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1.
Acta Biomed ; 93(1): e2022030, 2022 03 14.
Article in English | MEDLINE | ID: covidwho-1754144

ABSTRACT

With the rising number of COVID-19 patients, there have been reports of patients presenting with concomitant infective endocarditis.  In this retrospective review, we included all articles from Medline with COVID-19 and infective endocarditis coinfection.  Ten articles were identified from eight different countries over the world over the past 11 months.  All patients reported with the above coinfections were male with a mean age of 53 years.  Clinical features of COVID-19 and the presence of ground-glass opacity in CT thorax were predominant among patients with positive RT-PCR for COVID-19.  New-onset embolic infarct, pulmonary edema was a contributor to the diagnosis of endocarditis in most patients.  Involvement of the aortic valve was most common.  Delayed diagnosis and cardiac surgery were contributors to increased morbidity.


Subject(s)
COVID-19 , Coinfection , Endocarditis, Bacterial , Endocarditis , COVID-19/complications , Endocarditis/complications , Endocarditis/diagnosis , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/surgery , Humans , Male , Middle Aged , Retrospective Studies
2.
BMJ Case Rep ; 15(2)2022 Feb 28.
Article in English | MEDLINE | ID: covidwho-1714388

ABSTRACT

Embolic events causing stroke and intracranial haemorrhage are among the most catastrophic complications of infective endocarditis (IE).A female patient presented with acute unilateral weakness following a 3-month history of fever, for which she had multiple remote consultations with her general practitioner. A brain MRI confirmed a left sided infarct with haemorrhagic transformation. Blood cultures grew Streptococcus mitis and her cardiac imaging showed an aortic valve vegetation with severe aortic regurgitation. Following 2 weeks of antibiotics she developed a new cerebral haemorrhage associated with a mycotic aneurysm which was treated with two coils. After discussions within the multidisciplinary meeting, she underwent aortic valve replacement 3 weeks later. She made a remarkable recovery and was discharged.Our case highlights the importance of face-to-face clinical review in the post-COVID era. It stresses that the management of patients with infective endocarditis and neurological complications is challenging and requires a multidisciplinary approach.


Subject(s)
COVID-19 , Endocarditis, Bacterial , Endocarditis , Remote Consultation , Aortic Valve/diagnostic imaging , Aortic Valve/surgery , Delayed Diagnosis , Endocarditis/complications , Endocarditis/diagnosis , Endocarditis/surgery , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/drug therapy , Female , Humans , SARS-CoV-2
3.
APMIS ; 130(5): 270-275, 2022 May.
Article in English | MEDLINE | ID: covidwho-1714127

ABSTRACT

We report a case of Staphylococcus warneri native valve endocarditis in an immunocompetent healthy adult, without known risk factors for infective endocarditis, two months following COVID-19 infection, who recovered with conservative treatment. Additionally, we reviewed previous cases of native valve endocarditis caused by Staphylococcus warneri and summarized the main clinical implications.


Subject(s)
COVID-19 , Endocarditis, Bacterial , Endocarditis , Staphylococcal Infections , Adult , Aortic Valve , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/drug therapy , Humans , Staphylococcal Infections/drug therapy , Staphylococcus
4.
Am J Med Sci ; 364(1): 16-22, 2022 Jul.
Article in English | MEDLINE | ID: covidwho-1702116

ABSTRACT

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.


Subject(s)
COVID-19 , Endocarditis, Bacterial , Endocarditis , Staphylococcal Infections , Adult , Aged , COVID-19/complications , Endocarditis/epidemiology , Endocarditis, Bacterial/diagnosis , Female , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , Staphylococcal Infections/complications
6.
Pediatr Infect Dis J ; 41(2): e58-e59, 2022 02 01.
Article in English | MEDLINE | ID: covidwho-1541588

ABSTRACT

We present a case of a 10-year-old male with Staphylococcus aureus mitral endocarditis who was initially misdiagnosed with multisystem inflammatory syndrome associated with coronavirus disease 2019, with eventual fatal outcome due to brain hemorrhage after cardiac intervention. Our case differs from recent studies, in which microbleeds did not increase the risk of hemorrhagic stroke or global mortality risk.


