RESUMEN
Bordetella hinzii's route of transmission to human hosts and its pathogenicity remain unclear. Only a few cases have established this species as an opportunistic zoonotic disease. We introduce the first reported case of native aortic valve endocarditis presenting with fulminant aortic valve insufficiency that responded to conventional medical and surgical treatment. The patient did not have predisposing factors to this unusual infection. This case may provide a better understanding of the disease process, transmission, and pathogenicity of Bordetella hinzii.
Asunto(s)
Insuficiencia de la Válvula Aórtica/etiología , Válvula Aórtica/microbiología , Infecciones por Bordetella/microbiología , Bordetella/aislamiento & purificación , Endocarditis Bacteriana/microbiología , Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/diagnóstico , Insuficiencia de la Válvula Aórtica/microbiología , Biopsia , Infecciones por Bordetella/complicaciones , Infecciones por Bordetella/diagnóstico , Ecocardiografía Doppler , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/diagnóstico , Femenino , Humanos , Persona de Mediana EdadRESUMEN
Infections of proximal aortic vascular grafts are a catastrophic complication of aortic surgery. Despite aggressive antimicrobial and surgical intervention, mortality and reinfection rates remain significant. Here, we describe a man aged 71 years with a medical history of bioprosthetic aortic valve with aortic arch replacement (modified Bentall's procedure), who developed a large periprosthetic abscess due to Staphylococcus aureus 7 years after his initial surgery. The patient's preference was to avoid redo surgery, however despite high-dose intravenous flucloxacillin and oral rifampicin therapy, there was rapid progression of the abscess, necessitating urgent surgery. Notwithstanding the burden of infection, the patient underwent successful surgical excision and graft re-implantation and remains independent and well, almost 2 years postoperatively.
Asunto(s)
Absceso/microbiología , Insuficiencia de la Válvula Aórtica/microbiología , Implantación de Prótesis de Válvulas Cardíacas , Prótesis Valvulares Cardíacas/microbiología , Infecciones Relacionadas con Prótesis/microbiología , Absceso/fisiopatología , Absceso/cirugía , Anciano , Insuficiencia de la Válvula Aórtica/etiología , Insuficiencia de la Válvula Aórtica/cirugía , Procedimientos Quirúrgicos Cardíacos , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Humanos , Masculino , Infecciones Relacionadas con Prótesis/fisiopatología , Infecciones Relacionadas con Prótesis/cirugía , Reoperación , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Válvula Aórtica/microbiología , Endocarditis Bacteriana/microbiología , Agricultores , Infecciones Estreptocócicas/microbiología , Streptococcus suis/patogenicidad , Sus scrofa/microbiología , Insuficiencia de la Válvula Tricúspide/microbiología , Válvula Tricúspide/microbiología , Animales , Antibacterianos/uso terapéutico , Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/diagnóstico , Insuficiencia de la Válvula Aórtica/microbiología , Insuficiencia de la Válvula Aórtica/cirugía , Bioprótesis , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/cirugía , Endocarditis Bacteriana/transmisión , Prótesis Valvulares Cardíacas , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Humanos , Masculino , Persona de Mediana Edad , Pericardio/trasplante , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/cirugía , Infecciones Estreptocócicas/transmisión , Resultado del Tratamiento , Válvula Tricúspide/cirugía , Insuficiencia de la Válvula Tricúspide/diagnóstico , Insuficiencia de la Válvula Tricúspide/cirugía , ZoonosisRESUMEN
