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1.
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
2.
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
3.
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
4.
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
5.
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
6.
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
7.
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
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