Subject(s)
Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/surgery , Mitral Valve Insufficiency/diagnosis , Mitral Valve Insufficiency/surgery , Staphylococcal Infections/diagnosis , Staphylococcal Infections/surgery , COVID-19/complications , COVID-19/diagnosis , Child , Diagnostic Errors , Fatal Outcome , Humans , Intracranial Hemorrhages/diagnostic imaging , Male , Systemic Inflammatory Response Syndrome/diagnosis
7.
BMJ Case Rep ; 14(8)2021 Aug 03.
Article in English | MEDLINE | ID: covidwho-1341315

ABSTRACT

A 50-year-old man with no medical history of note presented with new onset of confusion and dyspnoea. He tested positive for coronavirus (COVID-19), and subsequently, was admitted to the intensive care unit due to severe sepsis and acute renal failure requiring haemodialysis. Shortly afterwards, he was intubated due to haemodynamic instability. His blood culture was positive for Staphylococcus aureus bacteraemia, and echocardiogram showed evidence of vegetation in the aortic valve area. He was commenced on intravenous antibiotics for infective endocarditis (IE). Following extubation, he underwent an MRI of the spine due to increasing back pain. This was suggestive of L5-S1 discitis, likely secondary to septic emboli from IE. A few days later, he developed acute ischaemia of the left toes and extensive thrombosis of the right cubital and left iliac veins. Following a prolonged hospital admission, he was discharged home and later underwent an elective forefoot amputation from which he made a good recovery.


Subject(s)
Bacteremia , COVID-19 , Endocarditis, Bacterial , Endocarditis , Staphylococcal Infections , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/drug therapy , Humans , Male , Middle Aged , SARS-CoV-2 , Staphylococcal Infections/complications , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Staphylococcus aureus
8.
BMJ Case Rep ; 14(7)2021 Jul 29.
Article in English | MEDLINE | ID: covidwho-1334545

ABSTRACT

A 29-year-old man with a history of congenital aortic stenosis and mechanical aortic valve replacement with previous Cutibacterium acnes prosthetic valve endocarditis (PVE) presented with a 2-week history of fevers and night sweats. Transoesophageal echocardiogram revealed a 0.6 cm×0.5 cm vegetation on the mechanical aortic valve. An anaerobic blood culture became positive for C. acnes 6 days after the blood cultures were obtained. He did not have any surgical intervention. He was successfully treated with 6 weeks of ceftriaxone, followed by chronic suppression with oral doxycycline. Despite its low virulence, a growing number of C. acnes PVE cases have been reported, owing to its biofilm production. When clinical suspicion is high, extending culture incubation duration beyond the standard 5 days might be helpful. Most cases are treated with surgical repair or replacement in conjunction with antibiotics, but medical therapy alone has been documented as being successful.


Subject(s)
Endocarditis, Bacterial , Endocarditis , Heart Valve Prosthesis , Prosthesis-Related Infections , Adult , Aortic Valve , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/drug therapy , Heart Valve Prosthesis/adverse effects , Humans , Male , Propionibacterium acnes , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/drug therapy
9.
Int J STD AIDS ; 32(11): 1078-1080, 2021 10.
Article in English | MEDLINE | ID: covidwho-1228970

ABSTRACT

Gonococcal infections have been increasing worldwide and in the United States. Rarely, Neisseria gonorrhoeae can cause disseminated disease, including endocarditis. We present a case of gonococcal endocarditis, confirmed by blood cultures and 16S rRNA sequencing on excised valvular tissue. Prior to presentation with heart failure, our patient was asymptomatic. Most gonococcal infections are diagnosed through routine screening of individuals at risk. During the COVID-19 pandemic, healthcare contact for nonurgent complaints has decreased, and test kit shortage has been a factor. With increased incidence and decreased opportunities for screening, healthcare providers should be aware of rising gonococcal infections, as well as potential complications.


Subject(s)
COVID-19 , Endocarditis, Bacterial , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/drug therapy , Humans , Pandemics , RNA, Ribosomal, 16S/genetics , SARS-CoV-2 , United States
10.
Echocardiography ; 38(5): 798-804, 2021 05.
Article in English | MEDLINE | ID: covidwho-1132888

ABSTRACT

The COVID-19 pandemic has presented countless new challenges for healthcare providers including the challenge of differentiating COVID-19 infection from other diseases. COVID-19 infection and acute endocarditis may present similarly, both with shortness of breath and vital sign abnormalities, yet they require very different treatments. Here, we present two cases in which life-threatening acute endocarditis was initially misdiagnosed as COVID-19 infection during the height of the pandemic in New York City. The first was a case of Klebsiella pneumoniae mitral valve endocarditis leading to papillary muscle rupture and severe mitral regurgitation, and the second a case of Streptococcus mitis aortic valve endocarditis with heart failure due to severe aortic regurgitation. These cases highlight the importance of careful clinical reasoning and demonstrate how cognitive errors may impact clinical reasoning. They also underscore the limitations of real-time reverse transcription-polymerase chain reaction (RT-PCR) for SARS-CoV-2 testing and illustrate the ways in which difficulty interpreting results may also influence clinical reasoning. Accurate diagnosis of acute endocarditis is critical given that surgical intervention can be lifesaving in unstable patients.


