after its initial description, right-sided infective endocarditis (RSIE) still poses a challenge to all medical practitioners. Epidemiological data reveal a rising incidence attributable to the global surge in the number of intravenous drug users and the increased use of central vascular catheters and implantable cardiac devices. RSIE differs from left-sided infective endocarditis in more than just the location of the involved cardiac valve. They have different clinical presentations, diagnostic findings, and prognoses; hence, they require different management strategies. Cardiac murmurs and systemic emboli are usually absent in RSIE, whereas pulmonary embolism and its related complications dominate the clinical picture. Diagnostic delay of RSIE is secondary to the similarity in its initial presentation to other entities. Complications may ensue as a result of this delay. Diagnosis can be initially confirmed by using transthoracic echocardiography, except in patients with implanted cardioverter defibrillator, where a transesophageal echocardiogram is necessary. Various factors may increase mortality and morbidity in RSIE such as tricuspid valve vegetation size, fungal etiology, and low CD4 cell count in HIV patients. Oxacillin and vancomycin had been the traditionally used agents for the treatment of methicillin-susceptible and methicillin-resistant Staphylococcus aureus, respectively. More recently, daptomycin has shown promising results, which has led to its Food and Drug Administration (FDA) approval for the treatment of S. aureus bacteremia and associated RSIE. The aim of this article is to provide a comprehensive update on RSIE including epidemiology, pathogenesis, microbiology, diagnosis, management, and prognosis.
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14
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Domingues K, Marta L, Monteiro I, Leal M. Native aortic valve pneumococcal endocarditis--fulminant presentation. Rev Bras Ter Intensiva 2017; 28:83-6. [PMID: 27096681 PMCID: PMC4828096 DOI: 10.5935/0103-507x.20160004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Accepted: 12/09/2015] [Indexed: 11/21/2022] Open
Abstract
Pneumococcal endocarditis is a rare entity, corresponding to 1 to 3% of native
valve endocarditis cases. It has a typically adverse prognosis, with high
mortality. There is a reported predilection for the aortic valve; thus, a common
presentation is acute left heart failure. We present a case of a 60-year-old
woman with a history of sinusitis, who was admitted with the diagnosis of
pneumonia. She rapidly deteriorated with signs of septic shock and was
transferred to the critical care unit. The transesophageal echocardiogram
revealed severe aortic regurgitation due to valve vegetations. Blood cultures
were positive for Streptococcus pneumoniae. She underwent
cardiac surgery and had multiple postoperative complications. Nonetheless, the
patient made a slow and complete recovery. Infectious endocarditis should be
ruled out if any suspicion arises, and echocardiography should be performed in
an early stage in patients with poor response to vasopressors and inotropes.
Patients with pneumococcal endocarditis benefit from an aggressive approach,
with performance of early surgery.
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15
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Characteristics and prognosis of pneumococcal endocarditis: a case–control study. Clin Microbiol Infect 2016; 22:572.e5-8. [DOI: 10.1016/j.cmi.2016.03.011] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2016] [Revised: 03/05/2016] [Accepted: 03/12/2016] [Indexed: 11/16/2022]
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16
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Rouzé S, Flécher E, Revest M, Anselmi A, Aymami M, Roisné A, Guihaire J, Verhoye JP. Infective Endocarditis With Paravalvular Extension: 35-Year Experience. Ann Thorac Surg 2016; 102:549-55. [PMID: 27207394 DOI: 10.1016/j.athoracsur.2016.02.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 02/01/2016] [Accepted: 02/08/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND We investigated our surgical strategy and clinical results in patients from active infective endocarditis (AIE) complicated by paravalvular involvement to determine the risk factors of early and late death and reoperation. METHODS From October 1979 to December 2014, 955 patients underwent operations for AIE; among them 207 had AIE with paravalvular extension. The patients were a mean age of 59.9 ± 15.4 years, and 162 (78%) were male. Of these patients, 137 (66%) had isolated aortic valve endocarditis, and 138 (67%) had native valve endocarditis. Follow-up was 99% complete. RESULTS The operative mortality of the cohort was 16% (n = 34). Abnormal communication, mechanical valve implantation, and renal failure were independent predictors of 30-day death. Survival at 1, 5, 10, and 15 years was 90.3% ± 2.3%, 62.4% ± 3.7%, 49.3% ± 4.1%, and 37.9% ± 4.4%, respectively. Streptococcus endocarditis (all species), complex annular repair, and preoperative heart failure were independent predictors of long-term death. A reoperation was required in 29 patients (14%). Streptococcus pneumoniae endocarditis was the only independent predictor of early reoperation (within 30 days after the operation or during the same hospitalization). Freedom from reoperation at 1, 5, 10, and 15 years was 91.9% ± 2.2%, 89.6% ± 2.6%, 89.6% ± 2.6%, and 87.0% ± 3.5%, respectively. Independent predictors of late reoperation were urgent/emergency operation, prosthetic valve endocarditis, and complex annular repair. CONCLUSIONS AIE complicated by paravalvular involvement remains a surgical challenge. Valve replacement (particularly using bioprosthesis) associated with ad hoc reconstruction seems to be a reliable option and showed very encouraging results in this context.
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Affiliation(s)
- Simon Rouzé
- Department of Vascular and Cardio-Thoracic Surgery, Rennes University Health Centre, Rennes, France.
