Bacterial co-infections and superinfections in COVID-19: a case report of right heart infective endocarditis and literature review

Impact of the SARS-CoV-2 Pandemic on the Management and Prognosis of Infective Endocarditis

BACKGROUND

Infective endocarditis (IE) is a serious condition which is difficult to diagnose and to treat, both medically and surgically.

OBJECTIVES

The objective of this study was to evaluate the impact of the SARS-CoV-2 pandemic on the management of patients with IE.

METHODS

We conducted a single-centre retrospective study including patients hospitalized for IE during the pandemic (Group 2) compared with the same period the year before (Group 1). We compared clinical, laboratory, imagery, therapeutic, and patient outcomes between the two groups.

RESULTS

A total of 283 patients were managed for possible or definite IE (164 in Group 1 and 119 in Group 2). There were more intravenous drug-related IE patients in Group 2 (p = 0.009). There was no significant difference in surgery including intra-cardiac device extraction (p = 0.412) or time to surgery (p = 0.894). The one-year mortality was similar in both groups (16% versus 17.7%, p = 0.704). The recurrence rate was not significantly different between the two groups (5.9% in Group 2 versus 9.1% in Group 1, p = 0.311).

CONCLUSIONS

The SARS-CoV-2 pandemic did not appear to have had a negative impact on the management of patients with IE. Maintenance of the activities of the endocarditis team within the referral centre probably contributed to this result. Nevertheless, the high proportion of intravenous drug-addicted patients in the pandemic cohort suggests that the SARS-CoV-2 pandemic had a major psychosocial impact.

Endocarditis caused by Aspergillus fumigatus in a patient 9 months after COVID-19 infection recovery: a case report and review of the literature

BACKGROUND

Aspergillus spp. are among the fungal pathogens that can cause life-threatening infections in patients with a history of COVID-19.

CASE PRESENTATION

We present the case of a 58-year-old Iranian woman with post-COVID-19 Aspergillus fumigatus endocarditis complicated by numerous thromboembolisms. She underwent mitral valve replacement surgery and multiple lower extremity embolectomies and was treated with voriconazole, which led to her final recovery.

CONCLUSIONS

Aspergillus endocarditis should be considered in any patient with suspected endocarditis who has a history of COVID-19 infection and does not respond to routine antibiotic and antifungal therapy, as COVID-19 interferes with proper immune function, and lack of underlying cardiac conditions and immunodeficiencies does not preclude the diagnosis. Culture and histopathological evaluation of vegetations and emboli, as well as PCR, can confirm the diagnosis. Early initiation of antifungal therapy and surgical removal of infected valves and emboli can improve prognosis in patients with Aspergillus endocarditis.

Infective Endocarditis as a complication of COVID-19 infection; A case report and review of literature

COVID-19 has been known to induce systemic inflammation and hyper coagulate state leading to different complications. Cardiovascular complications are one of the most important among complications following COVID-19 infection. A 57 years old woman with past medical history of COVID-19 infection about two months ago came to our hospital with presentation of fever and dyspnea. During workup, tricuspid valve infection associated with pulmonary septic emboli was diagnosed without any obvious risk factor for infective endocarditis. It seems that COVID-19 infection may increase the rate of endocarditis in patients with or without risk factors of endocarditis.

COVID-19 Vaccines and Myocarditis: An Overview of Current Evidence

COVID-19 vaccines have been widely used to reduce the incidence and disease severity of COVID-19. Questions have lately been raised about the possibility of an association between COVID-19 vaccines and myocarditis, an inflammatory condition affecting the myocardium, or the middle layer of the heart. Myocarditis can be caused by infections, immune reactions, or toxic exposure. The incidence rate of myocarditis and pericarditis was calculated to be 5.98 instances per million COVID-19 vaccine doses delivered, which is less than half of the incidences after SARS-CoV-2 infection. Myocarditis rates in people aged 12 to 39 years are around 12.6 cases per million doses following the second dose of mRNA vaccination. Adolescent men are more likely than women to develop myocarditis after receiving mRNA vaccines. The objectives of this systematic review and meta-analysis are to find out how often myocarditis occurs after receiving the COVID-19 vaccine, as well as the risk factors and clinical repercussions of this condition. Nevertheless, the causal relationship between vaccination and myocarditis has been difficult to establish, and further research is required. It is also essential to distinguish between suggested cases of myocarditis and those confirmed by endomyocardial biopsy.