Subject(s)
COVID-19 , Endocarditis, Bacterial , Endocarditis , Heart Valve Prosthesis , Aortic Valve , COVID-19 Testing , Diagnostic Errors , Endocarditis, Bacterial/diagnosis , Humans , Pandemics , SARS-CoV-2
11.
BMC Cardiovasc Disord ; 20(1): 494, 2020 11 23.
Article in English | MEDLINE | ID: covidwho-1094026

ABSTRACT

BACKGROUND: Infective endocarditis has a relevant clinical impact due to its high morbidity and mortality rates. Right-sided endocarditis has lower complication rates than left-sided endocarditis. Common complications are multiple septic pulmonary embolisms, haemoptysis, and acute renal failure. Risk factors associated with right-sided infective endocarditis are commonly related to intravenous drug abuse, central venous catheters, or infections due to implantable cardiac devices. However, patients with congenital ventricular septal defects might be at high risk of endocarditis and haemodynamic complications. CASE PRESENTATION: In the following, we present the case of a 23-year-old man without a previous intravenous drug history with tricuspid valve Staphylococcus aureus endocarditis complicated by acute renal failure and haemoptysis caused by multiple pulmonary emboli. In most cases, right-sided endocarditis is associated with several common risk factors, such as intravenous drug abuse, a central venous catheter, or infections due to implantable cardiac devices. In this case, we found a small perimembranous ventricular septal defect corresponding to a type 2 Gerbode defect. This finding raised the suspicion of a congenital ventricular septal defect complicated by a postendocarditis aneurysmal transformation. CONCLUSIONS: Management of the complications of right-sided infective endocarditis requires a multidisciplinary approach. Echocardiographic approaches should include screening for ventricular septal defects in patients without common risk factors for tricuspid valve endocarditis. Patients with undiagnosed congenital ventricular septal defects are at high risk of infective endocarditis. Therefore, endocarditis prophylaxis after dental procedures and/or soft-tissue infections is highly recommended. An acquired ventricular septal defect is a very rare complication of infective endocarditis. Surgical management of small ventricular septal defects without haemodynamic significance is still controversial.


Subject(s)
Acute Kidney Injury/etiology , Coronary Circulation , Endocarditis, Bacterial/microbiology , Heart Septal Defects, Ventricular/physiopathology , Hemodynamics , Hemoptysis/etiology , Staphylococcal Infections/microbiology , Acute Kidney Injury/microbiology , Acute Kidney Injury/physiopathology , Anti-Bacterial Agents/therapeutic use , Conservative Treatment , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/drug therapy , Heart Septal Defects, Ventricular/complications , Heart Septal Defects, Ventricular/diagnostic imaging , Hemoptysis/microbiology , Hemoptysis/physiopathology , Humans , Male , Risk Factors , Staphylococcal Infections/complications , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapy , Treatment Outcome , Young Adult
12.
BMJ Case Rep ; 14(2)2021 Feb 18.
Article in English | MEDLINE | ID: covidwho-1090979

ABSTRACT

A 9-year-old child, with a background of repaired pulmonary atresia and Ebstein's anomaly, presented with fever, night sweats and lethargy. Blood cultures grew Granulicatella elegans, a nutritionally variant Streptococcus and known cause of infective endocarditis (IE). Echocardiogram revealed no clear vegetation, but increased stenosis of the right ventricle to pulmonary artery conduit. The child was successfully managed with high-dose benzylpenicillin, completing 2 weeks in the hospital, and was discharged to complete the final 4 weeks of therapy with ceftriaxone in the community, as per European Society of Cardiology guidance. IE caused by any Granulicatella species is rare, with infection due to G. elegans rarer still. It is a Gram-positive bacteria that presents a diagnostic challenge due to non-specific symptoms at presentation and difficulty in growing the organism on culture medium. We present a case of G. elegans endocarditis in a young child, which illustrates the challenges in managing this condition and the importance of considering atypical organism endocarditis in children presenting with fever of unknown origin, in particular those with a background of congenital cardiac disease. We review the literature on Granulicatella endocarditis, and briefly discuss the challenges of managing this condition in a child with an autism spectrum disorder and learning difficulties.


