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PubMed2004

A rare case of Listeria monocytogenes presenting as prosthetic valve bacterial endocarditis and aortic root abscess.

Listeria monocytogenes is a gram-positive bacillus that is rarely associated with infections in the general population. Those susceptible to this pathogen include neonates, pregnant women, and the immunocompromised. The most common clinical manifestations of listeriosis are bacteremia and meningitis. Endocarditis caused by L. monocytogenes is rare with less than 60 cases reported in the world literature. We report the case of an 81-year-old man who suffered aortic prosthetic valve listeria endocarditis, and examine the literature regarding this rare manifestation of human listeriosis.

Aged↗
PubMed1976

Immediate and long-term results of emergency aortic valve replacement in acute bacterial endocarditis.

A surgically treated material comprising 18 patinets with heart failure from aortic insufficiency during acute endocarditis has been reviewed. At the time of operation the mean duration of heart failure was 3 weeks and duration of endocarditis 9 weeks. Blood culture was positive in half of the patients, 39% had predisposing valve disease, 14 (78%) had a preoperative heart catheterization. The peroperatively measured regurgitation averaged 55%. All 18 patients had an artifical valve implanted, and the mean observation time for 13 long-term survivors was 3 1/3 years. There were 3 postoperative and 2 late deaths. A long-term survival rate of 73% strongly supports early surgical treatment in patients with aortic insufficiency and heart failure during acute endocarditis.

Acute Disease↗
PubMed1990

Cardiovascular infections: bacterial endocarditis of oral origin. Pathogenesis and prophylaxis.

The diagnosis infective endocarditis describes infection of the endocardial surface of the heart and indicates the presence of micro-organisms in the lesion. In most cases, the heart valves are affected, but the disease can also occur on septal defects or on the mural endocardium. The disease has been classified as acute or subacute based on the progression of the untreated disease. The acute form has a fulminant course with high fever and leukocytosis with death in less than 6 weeks. It is most often associated with infections caused by Staphylococcus aureus, Streptococcus pneumoniae or Streptococcus pyogenes. The subacute (death within 6 weeks to 3 months) and chronic (death more than 3 months) forms are mostly described together. These forms usually occur in patients with prior valvular disease and are characterized by a slow, indolent course with low-grade fever, night sweats, and weight loss. This form is usually caused by the viridansstreptococci. The above mentioned classification does not include the nonbacterial forms of endocarditis and enterococci often give rise to a disease intermediate between acute and subacute endocarditis. It is preferable to have a classification based on the micro-organism responsible since this classification has implications for the course followed and the appropriate antimicrobial agent to use. The clinical manifestations of the disease are so varied that they may be encountered in most medical subspecialities. Successful management is also dependent on the close cooperation of medical and dental disciplines.

Endocarditis, Bacterial↗
PubMed1999

Predominant tricuspid stenosis secondary to bacterial endocarditis in a patient with permanent pacemaker and balloon dilatation of the stenosis.

In a 49-year-old woman with sick sinus syndrome and a permanent VVI pacemaker, severe tricuspid stenosis and its clinical consequences developed 4 years after the attack of endocarditis. Besides the quite unusual occurrence of lead related tricuspid stenosis, successful treatment with balloon dilatation is the unique feature of this case.

Catheterization↗
PubMed1975

Mechanism of anaemia in experimental bacterial endocarditis.

Rabits with Streptococcus viridans aortic valve endocarditis develop anaemia and reticulocytosis which increase with the duration of infection. Mean red cell counts decreased from 6.05 +/- 0.29 X 10(6) per mul before infection to 4.10 +/- 0.18 X 10(6) per mul after 11 to 20 days of endocarditis and reticulocytes increased from 1.16 +/- 0.14 X 10(5) per mul to 4.91 +/- 0.83 X 10(5) per mul after more than 20 days of endocarditis. The anaemia could not be explained by intravascular haemolysis. Anti-erythrocyte antibodies were not detected. Splenomegaly was a consistent finding and also increased with the duration of infection. Red cell half life (T1/2) was shortened to 4.7 +/- 0.3 days in rabbits with endocarditis compared with normal T1/2 of 11.1 +/- 0.5 days. The T1/2 of red cells from infected animals was prolonged when measured in noninfected rabbits and splenectomized animals had a mean red cell T1/2 of 9.25 days after three weeks of infection. These studies suggest that splenic enlargement associated with infection results in red cell sequestration, a mechanism not well recognized as contributing to the anaemia of endocarditis.

Anemia↗
PubMed1999

Cranial magnetic resonance imaging findings in bacterial endocarditis: the neuroimaging spectrum of septic brain embolization demonstrated in twelve patients.

Infective endocarditis (IE) is an elusive systemic disorder that is often associated with neurologic complications. The contribution of brain magnetic resonance imaging (MRI) to the diagnosis of IE and the spectrum of such findings has been only sparsely described previously. The authors report cranial MRI findings in 12 patients with IE. Each of the patients had MRI evidence of cerebral embolization, with multiple brain lesions noted in most patients (n = 10). Cortical branch infarction was the most common lesion (n = 8), which usually involved the distal middle cerebral artery tree. The next most common finding (n = 7) was numerous small embolic lesions which typically lodged in the supratentorial gray-white junction, some of which were clinically silent and many of which enhanced (probable microabscesses). Brain hemorrhages were noted in four patients, most commonly subarachnoid hemorrhage (n = 3). Two patients developed multiple frank parenchymal macroabscesses/cerebritis lesions. A previously unreported finding in septic embolization, a stroke that became infected with abscess formation ("septic infarction"), was noted in two patients. MRI showed orbital cellulitis in two patients. Most patients studied with gadolinium showed enhancement of lesions (n = 5/8). The authors conclude that cranial MRI may be a valuable tool in the evaluation of patients with IE. The presence of characteristic cranial MRI lesions, especially of multiple types, may prompt early diagnosis and treatment.

Adult↗
PubMed1997

Molecular diagnosis of bacterial endocarditis by broad-range PCR amplification and direct sequencing.

Broad-range PCR amplification of part of the 16S rRNA gene followed by single-strand sequencing was applied to samples of 18 resected heart valves from patients with infective endocarditis. The PCR results were compared with those of cultures of valves and with those of previous blood cultures. For two patients there was agreement with the cultures of the valves; for nine patients there was agreement with the previous blood cultures, which were positive, while the cultures of the valves were negative; a Streptococcus sp. and Tropheryma whippelii each were found in one patient with negative cultures (valve and blood); for two patients the cultures of the valves as well as the PCR results were negative but the blood cultures were positive; for one patient amplification was inhibited; and for two patients the PCR results were positive but the amplicons could not be sequenced. It is concluded that broad-range PCR is a promising tool for patients with culture-negative endocarditis and allows the detection of rare, noncultivable organisms.

Actinobacteria↗