BACKGROUND The term "predisposition" is used as an indication of antimicrobial prophylaxis to prevent infective endocarditis and as a criterion for diagnosing infective endocarditis according to the modified Duke criteria. The criterion for diagnosing infective endocarditis in native valves is not well defined. OBJECTIVES To identify conditions that increase the risk for infective endocarditis in native valves, for the diagnosis of infective endocarditis according to the modified Duke criteria. In parallel, we compared the results with the year of patient inclusion for each study and echocardiographic techniques. RESULTS Our systematic review included 207 studies published from January 1970 to August 2015. Studies that focused on mitral valve prolapse (112 studies), prior infective endocarditis (96) and bicuspid aortic valve (78) provided the most data. However, only six (5.3%), three (3.1%) and one (1.3%) of these studies, respectively, used analytical statistical methods. Three (2.7%), two (2.1%) and one (1.3%), respectively, were graded as good quality studies. Odds ratios (ORs) for developing infective endocarditis were 3.58.2 for mitral valve prolapse, and 2.2 and 2.8 for prior infective endocarditis. The hazard ratio for developing infective endocarditis was 6.3 for bicuspid aortic valve. The mean prevalence proportion of infective endocarditis in patients with these three heart conditions were 8.5% (mitral valve prolapse), 8.3% (prior infective endocarditis) and 8.8% (bicuspid aortic valve). The proportions of publications prior to the publication of the modified Duke criteria were 81.8, 75.6 and 74%, respectively. Evolution of the imaging method and echocardiographic technique was estimated to be considerable for mitral valve prolapse. The literature review on aortic valve stenosis (46 studies), mitral valve insufficiency (41) and aortic valve insufficiency (39) provided two analytical studies for aortic stenosis. One study was graded as good quality and reported a hazard ratio 4.9. The mean prevalence of these heart conditions in patients with infective endocarditis were 7.3, 19.9 and 10.2%, respectively. The proportions of publications prior to the publication of the modified Duke criteria were 78, 75.6 and 79.5%, respectively. The evolution of both the echocardiographic technique and the categorisation of valve disease severity was considerable for all three entities. CONCLUSIONS The evidence for native valve heart conditions predisposing to infective endocarditis is mainly based on studies with only descriptive statistics published prior to the release of the modified Duke criteria. Mitral valve prolapse, prior infective endocarditis and bicuspid aortic valve are frequently cited as predisposing heart conditions for infective endocarditis. The evolution in echocardiographic techniques over the past decades and its influence on diagnosis was considerable for mitral valve prolapse, aortic stenosis, mitral insufficiency and aortic insufficiency.
Asunto(s)
Ecocardiografía , Endocarditis/diagnóstico , Endocarditis/microbiología , Guías como Asunto , Válvula Aórtica/anomalías , Válvula Aórtica/diagnóstico por imagen , Válvula Aórtica/microbiología , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/microbiología , Enfermedad de la Válvula Aórtica Bicúspide , Enfermedades de las Válvulas Cardíacas , Humanos , Prolapso de la Válvula Mitral , Factores de RiesgoRESUMEN
Aortic syphilis has not disappeared. Few patients with aortic syphilis are diagnosed pre-operatively or after histologic examination of the resected aortas. The gross features of the wall of the syphilitic aortic aneurysm, however, are unique allowing diagnosis of this entity on the operating table. Thirty patients aged 33 to 84 years (mean 66) (18 women) had a syphilitic aneurysm involving the tubular portion of ascending aorta resected at Baylor University Medical Center at Dallas from 2009 through 2017. That syphilis was the cause of the aneurysm was not appreciated either preoperatively or at operation. Syphilis produces characteristic changes in the aorta: it is thicker than normal due to fibrous thickening of the intima and adventitia, the intimal surface is 100% abnormal, and the sinus portion of the aorta is uninvolved. The process begins at or just distal to the sinotubular junction. Histologic findings are specific. A negative serologic test for syphilis does not rule out the presence of syphilis of the aorta. The key to identifying at operation syphilis of the aorta is to note that its entire intimal surface is abnormal, that one or more saccular aneurysms may arise from the fusiform aneurysm, that the aneurysmal wall isthicker than normal, and that the wall of the sinus portion of the aorta is spared. Identificationof the syphilitic cause appears to be important because antibiotic therapy is recommended to prevent or retard the development of neurological syphilis, particularly in the younger patients.