| | - Erwan Flécher
- Department of Vascular and Cardio-Thoracic Surgery, Rennes University Health Centre, Rennes, France
| | - Matthieu Revest
- Department of Infectious Diseases, Rennes University Health Centre, Rennes, France
| | - Amedeo Anselmi
- Department of Vascular and Cardio-Thoracic Surgery, Rennes University Health Centre, Rennes, France
| | - Marie Aymami
- Department of Vascular and Cardio-Thoracic Surgery, Rennes University Health Centre, Rennes, France
| | - Antoine Roisné
- Department of Anaesthesiology and Intensive Care, Rennes University Health Centre, Rennes, France
| | - Julien Guihaire
- Department of Vascular and Cardio-Thoracic Surgery, Rennes University Health Centre, Rennes, France
| | - Jean Philippe Verhoye
- Department of Vascular and Cardio-Thoracic Surgery, Rennes University Health Centre, Rennes, France
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17
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Pneumococcal Meningitis and Endocarditis: A Case Report. Am J Med 2016; 129:e19-20. [PMID: 26561418 DOI: 10.1016/j.amjmed.2015.09.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2015] [Revised: 09/12/2015] [Accepted: 09/14/2015] [Indexed: 11/23/2022]
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18
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Lacalzada J, Padilla M, de la Rosa A, Laynez I. Infectious endocarditis due to Streptococcus pneumoniae in a cardiac surgery patient: a new form of clinical presentation. Clin Case Rep 2015; 4:129-32. [PMID: 26862407 PMCID: PMC4736536 DOI: 10.1002/ccr3.448] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 09/18/2015] [Accepted: 10/22/2015] [Indexed: 12/12/2022] Open
Abstract
High mortality associated with pneumococcal endocarditis is due to late diagnosis and the frequency of complications, which usually require early diagnostic and intensive therapeutic measures. We present the first reported case of pneumococcal endocarditis with simultaneous infection of an aortic prosthetic valve, native tricuspid valve, and permanent pacemaker lead.
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Affiliation(s)
- Juan Lacalzada
- Department of Cardiology University Hospital of the Canary Islands La Laguna Tenerife Spain
| | - Marta Padilla
- Department of Cardiology University Hospital of the Canary Islands La Laguna Tenerife Spain
| | - Alejandro de la Rosa
- Department of Cardiology University Hospital of the Canary Islands La Laguna Tenerife Spain
| | - Ignacio Laynez
- Department of Cardiology University Hospital of the Canary Islands La Laguna Tenerife Spain
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19
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Zachariah D, Manga P. HIV and invasive pneumococcal infection. Int J Cardiol 2015; 198:157-8. [DOI: 10.1016/j.ijcard.2015.06.167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 06/27/2015] [Indexed: 10/23/2022]
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20
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Baltimore RS, Gewitz M, Baddour LM, Beerman LB, Jackson MA, Lockhart PB, Pahl E, Schutze GE, Shulman ST, Willoughby R. Infective Endocarditis in Childhood: 2015 Update. Circulation 2015; 132:1487-515. [DOI: 10.1161/cir.0000000000000298] [Citation(s) in RCA: 201] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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21
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Baddour LM, Wilson WR, Bayer AS, Fowler VG, Tleyjeh IM, Rybak MJ, Barsic B, Lockhart PB, Gewitz MH, Levison ME, Bolger AF, Steckelberg JM, Baltimore RS, Fink AM, O'Gara P, Taubert KA. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation 2015; 132:1435-86. [PMID: 26373316 DOI: 10.1161/cir.0000000000000296] [Citation(s) in RCA: 1815] [Impact Index Per Article: 201.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
BACKGROUND Infective endocarditis is a potentially lethal disease that has undergone major changes in both host and pathogen. The epidemiology of infective endocarditis has become more complex with today's myriad healthcare-associated factors that predispose to infection. Moreover, changes in pathogen prevalence, in particular a more common staphylococcal origin, have affected outcomes, which have not improved despite medical and surgical advances. METHODS AND RESULTS This statement updates the 2005 iteration, both of which were developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It includes an evidence-based system for diagnostic and treatment recommendations used by the American College of Cardiology and the American Heart Association for treatment recommendations. CONCLUSIONS Infective endocarditis is a complex disease, and patients with this disease generally require management by a team of physicians and allied health providers with a variety of areas of expertise. The recommendations provided in this document are intended to assist in the management of this uncommon but potentially deadly infection. The clinical variability and complexity in infective endocarditis, however, dictate that these recommendations be used to support and not supplant decisions in individual patient management.
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22
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de Egea V, Muñoz P, Valerio M, de Alarcón A, Lepe JA, Miró JM, Gálvez-Acebal J, García-Pavía P, Navas E, Goenaga MA, Fariñas MC, Vázquez EG, Marín M, Bouza E. Characteristics and Outcome of Streptococcus pneumoniae Endocarditis in the XXI Century: A Systematic Review of 111 Cases (2000-2013). Medicine (Baltimore) 2015; 94:e1562. [PMID: 26426629 PMCID: PMC4616835 DOI: 10.1097/md.0000000000001562] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 12/22/2022] Open
Abstract
Streptococcus pneumoniae is an infrequent cause of severe infectious endocarditis (IE). The aim of our study was to describe the epidemiology, clinical and microbiological characteristics, and outcome of a series of cases of S. pneumoniae IE diagnosed in Spain and in a series of cases published since 2000 in the medical literature. We prospectively collected all cases of IE diagnosed in a multicenter cohort of patients from 27 Spanish hospitals (n = 2539). We also performed a systematic review of the literature since 2000 and retrieved all cases with complete clinical data using a pre-established protocol. Predictors of mortality were identified using a logistic regression model. We collected 111 cases of pneumococcal IE: 24 patients from the Spanish cohort and 87 cases from the literature review. Median age was 51 years, and 23 patients (20.7%) were under 15 years. Men accounted for 64% of patients, and infection was community-acquired in 96.4% of cases. The most important underlying conditions were liver disease (27.9%) and immunosuppression (10.8%). A predisposing heart condition was present in only 18 patients (16.2%). Pneumococcal IE affected a native valve in 93.7% of patients. Left-sided endocarditis predominated (aortic valve 53.2% and mitral valve 40.5%). The microbiological diagnosis was obtained from blood cultures in 84.7% of cases. In the Spanish cohort, nonsusceptibility to penicillin was detected in 4.2%. The most common clinical manifestations included fever (71.2%), a new heart murmur (55%), pneumonia (45.9%), meningitis (40.5%), and Austrian syndrome (26.1%). Cardiac surgery was performed in 47.7% of patients. The in-hospital mortality rate was 20.7%. The multivariate analysis revealed the independent risk factors for mortality to be meningitis (OR, 4.3; 95% CI, 1.4-12.9; P < 0.01). Valve surgery was protective (OR, 0.1; 95% CI, 0.04-0.4; P < 0.01). Streptococcus pneumoniae IE is a community-acquired disease that mainly affects native aortic valves. Half of the cases in the present study had concomitant pneumonia, and a considerable number developed meningitis. Mortality was high, mainly in patients with central nervous system (CNS) involvement. Surgery was protective.