Subject(s)
Autism Spectrum Disorder , Endocarditis, Bacterial , Endocarditis , Gram-Positive Bacterial Infections , Carnobacteriaceae , Child , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/drug therapy , Gram-Positive Bacterial Infections/diagnosis , Gram-Positive Bacterial Infections/drug therapy , Humans , Streptococcus
13.
BMJ Case Rep ; 14(1)2021 Jan 06.
Article in English | MEDLINE | ID: covidwho-1013027

ABSTRACT

We present a case of a 75-year-old woman with Austrian syndrome: pneumonia, meningitis and endocarditis all due to Streptococcus pneumoniae Transoesophageal echocardiogram demonstrated a large mitral valve vegetation with severe mitral regurgitation. She was treated with intravenous ceftriaxone and listed for surgical repair of her mitral valve. Preoperatively, she developed an idiosyncratic drug-induced agranulocytosis secondary to ceftriaxone, which resolved on cessation of the medication. However, while awaiting neutrophil recovery, she developed an acute deterioration, becoming critically unwell. This deterioration was multifactorial, with acute decompensated heart failure alongside COVID-19. After multidisciplinary discussion, she was considered too unwell for surgery and palliated.


Subject(s)
Agranulocytosis/chemically induced , COVID-19/epidemiology , Ceftriaxone/adverse effects , Endocarditis, Bacterial/epidemiology , Meningitis, Bacterial/epidemiology , Pneumococcal Infections/epidemiology , SARS-CoV-2 , Aged , Agranulocytosis/epidemiology , Anti-Bacterial Agents/adverse effects , Comorbidity , Echocardiography, Transesophageal , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/microbiology , Female , Humans , Meningitis, Bacterial/microbiology , Pandemics , Pneumococcal Infections/microbiology , Streptococcus pneumoniae/isolation & purification , Syndrome
14.
BMJ Case Rep ; 13(11)2020 Nov 04.
Article in English | MEDLINE | ID: covidwho-957913

ABSTRACT

A 60-year-old man recently admitted for bipedal oedema, endocarditis and a persistently positive COVID-19 swab with a history of anticoagulation on rivaroxaban for atrial fibrillation, transitional cell carcinoma, cerebral amyloid angiopathy, diabetes and hypertension presented with sudden onset diplopia and vertical gaze palsy. Vestibulo-ocular reflex was preserved. Simultaneously, he developed a scotoma and sudden visual loss, and was found to have a right branch retinal artery occlusion. MRI head demonstrated a unilateral midbrain infarct. This case demonstrates a rare unilateral cause of bilateral supranuclear palsy which spares the posterior commisure. The case also raises a question about the contribution of COVID-19 to the procoagulant status of the patient which already includes atrial fibrillation and endocarditis, and presents a complex treatment dilemma regarding anticoagulation.


Subject(s)
Aspirin/administration & dosage , Atrial Fibrillation , Blindness , Brain Stem Infarctions , Coronavirus Infections , Diplopia , Endocarditis, Bacterial , Ophthalmoplegia , Pandemics , Pneumonia, Viral , Pyrazoles/administration & dosage , Pyridones/administration & dosage , Retinal Artery Occlusion , Atrial Fibrillation/complications , Atrial Fibrillation/drug therapy , Betacoronavirus/isolation & purification , Blindness/diagnosis , Blindness/etiology , Brain Stem Infarctions/diagnostic imaging , Brain Stem Infarctions/drug therapy , Brain Stem Infarctions/physiopathology , COVID-19 , Coronavirus Infections/complications , Coronavirus Infections/diagnosis , Coronavirus Infections/physiopathology , Diplopia/diagnosis , Diplopia/etiology , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/physiopathology , Factor Xa Inhibitors/administration & dosage , Humans , Magnetic Resonance Imaging/methods , Male , Middle Aged , Ophthalmoplegia/diagnosis , Ophthalmoplegia/etiology , Platelet Aggregation Inhibitors/administration & dosage , Pneumonia, Viral/complications , Pneumonia, Viral/diagnosis , Pneumonia, Viral/physiopathology , Retinal Artery Occlusion/diagnostic imaging , Retinal Artery Occlusion/drug therapy , Retinal Artery Occlusion/etiology , Retinal Artery Occlusion/physiopathology , SARS-CoV-2 , Tomography, Optical Coherence/methods , Treatment Outcome
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