Asunto(s)
Aneurisma de la Aorta/microbiología , Aneurisma de la Aorta/cirugía , Insuficiencia de la Válvula Aórtica/microbiología , Insuficiencia de la Válvula Aórtica/cirugía , Sífilis Cardiovascular/diagnóstico , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Periodo Intraoperatorio , Masculino , Persona de Mediana Edad , Resultado del TratamientoAsunto(s)
Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Trombosis Coronaria/terapia , Endocarditis Bacteriana/diagnóstico , Infarto del Miocardio con Elevación del ST/terapia , Infecciones Estafilocócicas/diagnóstico , Trombectomía , Antibacterianos/uso terapéutico , Insuficiencia de la Válvula Aórtica/tratamiento farmacológico , Insuficiencia de la Válvula Aórtica/microbiología , Angiografía Coronaria , Trombosis Coronaria/complicaciones , Trombosis Coronaria/diagnóstico por imagen , Trombosis Coronaria/microbiología , Progresión de la Enfermedad , Ecocardiografía Doppler en Color , Ecocardiografía Transesofágica , Electrocardiografía , Endocarditis Bacteriana/tratamiento farmacológico , Endocarditis Bacteriana/microbiología , Resultado Fatal , Femenino , Humanos , Persona de Mediana Edad , Infarto del Miocardio con Elevación del ST/diagnóstico , Infarto del Miocardio con Elevación del ST/etiología , Infecciones Estafilocócicas/tratamiento farmacológico , Infecciones Estafilocócicas/microbiología , Resultado del TratamientoRESUMEN
Infective endocarditis is a rare disease associated with high morbidity and mortality. As a result, early diagnosis and prompt antibiotic treatment with or without surgical intervention is crucial in the management of such condition.We report a case of missed infective endocarditis of the aortic valve. The patient underwent mechanical aortic valve replacement, with the native valve being sent for histopathological examination. On re-admission 16 months later, he presented with syncope, shortness of breathing and complete heart block. On review of the histopathology of native aortic valve, endocarditis was identified which had not been acted on. The patient underwent redo aortic valve replacement for severe aortic regurgitation.We highlight the importance of following up histopathological results as well as the need for multidisciplinary treatment of endocarditis with a combination of surgical and antibiotic therapy.
Asunto(s)
Insuficiencia de la Válvula Aórtica/microbiología , Bloqueo Atrioventricular/microbiología , Errores Diagnósticos/efectos adversos , Endocarditis/diagnóstico , Implantación de Prótesis de Válvulas Cardíacas , Complicaciones Posoperatorias , Válvula Aórtica/microbiología , Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/cirugía , Bloqueo Atrioventricular/cirugía , Diagnóstico Tardío/efectos adversos , Endocarditis/microbiología , Endocarditis/cirugía , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/métodos , Humanos , Masculino , Persona de Mediana Edad , Reoperación/métodosRESUMEN
A 56-year-old man with lymphoma developed orchitis followed by septic arthritis of his right glenohumeral joint. Synovial fluid cultures were negative but PCR amplification test was positive forUreaplasmaparvum. The patient was treated with doxycycline. Two and a half years later, the patient presented with shortness of breath and grade III/IV diastolic murmur on auscultation. Echocardiography revealed severely dilated left heart chambers, severe aortic regurgitation and several mobile masses on the aortic valve cusps suspected to be vegetations. He underwent valve replacement; valve tissue culture was negative but the 16S rRNA gene amplification test was positive for U. parvumHe was treated again with doxycycline. In an outpatient follow-up 1 year and 3 months later, the patient was doing well. Repeated echocardiography showed normal aortic prosthesis function.
Asunto(s)
Insuficiencia de la Válvula Aórtica/diagnóstico , Válvula Aórtica , Linfoma , Infecciones por Ureaplasma/diagnóstico , Ureaplasma/aislamiento & purificación , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/microbiología , Insuficiencia de la Válvula Aórtica/cirugía , Diagnóstico Diferencial , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Masculino , Persona de Mediana Edad , Reacción en Cadena de la Polimerasa , ARN Ribosómico 16S , Ureaplasma/genética , Infecciones por Ureaplasma/diagnóstico por imagen , Infecciones por Ureaplasma/microbiología , Infecciones por Ureaplasma/cirugíaRESUMEN
A 66-year-old Australian man underwent elective replacement of a severely stenotic aortic valve with a 22-mm Medtronic-Hall valve. Six weeks later, he was readmitted with worsening dyspnea, fever, and mild anemia. Investigations confirmed pulmonary edema and moderate periprosthetic aortic regurgitation. The pulmonary edema was managed conservatively, and a second 22-mm Medtronic-Hall valve was implanted. Infective endocarditis was suspected in the aortic annulus below the orifice of the right coronary artery. A bacteriological study revealed a rare bacteria of Streptomyces species. The patient received intensive antibiotic therapy over a 6-week period of hospitalization, and the aortic regurgitation disappeared one week postoperatively.