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Affiliation(s)
- Viviana de Egea
- From the Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón (VDE, PM, MV, MM, EB); Department of Medicine, Universidad Complutense, Madrid (UCM), Spain (PM, MM, EB); CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III (CIBERES), Madrid, Spain (PM, MM, EB); Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) Madrid, Spain (PM, MV, MM, EB); Microbiology and Infectious disease department, Hospital Universitario Virgen del Rocio, Sevilla (ADA, JAL); Infectious Diseases Department. Hospital Clinic-IDIBAPS, University of Barcelona (Barcelona) (JMM); Department of Medicine, Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiolo gía y Medicina Preventiva Hospital Universitario Virgen Macarena. Departamento de Medicina. Universidad de Sevilla (JG-A); Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid (PG-P); Hospital Ramón y Cajal, Madrid (EN); UEI HU Donostia, San Sebastián (MAG); Hospital Marqués de Valdecilla, University of Catabria, Santander (MCF); and Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Facultad de Medicina-Universidad de Murcia, Spain (EGV)
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Shokoohi H, Haywood Y, Najam F, Taheri MR. Emergent double valve replacement in Austrian syndrome. Am J Emerg Med 2014; 33:314.e3-6. [PMID: 25218621 DOI: 10.1016/j.ajem.2014.08.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Accepted: 08/09/2014] [Indexed: 10/24/2022] Open
Abstract
Bi-valvular pneumococcal endocarditis in Austrian syndrome, which includes a triad of pneumococcal endocarditis, pneumonia, and meningitis, is a rare but life-threatening disease. We present a case of a woman found to have Austrian syndrome who presented to the emergency department (ED) with dehydration and radiographical signs of lobar pneumonia and quickly deteriorated to fulminant cardiogenic shock in less than four hours. An early echocardiogram in the ED confirmed a diagnosis of bi-valvular endocarditis with severe aortic and mitral valve insufficiency and large vegetations on the valve leaflets requiring emergent surgical intervention with double valve replacement. Assumed meningitis as a part of the triad of Austrian syndrome was confirmed by imaging the day after hospital admission. Early diagnosis of endocarditis by obtaining the echocardiogram in the ED along with emergent surgical intervention allowed for a favorable outcome for the patient.
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Affiliation(s)
- Hamid Shokoohi
- Department of Emergency Medicine, The George Washington University, Washington, DC.
| | - Yolanda Haywood
- Department of Emergency Medicine, The George Washington University, Washington, DC
| | - Farzad Najam
- Department of Cardiovascular Thoracic Surgery, The George Washington University, Washington, DC
| | - M Reza Taheri
- Department of Radiology, The George Washington University, Washington, DC
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24
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Natsheh A, Vidberg M, Friedmann R, Ben-Chetrit E, Yinnon AM, Zevin S. Prosthetic valve endocarditis due to Streptococcus pneumoniae. SPRINGERPLUS 2014; 3:375. [PMID: 25126484 PMCID: PMC4130964 DOI: 10.1186/2193-1801-3-375] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 07/15/2014] [Indexed: 11/22/2022]
Abstract
Introduction In the pre-antibiotic era up 10% of cases of infective endocarditis were due to Streptococcus pneumoniae, but this association is currently exceedingly rare. Case description Since 1997 we have diagnosed three patients, all aged >70, with endocarditis due to S. pneumoniae. One of these three cases involved a prosthetic valve, another a prosthetic ring. All three patients completely recovered with antibiotic treatment only. Discussion and evaluation During the same period there were 1694 cases of pneumococcal bacteremia, of whom 395 (23%) after age 70. Therefore, after age 70 the prevalence of endocarditis out of all cases of pneumococcal bacteremia was 0.7%. A literature review detected another 16 cases of pneumococcal PVE. The mean age of these 17 patients was 64±14; 10 were female and 7 male. In most instances, symptom duration was short, < 6 days. Valve surgery was performed in 5 cases (29%) and 13 patients (76%) survived. Conclusions Endocarditis due to S. pneumoniae is rare in the antibiotic era; even in patients with prosthetic valves its course is evidently not more virulent than with other low-virulent organisms.
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Affiliation(s)
- Ayman Natsheh
- Department of Medicine B, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Michal Vidberg
- Department of Medicine A, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Reuven Friedmann
- Department of Geriatrics, Shaare Zedek Medical Center, Jerusalem, Israel
| | - Eli Ben-Chetrit
- Infectious Disease Unit, Shaare Zedek Medical Center, Jerusalem, Israel ; Division of Internal Medicine, Shaare Zedek Medical Center, affiliated with The Hebrew University-Hadassah Medical School, P.O. Box 3235, Jerusalem, Israel
| | - Amos M Yinnon
- Infectious Disease Unit, Shaare Zedek Medical Center, Jerusalem, Israel ; Division of Internal Medicine, Shaare Zedek Medical Center, affiliated with The Hebrew University-Hadassah Medical School, P.O. Box 3235, Jerusalem, Israel
| | - Shoshana Zevin
- Department of Medicine B, Shaare Zedek Medical Center, Jerusalem, Israel
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25
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Recurrent Mitral Valve Endocarditis Caused by Streptococcus pneumoniae in a Splenectomized Host. Case Rep Infect Dis 2014; 2013:929615. [PMID: 24459593 PMCID: PMC3888697 DOI: 10.1155/2013/929615] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2013] [Accepted: 12/02/2013] [Indexed: 11/25/2022] Open
Abstract
A 72-year-old male with a remote history of splenectomy and two previous episodes of pneumococcal endocarditis of mitral valve presented with high-grade fever and confusion for 3 days. Nine months priorly, patient underwent mitral valve repair when he had the first episode of pneumococcal mitral valve endocarditis. He received pneumococcal vaccination two years ago. On examination during this admission, he was found to be febrile (104.3 F) and confused and had a grade 2/6 systolic murmur at the apex without any radiation. Laboratory data was significant for a white blood cell count of 22,000/mm3 (normal: 4000–11000/mm3). Blood cultures (4/4 bottles) grew penicillin-sensitive Streptococcus pneumoniae. Transesophageal echocardiogram revealed small vegetation on the posterior mitral leaflet without any evidence of abscess and severe mitral regurgitation. Patient clinically responded to intravenous ceftriaxone. However, due to recurrent pneumococcal mitral valve endocarditis and severe mitral regurgitation, the patient underwent mitral valve replacement. Patient had an uneventful recovery and was discharged home. Pneumococcal endocarditis itself is being uncommon in this current, penicillin, era; our case highlights the recurrent nature of pneumococcal endocarditis in a splenectomized host and the importance of pursuing aggressive treatment options in this clinical scenario.