[Global and national trends in the evolution of infective endocarditis]

For the recent 20 years, substantial changes have occurred in all aspects of infectious endocarditis (IE), the evolution of risk factors, modernization of diagnostic methods, therapeutic and preventive approaches. The global trends are characterized by increased IE morbidity among people older than 65 who use intravenous psychoactive drugs. The epidemiological trend is represented by reduced roles of chronic rheumatic heart disease and congenital heart defects, increased proportion of IE associated with medical care, valve replacement, installation of intracardiac devices, and increased contribution of Staphylococcus spp. and Enterococcus spp. to the IE etiology. Additional visualization methods (fluorodeoxyglucose positron emission tomography with 18F-fludesoxyglucose (18F-FDG PET-CT), labeled white blood cell single-photon emission computed tomography (SPECT), and modernization of the etiological diagnostic algorithm for determining the true pathogen (immunochemistry, polymerase chain reaction, sequencing) also become increasingly important. The COVID-19 pandemic has also adversely contributed to the IE epidemiology. New prospects of treatment have emerged, such as bacteriophages, lysins, oral antibacterial therapy, minimally invasive surgical strategies (percutaneous mechanical aspiration), endovascular mechanical embolectomy. The physicians' compliance with clinical guidelines (CG) is low, which contributes to the high rate of adverse outcomes of IE, while simple adherence to the CG together with more frequent use of surgical treatment doubles survival. Systematic adherence to CG, timely prevention and implementation of the Endocarditis Team into practice play the decisive role in a favorable prognosis of dynamically changing IE. This article presents the authors' own data that confirm the evolutionary trends of current IE.

Endocarditis in the intensive care unit: an update

PURPOSE OF REVIEW

The incidence of infective endocarditis (IE) is increasing worldwide, resulting in a higher number of patients with IE being admitted to intensive care units (ICU). Nearly half of patients with IE develop a complication during their clinical course. However, few well conducted studies or reviews are devoted to critically ill IE patients. This review discusses the contemporary perioperative and intensive care literature.

RECENT FINDINGS

IE epidemiology is changing towards elderly and frail patients. ICU patients are at risk of risk of developing IE because they are often in a pro-inflammatory state and many also have several indwelling catheters, which favors infection. Increased performance and recent advances in cardiac imaging allow for easier diagnosis of EI, but the applicability of these techniques to ICU patients is still relatively limited. New developments in antibiotic treatment and adjunctive therapies are explored further in this review.

SUMMARY

The lack of evidence on ICU patients with IE highlights the critical importance of multidisciplinary decision-making and the need for further research.

TEA Clinical Profile of Infective Endocarditis in Patients with Recent COVID-19: A Systematic Review

Background

Coronavirus disease 2019 (COVID-19) can progress to cardiovascular complications which are linked to higher in-hospital mortality rates. Infective endocarditis (IE) can develop in patients with recent COVID-19 infections, however, characterization of IE following COVID-19 infection has been lacking. To better characterize this disease, we performed a systematic review with descriptive analysis of the clinical features and outcomes of these patients.

Methods

Our search was conducted in 8 databases for all published reports of probable or definite IE in patients with a prior COVID-19 confirmed diagnosis. After ensuring an appropriate inclusion of the articles, we extracted data related to clinical characteristics, modified duke criteria, microbiology, outcomes, and procedures.

Results

Searches generated a total of 323 published reports, and 20 articles met our inclusion criteria. The mean age of patients was 52.2 ± 16.9 years and 76.2% were males. Staphylococcus aureus was isolated in 8 (38.1%) patients, Enterococcus faecalis in 3 patients (14.3%) and Streptococcus mitis/oralis in 2 (9.5%) patients. The mean time interval between COVID-19 and IE diagnoses was 16.7 ± 15 days. Six (28.6%) patients required critical care due to IE, 7 patients (33.3%) underwent IE-related cardiac surgery and 5 patients (23.8%) died during their IE hospitalization.

Conclusions

Our systematic review provides a profile of clinical features and outcomes of patients with a prior COVID-19 infection diagnosis who subsequently developed IE. Due to the ongoing COVID-19 pandemic, it is essential that clinicians appreciate the possibility of IE as a unique complication of COVID-19 infection.

Infective endocarditis following COVID-19 pneumonia: about two cases

Coronavirus disease 2019 (COVID-19) has emerged as a pandemic and public health crisis across the world. The severity of this situation is escalating in certain populations, particularly when the COVID-19 diagnosis may delay the recognition of more dramatic illnesses such as infective endocarditis, which is a dreaded complication in patients with cardiac disease. We report the case of two patients who presented with infective endocarditis initially mistaken for COVID-19 pneumonia, which was responsible for a delay in diagnosis. We discuss the diagnostic difficulties as well as the management of this complication in the COVID-19 era. As a physician, one must remain alert to this dreaded complication, especially in patients with a cardiac history, in order to prevent it, detect it early, and manage it in time.

A fatal case of infective endocarditis complicated by acute COVID-19 pneumonia

A 74-year-old man with no co-morbidities presented to hospital with a 3-day history of diarrhoea and vomiting. He met the modified Duke’s criteria for definite infective endocarditis and was immediately started on an intravenous antibiotic. Over Days 1–9, he developed renal failure. On Day 10, he was transferred to a tertiary hospital for mitral valve replacement. However, he tested positive for SARS-CoV-2 on arrival at the tertiary hospital, which delayed his surgery. He underwent bi-weekly nasopharyngeal swabs for SARS-CoV-2 with a plan to operate as soon as he tested negative, or as soon as his incubation period for COVID-19 pneumonia had elapsed. Unfortunately, he died on Day 31 from acute respiratory distress syndrome secondary to COVID-19 pneumonia. We describe the challenges in deciding on the optimal timing for valve replacement. We conclude by suggesting that earlier valve replacement may result in better outcomes.