RESUMO
We report a case of infectious endocarditis attributable to Legionella longbeachae. L. longbeachae is usually associated with lung infections. It is commonly found in composted waste wood products. L. longbeachae should be regarded as an agent of infectious endocarditis, notably in the context of gardening involving handling of potting soils.
Assuntos
Endocardite Bacteriana/microbiologia , Legionella longbeachae/isolamento & purificação , Legionelose/microbiologia , Infecções Relacionadas à Prótese/microbiologia , Idoso , Antibacterianos/uso terapêutico , Bioprótese/microbiologia , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/cirurgia , Próteses Valvulares Cardíacas/microbiologia , Humanos , Legionelose/tratamento farmacológico , Legionelose/cirurgia , MasculinoRESUMO
Infective endocarditis (IE) is a difficult and complex disease. In recent years epidemiology and microbiology have changed. In developed countries IE is now affecting older patients and patients with no previously known valve disease. Prosthetic IE (prosthetic valve endocarditis [PVE]) and endocarditis in patients with pacemakers and other devices (cardiac device related infective endocarditis [CDRIE]) are becoming more frequent. The number of Staphylococcus aureus IE is increasing related to the number of endocarditis that occurs because of health care associated procedures, especially in diabetics or patients on chronic hemodialysis. The change in the underlying population and the increase in the number of cases caused by very virulent organism explain why the disease still carries a poor prognosis and a high mortality. The variety of clinical manifestations and complications, as well as the serious prognosis, makes it mandatory that IE patients need to be treated in experienced hospitals with a collaborative approach between different specialists, involving cardiologists, infectious disease specialists, microbiologists, surgeons, and frequently others, including neurologists and radiologists. Only an early diagnosis followed by risk stratification and a prompt institution of the correct antibiotic treatment as well as an appropriate and timed surgical indication may improve mortality figures. The recent European Guidelines try to provide clear and simple recommendations, obtained by expert consensus after thorough review of the available literature to all specialists involved in clinical decision-making of this difficult and changing disease.