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26
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Tak T, Dhawan S, Reynolds C, Shukla SK. Current diagnosis and treatment of infective endocarditis. Expert Rev Anti Infect Ther 2014; 1:639-54. [PMID: 15482161 DOI: 10.1586/14787210.1.4.639] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The incidence of infective endocarditis continues to rise with a yearly incidence of around 15,000 to 20,000 new cases in the USA. As a result, rapid diagnosis, effective treatment and prompt recognition of complications are essential to desirable clinical outcomes. Recent guidelines such as the Duke criteria have incorporated echocardiography for diagnosis of infective endocarditis, making this diagnostic test mandatory for patients with suspected infective endocarditis. The diversity of pathogens that can cause infective endocarditis, some of which cannot be cultured easily, makes diagnosis even more difficult. Coagulase-negative staphylococci and viridans streptococci groups continue to be the major causative microorganisms of infective endocarditis. In the case of culture-negative endocarditis or infective endocarditis caused by fastidious microorganisms, the polymerase chain reaction and probe-based diagnostic methods are available to clinical reference laboratories.
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Affiliation(s)
- Tahir Tak
- Department of Internal Medicine, Marshfield Clinic, 1000 North Oak Avenue, Marshfield, WI 54449, USA.
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27
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28
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Akinosoglou K, Apostolakis E, Marangos M, Pasvol G. Native valve right sided infective endocarditis. Eur J Intern Med 2013; 24:510-9. [PMID: 23369408 DOI: 10.1016/j.ejim.2013.01.010] [Citation(s) in RCA: 57] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2012] [Revised: 12/23/2012] [Accepted: 01/04/2013] [Indexed: 11/25/2022]
Abstract
Right-sided infective endocarditis (RSIE) accounts for 5-10% of all cases of infective endocarditis (IE), and is predominantly encountered in the injecting drug user (IDU) population, where HIV and HCV coinfections often coexist. Staphylococcus aureus is the most common pathogen. The pathogenesis of RSIE is still not well understood. RSIE usually presents as a persistent fever with respiratory symptoms whilst signs of systemic embolisation as seen in left-sided IE are notably absent. The prompt diagnosis of RSIE thus requires a high index of suspicion. Transthoracic echocardiography (TTE) can detect the majority of RSIE, whilst transoesophageal echocardiography (TOE) can increase sensitivity. Virulence of the causative organism and vegetation size are the major determinants of prognosis. Most cases of RSIE resolve with appropriate antibiotic administration.
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Affiliation(s)
- Karolina Akinosoglou
- Department of Internal Medicine and Infectious Diseases, University Hospital of Patras, 26504, Rio, Greece.
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29
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Kanakadandi V, Annapureddy N, Agarwal SK, Sabharwal MS, Ammakkanavar N, Simoes P, Sanjani HP, Nadkarni GN. The Austrian syndrome: a case report and review of the literature. Infection 2012; 41:695-700. [PMID: 23124908 DOI: 10.1007/s15010-012-0361-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2012] [Accepted: 10/20/2012] [Indexed: 11/27/2022]
Abstract
A 61-year-old man presented with fever and altered mental status. He was intubated for respiratory distress and was found to have multilobar pneumonia for which antibiotic therapy was instituted. However, his mental status continued to deteriorate despite appropriate antibiotic therapy for his pneumonia. The results from lumar puncture revealed meningitis and endocarditis was evident on a trans-esophageal echocardiogram. His blood and respiratory cultures grew Streptococcus pneumoniae. The patient was diagnosed with Austrian syndrome. After appropriate changes to his antibiotic regimen and an aortic valve replacement, he recovered and was discharged.
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MESH Headings
- Anti-Bacterial Agents/therapeutic use
- Aortic Valve/surgery
- Bacteremia/complications
- Bacteremia/diagnosis
- Bacteremia/microbiology
- Bacteremia/pathology
- Blood/microbiology
- Endocarditis, Bacterial/complications
- Endocarditis, Bacterial/diagnosis
- Endocarditis, Bacterial/microbiology
- Endocarditis, Bacterial/pathology
- Humans
- Male
- Meningitis, Pneumococcal/complications
- Meningitis, Pneumococcal/diagnosis
- Meningitis, Pneumococcal/microbiology
- Meningitis, Pneumococcal/pathology
- Middle Aged
- Pneumonia, Pneumococcal/complications
- Pneumonia, Pneumococcal/diagnosis
- Pneumonia, Pneumococcal/microbiology
- Pneumonia, Pneumococcal/pathology
- Respiratory System/microbiology
- Streptococcus pneumoniae/isolation & purification
- Treatment Outcome
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Affiliation(s)
- V Kanakadandi
- Kansas City Veterans Affairs Medical Center, Kansas City, MO 64128, USA.