Asunto(s)
Insuficiencia de la Válvula Aórtica/microbiología , Estenosis de la Válvula Aórtica/cirugía , Endocarditis Bacteriana/microbiología , Infecciones por Bacterias Grampositivas/microbiología , Implantación de Prótesis de Válvulas Cardíacas/efectos adversos , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Prótesis Valvulares Cardíacas/efectos adversos , Infecciones Relacionadas con Prótesis/microbiología , Streptomyces/aislamiento & purificación , Anciano , Antibacterianos/uso terapéutico , Insuficiencia de la Válvula Aórtica/diagnóstico , Insuficiencia de la Válvula Aórtica/cirugía , Estenosis de la Válvula Aórtica/diagnóstico por imagen , Procedimientos Quirúrgicos Electivos , Endocarditis Bacteriana/diagnóstico , Endocarditis Bacteriana/terapia , Infecciones por Bacterias Grampositivas/diagnóstico , Infecciones por Bacterias Grampositivas/terapia , Humanos , Masculino , Infecciones Relacionadas con Prótesis/diagnóstico , Infecciones Relacionadas con Prótesis/terapia , Reoperación , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del TratamientoAsunto(s)
Insuficiencia de la Válvula Aórtica/cirugía , Válvula Aórtica/cirugía , Endocarditis Bacteriana/microbiología , Endocarditis Bacteriana/cirugía , Atrios Cardíacos/cirugía , Cardiopatías/cirugía , Insuficiencia de la Válvula Mitral/cirugía , Válvula Mitral/cirugía , Infecciones Estreptocócicas , Fístula Vascular/cirugía , Adulto , Aorta , Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/complicaciones , Insuficiencia de la Válvula Aórtica/microbiología , Procedimientos Quirúrgicos Cardíacos/métodos , Ecocardiografía , Ecocardiografía Transesofágica , Endocarditis Bacteriana/diagnóstico por imagen , Estudios de Seguimiento , Atrios Cardíacos/diagnóstico por imagen , Cardiopatías/complicaciones , Cardiopatías/diagnóstico por imagen , Implantación de Prótesis de Válvulas Cardíacas , Humanos , Masculino , Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/complicaciones , Insuficiencia de la Válvula Mitral/microbiología , Streptococcus anginosus , Resultado del Tratamiento , Fístula Vascular/complicaciones , Fístula Vascular/diagnóstico por imagenRESUMEN
A 65-year-old Japanese man was admitted with a 4-month history of fatigue and exertional dyspnea. Transthoracic echocardiography revealed a vegetation on the aortic valve and severe aortic regurgitation. Accordingly, infective endocarditis and heart failure were diagnosed. Although a blood culture was negative on day 7 after admission, a prolonged blood culture with subculture was performed according to the patient's history of contact with cats. Consequently, Bartonella henselae was isolated. Bartonella species are fastidious bacteria that cause blood culture-negative infective endocarditis. This case demonstrates that B. henselae may be detected by prolonged incubation of blood cultures.
