ABSTRACT
BACKGROUND: Legionella is a well known but infrequent cause of bacterial endocarditis. METHODS: We report a case of endocarditis caused by Legionella spp. We reviewed previously reported cases in PubMed, Google Scholar and in references included in previous reports, and summarized relevant clinical data. RESULTS: A 63-year-old man with a history of aortic valve replacement developed persistent fever and monoarthritis. Transesophageal echocardiography showed perivalvular abscess. He died during surgery. Blood and valve cultures were negative. Legionella spp. was demonstrated with 16S-rRNA PCR from the resected material. Twenty cases of Legionella endocarditis have been reported. Harboring a prosthetic valve was the main risk factor. Prognosis was favorable, both for patients treated with or without surgical valve replacement. Overall mortality was <10%. CONCLUSIONS: Legionella is an infrequent cause of endocarditis. It frequently requires surgical treatment. Prognosis is good. Molecular techniques are likely to become the gold standard for diagnosis.
Subject(s)
Endocarditis, Bacterial , Endocarditis , Heart Valve Prosthesis , Legionella , Abscess/complications , Endocarditis, Bacterial/microbiology , Heart Valve Prosthesis/adverse effects , Humans , Male , Middle AgedABSTRACT
BackgroundLegionella is a well known but infrequent cause of bacterial endocarditis.MethodsWe report a case of endocarditis caused by Legionella spp. We reviewed previously reported cases in PubMed, Google Scholar and in references included in previous reports, and summarized relevant clinical data.ResultsA 63-year-old man with a history of aortic valve replacement developed persistent fever and monoarthritis. Transesophageal echocardiography showed perivalvular abscess. He died during surgery. Blood and valve cultures were negative. Legionella spp. was demonstrated with 16S-rRNA PCR from the resected material. Twenty cases of Legionella endocarditis have been reported. Harboring a prosthetic valve was the main risk factor. Prognosis was favorable, both for patients treated with or without surgical valve replacement. Overall mortality was <10%.ConclusionsLegionella is an infrequent cause of endocarditis. It frequently requires surgical treatment. Prognosis is good. Molecular techniques are likely to become the gold standard for diagnosis.
IntroducciónLegionella es una causa bien conocida, aunque infrecuente, de endocarditis bacteriana.MétodosA continuación, presentamos un caso de endocarditis por Legionella spp. Hemos revisado los casos publicados hasta la fecha en PubMed, Google Scholar y otras referencias incluidas en las comunicaciones previas, y resumimos aquí los datos clínicos relevantes. Un varón de 63 años con historia de recambio valvular aórtico desarrolló fiebre y monoartritis por lo que se realizó un ecocardiograma transesofágico que demostró un absceso perivalvular. Se decidió tratamiento quirúrgico, y el paciente falleció durante la cirugía. Los cultivos tanto de sangre como valvulares fueron negativos. El análisis mediante 16S rRNA PCR del material valvular resecado durante la cirugía demostró Legionella spp. Se han publicado un total de veinte casos de endocarditis por Legionella en la literatura médica. El principal factor de riesgo observado fue la presencia de una válvula protésica. El pronóstico fue bueno tanto para los pacientes tratados de manera conservadora como para aquellos sometidos a recambio valvular quirúrgico. La mortalidad global fue <10%.ConclusionesLegionella es una causa infrecuente de endocarditis. Generalmente requiere tratamiento quirúrgico. El pronóstico es bueno. Las técnicas moleculares podrían convertirse en el método de referencia para su diagnóstico.
Subject(s)
Humans , Male , Adult , Health Sciences , Endocarditis, Bacterial , Legionella , Blood Culture , Microbiology , Communicable Diseases , Case-Control StudiesABSTRACT
BACKGROUND: Legionella is a well known but infrequent cause of bacterial endocarditis. METHODS: We report a case of endocarditis caused by Legionella spp. We reviewed previously reported cases in PubMed, Google Scholar and in references included in previous reports, and summarized relevant clinical data. RESULTS: A 63-year-old man with a history of aortic valve replacement developed persistent fever and monoarthritis. Transesophageal echocardiography showed perivalvular abscess. He died during surgery. Blood and valve cultures were negative. Legionella spp. was demonstrated with 16S-rRNA PCR from the resected material. Twenty cases of Legionella endocarditis have been reported. Harboring a prosthetic valve was the main risk factor. Prognosis was favorable, both for patients treated with or without surgical valve replacement. Overall mortality was <10%. CONCLUSIONS: Legionella is an infrequent cause of endocarditis. It frequently requires surgical treatment. Prognosis is good. Molecular techniques are likely to become the gold standard for diagnosis.