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30
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O'Brien S, Dayer M, Benzimra J, Hardman S, Townsend M. Streptococcus pneumoniae endocarditis on replacement aortic valve with panopthalmitis and pseudoabscess. BMJ Case Rep 2011; 2011:bcr.06.2011.4304. [PMID: 22678733 DOI: 10.1136/bcr.06.2011.4304] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
A 63-year-old woman with a previous episode of Streptococcus agalactiae endocarditis requiring a bioprosthetic aortic valve replacement presented with a short history of malaise, a right panopthalmitis with a Roth spot on funduscopy of the left eye and Streptococcus pneumoniae grown from vitreous and aqueous taps as well as blood cultures. She developed first degree heart block and her ECG was suggestive of an aortic root abscess. This gradually resolved over 6 weeks, during which she was treated with intravenous antibiotics. After careful consideration, it is likely that what was thought to be an aortic root abscess was instead an area of perivalvular inflammation.
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Affiliation(s)
- Stephen O'Brien
- Care of the Elderly, Musgrove Park Hospital, Taunton, Somerset, UK
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31
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Morita H, Misawa Y, Oki S, Saito T. Infection of pacemaker lead by penicillin-resistant Streptococcus Pneumoniae. Ann Thorac Cardiovasc Surg 2011; 17:313-5. [PMID: 21697800 DOI: 10.5761/atcs.cr.10.01559] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2010] [Accepted: 04/12/2010] [Indexed: 11/16/2022] Open
Abstract
Penicillin-resistant Streptococcus pneumoniae (PRSP) infections have steadily increased worldwide; however, there are only a few reports of permanent pacemaker-related infections caused by PRSP. Here, we describe a patient who developed 7 episodes of endocarditis and sepsis from PRSP infection of the pacemaker lead in the right atrium. By periodic administration of vancomycin and extraction of both leads, we resolved the infection.
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Affiliation(s)
- Hideki Morita
- Division of Cardiovascular Surgery, Jichi Medical University, Shimotsuke, Tochigi, Japan.
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32
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Chan JFW, Hwang GYY, Lamb S, Chan GSW, So JCC, Leung SSM, To KKW, Li IWS, Cheng VCC, Yuen KY. Pneumococcal native aortic valve endocarditis with mycotic abdominal aortic aneurysm, paraspinal and iliopsoas abscesses and pneumonia revealing a multiple myeloma. J Med Microbiol 2011; 60:851-855. [DOI: 10.1099/jmm.0.028191-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Affiliation(s)
- Jasper F. W. Chan
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR
| | - Gloria Y. Y. Hwang
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR
| | - Sophia Lamb
- Department of Medicine, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR
| | - Gavin S. W. Chan
- Department of Pathology and Clinical Biochemistry, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR
| | - Jason C. C. So
- Department of Pathology and Clinical Biochemistry, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR
| | - Sally S. M. Leung
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR
| | - Kelvin K. W. To
- Carol Yu Centre for Infection, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR
| | - Iris W. S. Li
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR
| | - Vincent C. C. Cheng
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR
| | - Kwok-Yung Yuen
- Carol Yu Centre for Infection, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR
- Department of Microbiology, The University of Hong Kong, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong SAR
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Kim YM, Kim SA, Kim MG, Kwon YS, Kim EJ, Jo SH, Kim HS, Han SJ, Park WJ, Rhim CY. Austrian syndrome with a delayed onset of heart failure. J Cardiovasc Ultrasound 2011; 19:35-7. [PMID: 21519491 PMCID: PMC3079083 DOI: 10.4250/jcu.2011.19.1.35] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2010] [Revised: 12/22/2010] [Accepted: 12/22/2010] [Indexed: 12/01/2022] Open
Abstract
A 59-year-old man treated with pneumococcal meningitis 4 months ago was hospitalized for acute heart failure and performed aortic valve replacement by rupture of aortic valve. The frequent association of pneumococcal meningitis and endocarditis is known as Austrian syndrome. Though Austrian syndrome is a clinically rare disease, the evolution of pneumococcal endocarditis is very aggressive and associated with high mortality, and early recognition for evidence of endocardial lesion in patients with pneumococcal meningitis is important to reduce the complications and mortality rate.
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Affiliation(s)
- Yong-Min Kim
- Division of Cardiology, Department of Internal Medicine, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
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Randazzo M, Flückiger U, Eich G, Komminoth P, Lauber P, Herren T. [A drug addict presenting with complicated tricuspid valve endocarditis]. Internist (Berl) 2010; 51:1185-9. [PMID: 20848268 DOI: 10.1007/s00108-010-2614-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The right-sided heart valves are affected in about 10% of patients with infective endocarditis. However, the tricuspid valve is the most frequently involved valve in intravenous drug users with infective endocarditis. When treated with antibiotics, the prognosis is considered favorable. Reported here is the case of a drug-addicted patient with polymicrobial (Staphylococcus aureus and Streptococcus pneumoniae) infective endocarditis of the tricuspid valve and a lethal outcome due to multiple organ failure. The indications and options to perform cardiac surgery in patients with infective endocarditis of the tricuspid valve are discussed.
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Affiliation(s)
- M Randazzo
- Chirurgische Klinik, Spital Limmattal, Schlieren, Schweiz
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Park JY, Hwang EJ, Park SY, Moon SY, Son JS, Lee MS. A Case of Pneumococcal Endocarditis Accompanied by Arthritis and Meningitis. Infect Chemother 2010. [DOI: 10.3947/ic.2010.42.5.307] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Ji Young Park
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Eun Jung Hwang
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - So-Youn Park
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Soo-Youn Moon
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Jun Seong Son
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
| | - Mi Suk Lee
- Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea
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Porres-Aguilar M, Flavin NE, Fleming RV, Lalude O. Severe bivalvular pneumococcal endocarditis and suppurative pericarditis in an immunocompetent patient. Intern Med 2010; 49:321-3. [PMID: 20154438 DOI: 10.2169/internalmedicine.49.2869] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Pneumococcal endocarditis is a very serious and rare clinical entity that results in significant morbidity and high mortality rates. It causes severe disease and is typically seen in alcoholics and immunocompromised patients. Antimicrobial therapy and timely surgery are warranted for optimal management and improving outcomes. We present a case of a previously healthy 31-year-old Hispanic man with bicuspid aortic valve who developed severe bivalvular pneumococcal endocarditis complicated by suppurative pericarditis that was promptly treated with antimicrobial therapy and subsequent aortic valve replacement with initial favorable clinical and hemodynamic improvement.