Asunto(s)
Insuficiencia de la Válvula Aórtica/microbiología , Bartonella henselae/aislamiento & purificación , Enfermedad por Rasguño de Gato/diagnóstico , Endocarditis Bacteriana/microbiología , Insuficiencia Cardíaca/microbiología , Anciano , Animales , Insuficiencia de la Válvula Aórtica/diagnóstico , Cultivo de Sangre , Enfermedad por Rasguño de Gato/etiología , Gatos , Ecocardiografía , Endocarditis Bacteriana/diagnóstico , Insuficiencia Cardíaca/diagnóstico , Humanos , MasculinoAsunto(s)
Válvula Aórtica/microbiología , Infecciones por Bartonella/diagnóstico , Bartonella quintana/aislamiento & purificación , Endocarditis Bacteriana Subaguda/diagnóstico , Endocarditis Bacteriana Subaguda/microbiología , Adulto , Amoxicilina/uso terapéutico , Antibacterianos/uso terapéutico , Válvula Aórtica/patología , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/tratamiento farmacológico , Insuficiencia de la Válvula Aórtica/etiología , Insuficiencia de la Válvula Aórtica/microbiología , Artralgia/microbiología , Infecciones por Bartonella/diagnóstico por imagen , Infecciones por Bartonella/tratamiento farmacológico , Infecciones por Bartonella/microbiología , Doxiciclina/uso terapéutico , Electrocardiografía , Endocarditis Bacteriana Subaguda/diagnóstico por imagen , Endocarditis Bacteriana Subaguda/tratamiento farmacológico , Femenino , Gentamicinas/uso terapéutico , Enfermedades de las Válvulas Cardíacas/diagnóstico por imagen , Enfermedades de las Válvulas Cardíacas/tratamiento farmacológico , Enfermedades de las Válvulas Cardíacas/microbiología , Humanos , Oxacilina/uso terapéutico , Factores Socioeconómicos , Resultado del TratamientoRESUMEN
Pneumococcal endocarditis is a rare entity, corresponding to 1 to 3% of native valve endocarditis cases. It has a typically adverse prognosis, with high mortality. There is a reported predilection for the aortic valve; thus, a common presentation is acute left heart failure. We present a case of a 60-year-old woman with a history of sinusitis, who was admitted with the diagnosis of pneumonia. She rapidly deteriorated with signs of septic shock and was transferred to the critical care unit. The transesophageal echocardiogram revealed severe aortic regurgitation due to valve vegetations. Blood cultures were positive for Streptococcus pneumoniae. She underwent cardiac surgery and had multiple postoperative complications. Nonetheless, the patient made a slow and complete recovery. Infectious endocarditis should be ruled out if any suspicion arises, and echocardiography should be performed in an early stage in patients with poor response to vasopressors and inotropes. Patients with pneumococcal endocarditis benefit from an aggressive approach, with performance of early surgery.
Asunto(s)
Insuficiencia de la Válvula Aórtica/diagnóstico , Endocarditis Bacteriana/diagnóstico , Enfermedades de las Válvulas Cardíacas/diagnóstico , Infecciones Neumocócicas/diagnóstico , Válvula Aórtica/microbiología , Válvula Aórtica/patología , Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/microbiología , Insuficiencia de la Válvula Aórtica/cirugía , Ecocardiografía Transesofágica , Endocarditis Bacteriana/microbiología , Femenino , Enfermedades de las Válvulas Cardíacas/microbiología , Enfermedades de las Válvulas Cardíacas/cirugía , Humanos , Persona de Mediana Edad , Infecciones Neumocócicas/microbiología , Choque Séptico/fisiopatología , Streptococcus pneumoniae/aislamiento & purificaciónRESUMEN
RESUMO A endocardite pneumocócica é uma entidade rara, cuja incidência se situa entre 1% e 3% dos casos de endocardite de válvula nativa. Esta patologia tem um prognóstico naturalmente adverso, com elevada mortalidade. Relata-se predileção pela válvula aórtica, de forma que é frequente que se apresente com insuficiência cardíaca. Apresentamos o caso de uma paciente do sexo feminino com 60 anos de idade e história pregressa de sinusite, admitida com diagnóstico de pneumonia. Após rápida deterioração, com sinais de choque séptico, ela foi transferida para a unidade de terapia intensiva. O ecocardiograma transesofágico revelou grave refluxo aórtico, devido à presença de vegetações valvares. As hemoculturas foram positivas para Streptococcus pneumoniae. A paciente foi submetida à cirurgia cardíaca e apresentou múltiplas complicações pós-operatórias. Apesar disso, apresentou lenta, porém completa recuperação. A endocardite infecciosa deve ser afastada em caso do surgimento de qualquer suspeita, e a ecocardiografia deve ser realizada precocemente nos pacientes com resposta insuficiente aos vasopressores e inotrópicos. Pacientes com endocardite pneumocócica se beneficiam de uma abordagem agressiva, com realização precoce da intervenção cirúrgica.