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Affiliation(s)
- Mateo Porres-Aguilar
- Division of Respiratory, Critical Care, and Occupational Pulmonary Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA.
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Abstract
This report describes a case of Austrian syndrome (pneumonia, meningitis, and endocarditis, as a result of Streptococcus pneumoniae infection). A computerized medline search was performed for review of literature. In the review of literature, 54 cases including our case were found. Complete clinical and microbiological information was available only for 20 cases. Most invasive pneumococcal infections occurred in debilitated middle aged men with chronic alcoholism. Native aortic valve insufficiency was the commonest cause of cardiac failure among these patients, requiring valve replacement. Austrian syndrome is seen infrequently in this antibiotic era but is still associated with a poor outcome. Hence early recognition and appropriate medical or combined medical-surgical treatment needs to be considered promptly.
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Hoen B. Non-staphylococcal Gram-positive bacteraemia without a known source. Int J Antimicrob Agents 2008; 32 Suppl 1:S15-7. [DOI: 10.1016/j.ijantimicag.2008.08.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2008] [Accepted: 08/05/2008] [Indexed: 10/21/2022]
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Olaechea Astigarraga PM, Garnacho Montero J, Grau Cerrato S, Rodríguez Colomo O, Palomar Martínez M, Zaragoza Crespo R, Muñoz García-Paredes P, Cerdá Cerdá E, Alvarez Lerma F. [Summary of the GEIPC-SEIMC and GTEI-SEMICYUC recommendations for the treatment of infections caused by gram positive cocci in critical patients]. FARMACIA HOSPITALARIA 2008; 31:353-69. [PMID: 18348666 DOI: 10.1016/s1130-6343(07)75407-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE In recent years there has been an increase in infections caused by gram-positive cocci in critical patients, together with a rapid development of resistance to the antibiotics which are normally used to treat them. The objective is to prepare an antibiotic treatment guide for the most common infections caused by gram positive cocci in critical patients. This guide will help in the decision-making process regarding the care of such patients. METHOD Experts from two scientific societies worked together to prepare a consensus document. They were members of the Study Group on Infections in Critical Patients (GEIPC), which is part of the Spanish Society of Infectious Diseases and Clinical Microbiology (SEIMC), and the Infectious Diseases Working Group (GTEI), belonging to the Spanish Society of Intensive Care Medicine and Coronary Units (SEMICYUC). There was a systematic review of the literature published up to September 2006 regarding this type of infections and the antibiotic treatments marketed to that date. An evidence grading system was applied according to the strength of the recommendation (categories A, B or C) and the level of evidence (categories I, II or III). Recommendations were given if there was consensus among the experts from both societies. RESULTS The antibiotic regimens recommended for treating infections caused by gram-positive cocci were presented in the form of tables, showing the recommendation grade. Alternatives were given for allergic patients. The scientific basis supporting the aforementioned recommendations is explained within the text and the references upon which they are based are cited. CONCLUSIONS A summary of an evidence-based practical guide for the treatment of infections caused by gram-positive cocci in critical patients is presented.
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Ishiwada N, Niwa K, Tateno S, Yoshinaga M, Terai M, Nakazawa M. Pneumococcal endocarditis in children: A nationwide survey in Japan. Int J Cardiol 2008; 123:298-301. [PMID: 17383029 DOI: 10.1016/j.ijcard.2006.12.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Revised: 11/22/2006] [Accepted: 12/11/2006] [Indexed: 11/27/2022]
Abstract
BACKGROUND Infective endocarditis (IE) due to Streptococcus pneumoniae (S. pneumoniae) carries a high mortality rate. However, little is known about pneumococcal IE in children and no optimal therapy has been established. Thus, we attempted to identify the clinical features of this disorder through a Japanese nationwide survey. METHODS Members of the Japanese Society of Pediatrics Cardiology and Cardiac Surgery registered 170 pediatric patients with IE diagnosed during a 5-year period (1997-2001). Nine of these patients (5.3%) had pneumococcal IE. The clinical course, treatment and outcome of these 9 patients, aged 7 months to 4 years, were analyzed. RESULTS Pneumococcal IE was associated with congenital heart disease in 7 patients and accompanied by other systemic infections including meningitis, pneumonia and otitis media, in 4 patients. Five of the 9 (55.6%) strains isolated by blood culture were penicillin-resistant S. pneumoniae strains. Seven patients were treated with carbapenem. Three underwent cardiac surgery due to cardiac failure and/or vegetation. One died due to septic shock on the first day of hospitalization. CONCLUSIONS In children, pneumococcal endocarditis is often accompanied by severe systemic infections. The majority of pediatric cases are caused by penicillin-resistant S. pneumoniae strains. Carbapenem is an effective for IE caused by penicillin-resistant S. pneumoniae. This survey might be helpful to establish proper management strategies for pediatric pneumococcal IE.
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Affiliation(s)
- Naruhiko Ishiwada
- Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan.
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Astigarraga PMO, Montero JG, Cerrato SG, Colomo OR, Martínez MP, Crespo RZ, García-Paredes PM, Cerdá EC, Lerma FA. [GEIPC-SEIMC (Study Group for Infections in the Critically Ill Patient of the Spanish Society for Infectious Diseases and Clinical Microbiology) and GTEI-SEMICYUC ( Working Group on Infectious Diseases of the Spanish Society of Intensive Medicine, Critical Care, and Coronary Units) recommendations for antibiotic treatment of gram-positive cocci infections in the critical patient]. Enferm Infecc Microbiol Clin 2007; 25:446-66. [PMID: 17692213 DOI: 10.1157/13108709] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
In recent years, an increment of infections caused by gram-positive cocci has been documented in nosocomial and hospital-acquired-infections. In diverse countries, a rapid development of resistance to common antibiotics against gram-positive cocci has been observed. This situation is exceptional in Spain but our country might be affected in the near future. New antimicrobials active against these multi-drug resistant pathogens are nowadays available. It is essential to improve our current knowledge about pharmacokinetic properties of traditional and new antimicrobials to maximize its effectiveness and to minimize toxicity. These issues are even more important in critically ill patients because inadequate empirical therapy is associated with therapeutic failure and a poor outcome. Experts representing two scientific societies (Grupo de estudio de Infecciones en el Paciente Crítico de la SEIMC and Grupo de trabajo de Enfermedades Infecciosas de la SEMICYUC) have elaborated a consensus document based on the current scientific evidence to summarize recommendations for the treatment of serious infections caused by gram-positive cocci in critically ill patients.