ABSTRACT Pneumococcal endocarditis is a rare entity, corresponding to 1 to 3% of native valve endocarditis cases. It has a typically adverse prognosis, with high mortality. There is a reported predilection for the aortic valve; thus, a common presentation is acute left heart failure. We present a case of a 60-year-old woman with a history of sinusitis, who was admitted with the diagnosis of pneumonia. She rapidly deteriorated with signs of septic shock and was transferred to the critical care unit. The transesophageal echocardiogram revealed severe aortic regurgitation due to valve vegetations. Blood cultures were positive for Streptococcus pneumoniae. She underwent cardiac surgery and had multiple postoperative complications. Nonetheless, the patient made a slow and complete recovery. Infectious endocarditis should be ruled out if any suspicion arises, and echocardiography should be performed in an early stage in patients with poor response to vasopressors and inotropes. Patients with pneumococcal endocarditis benefit from an aggressive approach, with performance of early surgery.
Asunto(s)
Humanos , Femenino , Insuficiencia de la Válvula Aórtica/diagnóstico , Infecciones Neumocócicas/diagnóstico , Endocarditis Bacteriana/diagnóstico , Enfermedades de las Válvulas Cardíacas/diagnóstico , Válvula Aórtica/cirugía , Válvula Aórtica/microbiología , Válvula Aórtica/patología , Insuficiencia de la Válvula Aórtica/cirugía , Insuficiencia de la Válvula Aórtica/microbiología , Infecciones Neumocócicas/microbiología , Choque Séptico/fisiopatología , Streptococcus pneumoniae/aislamiento & purificación , Ecocardiografía Transesofágica , Endocarditis Bacteriana/microbiología , Enfermedades de las Válvulas Cardíacas/cirugía , Enfermedades de las Válvulas Cardíacas/microbiología , Persona de Mediana EdadRESUMEN
Aortitis is an established manifestation of tertiary syphilis. We report a rare case of aortitis with ostial occlusion and left ventricular failure in secondary syphilis. Her management required a true multidisciplinary approach from multiple specialities due to complications of concomitant psychosis and a history of anaphylaxis to penicillin. This case illustrates the complexities of diagnosing and managing a rare presentation of this increasingly prevalent infection.
Asunto(s)
Antibacterianos/uso terapéutico , Insuficiencia de la Válvula Aórtica/microbiología , Estenosis Coronaria/tratamiento farmacológico , Metilprednisolona/uso terapéutico , Sífilis Cardiovascular/diagnóstico , Sífilis/diagnóstico , Adulto , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Estenosis Coronaria/diagnóstico , Estenosis Coronaria/microbiología , Estenosis Coronaria/cirugía , Ecocardiografía Doppler en Color , Femenino , Humanos , Sífilis/complicaciones , Sífilis/tratamiento farmacológico , Sífilis Cardiovascular/complicaciones , Sífilis Cardiovascular/tratamiento farmacológico , Resultado del TratamientoRESUMEN
BACKGROUND: Tuberculous aortitis is an unusual presentation of a common disease in Sri Lanka. There were no reported cases of tuberculous aortitis from Sri Lanka. Here we report a case of a 40-year-old woman who developed an ascending aortic aneurysm with severe aortic regurgitation caused by Mycobacterium tuberculosis. CASE PRESENTATION: A 40-year-old Sri Lankan female who presented with exertional breathlessness (NYHA II) and weight loss for 4 weeks duration was found to have collapsing pulse and early diastolic murmur at left sternal edge. Transthoracic and transesophageal echocardiogram showed ascending aortic aneurysm with severe aortic regurgitation. Computed tomographic aortography confirmed the diagnosis of aneurysmal dilatation of the ascending aorta. She underwent successful aortic valve replacement and aortic root replacement. The final diagnosis of tuberculous aortitis was made on the basis of macroscopic appearance of inflammation and microscopic confirmation of caseating granuloma. She made a good clinical recovery with category 1 antituberculous chemotherapy. CONCLUSIONS: Although most cases of aortitis are non-infectious in Sri Lanka, an infectious etiology must be considered in the differential diagnosis because therapeutic approaches differ widely. Tuberculous aortitis may be under diagnosed in Sri Lanka, a country with intermediate tuberculosis burden, as the histological or microbiological diagnosis is not possible in most cases. The clinical and radiological diagnostic criteria for tuberculous aortitis need to be set out in case of aneurysmal aortic disease in the absence of apparent etiology.