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Olaechea Astigarraga PM, Garnacho Montero J, Grau Cerrato S, Rodríguez Colomo O, Palomar Martínez M, Zaragoza Crespo R, Muñoz García-Paredes P, Cerdá Cerdá E, Alvarez Lerma F. Recomendaciones GEIPC-SEIMC y GTEI-SEMICYUC para el tratamiento antibiótico de infecciones por cocos grampositivos en el paciente crítico. Med Intensiva 2007; 31:294-317. [PMID: 17663956 DOI: 10.1016/s0210-5691(07)74829-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
In recent years, an increment of infections caused by gram-positive cocci has been documented in nosocomial and hospital-acquired infections. In diverse countries, a rapid development of resistance to common antibiotics against gram-positive cocci has been observed. This situation is exceptional in Spain but our country might be affected in the near future. New antimicrobials active against these multi-drug resistant pathogens are nowadays available. It is essential to improve our current knowledge about pharmacokinetic properties of traditional and new antimicrobials to maximize its effectiveness and to minimize toxicity. These issues are even more important in critically ill patients because inadequate empirical therapy is associated with therapeutic failure and a poor outcome. Experts representing two scientific societies (Grupo de estudio de Infecciones en el Paciente Critico de la SEIMC and Grupo de trabajo de Enfermedades Infecciosas de la SEMICYUC) have elaborated a consensus document based on the current scientific evidence to summarize recommendations for the treatment of serious infections caused by gram-positive cocci in critically ill patients.
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Affiliation(s)
- P M Olaechea Astigarraga
- Servicio de Medicina Intensiva, Hospital de Galdakao, Bo. de Labeaga s/n, 48960 Galdakao, Vizcaya, Spain.
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Booker J, Musher D. Sinusitis complicated by dural sinus thrombosis and Streptococcus pneumoniae endocarditis: a case report and review of the literature. J Infect 2007; 55:106-10. [PMID: 17434591 DOI: 10.1016/j.jinf.2007.02.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2006] [Revised: 02/05/2007] [Accepted: 02/07/2007] [Indexed: 11/29/2022]
Abstract
Streptococcus pneumoniae endocarditis is most commonly associated with pneumonia. It is relatively uncommon disease but its severity makes it clinically relevant. We present a case and review of sinusitis complicated by both pneumococcal endocarditis and cavernous sinus thrombosis. Both endocarditis and dural sinus thrombosis are known complications of facial infections. To our knowledge, this is the first reported case of both S. pneumoniae endocarditis and dural sinus thrombosis complicating sinusitis. A case report and review of the literature is presented.
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Affiliation(s)
- Julian Booker
- Cardiology, Baylor College of Medicine, One Baylor Plaza, Houston, TX 77030, USA.
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Valero Novella B, Reus Bañuls S, Botella Ortiz A, Merino de Lucas E. El curso clínico agresivo de la endocarditis neumocócica. Rev Clin Esp 2007; 207:183-6. [PMID: 17475181 DOI: 10.1157/13101847] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
The aggressive clinical course of pneumococcal endocarditis. A retrospective study was conducted between 2000 and 2005 in five patients with pneumococcal endocarditis were diagnosed at our center. Three female and 2 males, 13 to 76 year-old, were attended. Most of them had left valve endocarditis and were suffering from predisposing conditions. All of them developed distant complications as embolism or septic metastases. Two patients were successfully operated. Surgery was considered in another one but it was discarded due to her poor general condition. This was the only death in the series.
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Affiliation(s)
- B Valero Novella
- Servicio de Medicina Interna, Unidad de Enfermedades Infecciosas, Hospital General Universitario, Avenida Pintor Baeza s/n, 03010 Alicante, Spain.
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Kan B, Ries J, Normark BH, Chang FY, Feldman C, Ko WC, Rello J, Snydman DR, Yu VL, Ortqvist A. Endocarditis and pericarditis complicating pneumococcal bacteraemia, with special reference to the adhesive abilities of pneumococci: results from a prospective study. Clin Microbiol Infect 2006; 12:338-44. [PMID: 16524410 DOI: 10.1111/j.1469-0691.2006.01363.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The incidence of pneumococcal cardiac infections is unknown and the pathogenicity of such complications is poorly understood. In a prospective, international, observational study, eight of 844 patients hospitalised with Streptococcus pneumoniae bacteraemia developed endocarditis (n = 5) or pericarditis (n = 3). The clinical and microbiological characteristics of these patients were compared with those of control patients. The corresponding incidence of pneumococcal endocarditis was c. 1-3/1 million inhabitants/year. There was no common pattern in the medical history of patients with an infectious cardiac complication. The severity of illness upon admission was comparable with that for patients without infectious cardiac complications, as was the 14-day mortality rate (25% and 17%, respectively). For encapsulated S. pneumoniae, no significant differences were found between patients with infectious cardiac complications and controls in adherence assays. However, non-encapsulated S. pneumoniae showed higher hydrophobicity and increased adherence to human epithelial cells.
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Affiliation(s)
- B Kan
- Unit of Infectious Diseases, Department of Medicine, Karolinska Institutet, Karolinska University Hospital, Solna, Sweden
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Gonzalez-Juanatey C, Testa A, Mayo J, Gonzalez-Gay MA. Austrian syndrome: Report of two new cases and literature review. Int J Cardiol 2006; 108:273-5. [PMID: 16139379 DOI: 10.1016/j.ijcard.2005.02.045] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2005] [Revised: 02/16/2005] [Accepted: 02/19/2005] [Indexed: 11/26/2022]
Abstract
In April 2004, Rammeloo et al. reported a child-aortic-valve endocarditis following pneumococcal meningitis. Classically, the association of pneumococcal pneumonia along with meningitis and infectious endocarditis (IE) is known as Austrian syndrome. We assessed the incidence, clinical manifestations and follow-up of patients diagnosed with Austrian syndrome in Lugo (Northwest Spain) between 1987 and 2002. A computerized MEDLINE search was also performed for literature review. During the study period 165 Lugo patients met criteria for definite IE. Two of the 3 patients with definite streptococcus pneumoniae IE also met definitions for Austrian syndrome. The incidence of this syndrome in Lugo patients with definite IE was 1.2%. In the literature review 48 cases, including our two patients, were found. Complete clinical information was only available on 16 patients. Alcoholism constituted the most common predisposing factor. Aortic valve involvement and high grade of valve regurgitation leading to cardiac failure and the need of cardiac surgery during the admission were common in these patients. This review confirms that Austrian syndrome is a rare but severe disease. Early recognition of these patients is required to avoid ominous complications.
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Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME, Ferrieri P, Gerber MA, Tani LY, Gewitz MH, Tong DC, Steckelberg JM, Baltimore RS, Shulman ST, Burns JC, Falace DA, Newburger JW, Pallasch TJ, Takahashi M, Taubert KA. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation 2006; 111:e394-434. [PMID: 15956145 DOI: 10.1161/circulationaha.105.165564] [Citation(s) in RCA: 1041] [Impact Index Per Article: 57.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite advances in medical, surgical, and critical care interventions, infective endocarditis remains a disease that is associated with considerable morbidity and mortality. The continuing evolution of antimicrobial resistance among common pathogens that cause infective endocarditis creates additional therapeutic issues for physicians to manage in this potentially life-threatening illness. METHODS AND RESULTS This work represents the third iteration of an infective endocarditis "treatment" document developed by the American Heart Association under the auspices of the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease of the Young. It updates recommendations for diagnosis, treatment, and management of complications of infective endocarditis. A multidisciplinary committee of experts drafted this document to assist physicians in the evolving care of patients with infective endocarditis in the new millennium. This extensive document is accompanied by an executive summary that covers the key points of the diagnosis, antimicrobial therapy, and management of infective endocarditis. For the first time, an evidence-based scoring system that is used by the American College of Cardiology and the American Heart Association was applied to treatment recommendations. Tables also have been included that provide input on the use of echocardiography during diagnosis and treatment of infective endocarditis, evaluation and treatment of culture-negative endocarditis, and short-term and long-term management of patients during and after completion of antimicrobial treatment. To assist physicians who care for children, pediatric dosing was added to each treatment regimen. CONCLUSIONS The recommendations outlined in this update should assist physicians in all aspects of patient care in the diagnosis, medical and surgical treatment, and follow-up of infective endocarditis, as well as management of associated complications. Clinical variability and complexity in infective endocarditis, however, dictate that these guidelines be used to support and not supplant physician-directed decisions in individual patient management.
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Takabayashi S, Shimpo H, Miyake Y, Onoda K, Sawada H, Mitani Y. Performance of the fontan procedure using extra-cardiac direct anastomosis on patients treated for penicillin-resistant Streptococcus pneumoniae endocarditis. ACTA ACUST UNITED AC 2005; 53:176-9. [PMID: 15828303 DOI: 10.1007/s11748-005-0029-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Streptococcus pneumoniae is now a rare cause of endocarditis in humans. We report a patient with a double outlet right ventricle and mitral atresia, who underwent the Fontan procedure without prosthetic materials after treatment for penicillin-resistant Streptococcus pneumoniae endocarditis. Postoperative infectious endocarditis was not found. In patients with a history of infectious endocarditis, direct anastomosis of the main pulmonary artery and inferior vena cava would reduce the risk of recurrent infectious endocarditis.
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Affiliation(s)
- Shin Takabayashi
- Department of Thoracic and Cardiovascular Surgery, Mie University School of Medicine, Mie, Japan
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Upton A, Drinkovic D, Pottumarthy S, West T, Morris AJ. Culture results of heart valves resected because of streptococcal endocarditis: insights into duration of treatment to achieve valve sterilization. J Antimicrob Chemother 2005; 55:234-9. [PMID: 15649988 DOI: 10.1093/jac/dkh527] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES To analyse the culture results of heart valves removed following streptococcal endocarditis in order to gain insight into the duration of treatment required for valve sterilization. PATIENTS AND METHODS Retrospective review of 131 episodes of streptococcal endocarditis: 94 due to alpha-haemolytic streptococci; 15 due to beta-haemolytic streptococci; 10 due to nutritionally deficient streptococci; eight due to the Streptococcus anginosus group and four due to Streptococcus pneumoniae. Patients had their valves removed during antimicrobial treatment. Culture results were analysed with respect to duration of treatment before surgery. RESULTS For alpha-haemolytic streptococci, 17 (18%) valves were culture-positive and 77 (82%) culture-negative after a median (range) of 4 (1-20) and 16 (4-58) days of treatment, respectively, P < 0.001. For beta-haemolytic streptococci, two valves (13%) were culture-positive; both patients had received < or = 4 days of treatment. Four patients (40%) with nutritionally deficient streptococci were culture-positive, and had received < or = 8 days of treatment. For the S. anginosus group, two valves (25%) were culture-positive; both patients had received < or = 4 days of treatment before operation. Overall, only one of 131 (0.8%) valves was culture-positive after 14 days of treatment. All valves infected with beta-haemolytic streptococci, nutritionally deficient streptococci and the S. anginosus group, who were treated for more than 8 days before surgery, were culture-negative. CONCLUSIONS Our findings support current treatment guidelines for endocarditis caused by alpha-haemolytic streptococci. We suggest that the recommended duration of treatment for endocarditis resulting from other streptococci may be excessive and treatment trials evaluating 2 and 4 week regimens are justified.
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Affiliation(s)
- Arlo Upton
- Departments of Clinical Microbiology, Auckland District Health Board, Auckland, New Zealand
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