Asunto(s)
Aorta/microbiología , Aneurisma de la Aorta/microbiología , Aortitis/microbiología , Mycobacterium tuberculosis/fisiología , Tuberculosis/microbiología , Adulto , Antibióticos Antituberculosos/uso terapéutico , Aorta/efectos de los fármacos , Aorta/efectos de la radiación , Aneurisma de la Aorta/diagnóstico , Aneurisma de la Aorta/tratamiento farmacológico , Válvula Aórtica , Insuficiencia de la Válvula Aórtica/diagnóstico , Insuficiencia de la Válvula Aórtica/tratamiento farmacológico , Insuficiencia de la Válvula Aórtica/microbiología , Aortitis/diagnóstico , Aortitis/tratamiento farmacológico , Aortografía , Ecocardiografía Transesofágica , Femenino , Granuloma/diagnóstico , Granuloma/tratamiento farmacológico , Granuloma/microbiología , Prótesis Valvulares Cardíacas , Interacciones Huésped-Patógeno/efectos de los fármacos , Humanos , Mycobacterium tuberculosis/efectos de los fármacos , Tomógrafos Computarizados por Rayos X , Resultado del Tratamiento , Tuberculosis/diagnóstico , Tuberculosis/tratamiento farmacológicoAsunto(s)
Aneurisma Falso/microbiología , Endocarditis Bacteriana/complicaciones , Aneurisma Cardíaco/microbiología , Rotura Cardíaca/microbiología , Infecciones Relacionadas con Prótesis/complicaciones , Infecciones Estafilocócicas , Insuficiencia de la Válvula Aórtica/microbiología , Ecocardiografía Tridimensional , Ecocardiografía Transesofágica , Resultado Fatal , Prótesis Valvulares Cardíacas , Humanos , Masculino , Persona de Mediana Edad , Válvula Mitral , Imagen Multimodal , Staphylococcus aureusRESUMEN
Neisseria elongata, a normal resident in the human oral cavity, rarely causes invasive infections. We herein report a case of endocarditis caused by Neisseria elongata subsp. nitroreducens that occurred in a patient without any apparent cardiac complications. The patient received aortic valve replacement following the administration of intravenous beta-lactam for five weeks. To our knowledge, this is the first published case in Japan of N. elongata infection in a patient without a prosthetic device.
Asunto(s)
Insuficiencia de la Válvula Aórtica/microbiología , Endocarditis Bacteriana/microbiología , Neisseria elongata , Infecciones por Neisseriaceae , Anciano , Válvula Aórtica , Insuficiencia de la Válvula Aórtica/cirugía , Endocarditis Bacteriana/cirugía , Prótesis Valvulares Cardíacas , Implantación de Prótesis de Válvulas Cardíacas , Humanos , MasculinoAsunto(s)
Abiotrophia , Endocarditis Bacteriana/diagnóstico , Infecciones por Bacterias Grampositivas/diagnóstico , Aneurisma Infectado/diagnóstico , Aneurisma Infectado/microbiología , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/microbiología , Arteriopatías Oclusivas/diagnóstico , Arteriopatías Oclusivas/microbiología , Ecocardiografía Transesofágica , Femenino , Humanos , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/microbiología , Tomografía Computarizada por Rayos X , Ultrasonografía Doppler Dúplex , Adulto JovenRESUMEN
Lactobacilli are Gram-positive anaerobic rods or coccobacilli, commonly found as commensals in human mucosa. Rarely, they can cause serious infections such as infective endocarditis (IE), and the most frequently implicated species causing serious infections are L. casei and L. rhamnosus. IE caused by Lactobacillus jensenii is very rare, with only six reported cases so far, to the best of our knowledge. We present a case of native aortic valve endocarditis caused by L. jensenii, complicated by root abscess and complete heart block, and requiring emergent surgical intervention.