Abiotrophia defectiva endocarditis - Diagnostic and therapeutic challenge: Case report.

Belonging to the normal oral, gastrointestinal, and urogenital flora, Abiotrophia defectiva is responsible for 1-2 % of all infective endocarditis (IE) cases. The manifestation of A.defectiva endocarditis may by atypical, without fever. Difficult to isolate pathogen requires special culture media. A 45-year-old female was admitted due to anemia and progressive weight loss (8 kg in 6 months). She had a history of benign mitral valve (MV) prolapse and non-stenotic bicuspid aortic valve (BAV). In echocardiography, large vegetations on MV and small vegetation on BAV were found. An enriched medium for fastidious pathogens was used. A. defectiva was identified using biochemical analysis with VITEK-2 Compact. In the fourth week of antibiotic therapy, she required urgent MV replacement due to MV regurgitation progression while vegetation on BAV disappeared. Although patient's frailty and underweight caused prolonged postoperative wound healing, she was transferred to rehabilitation in good conditions. No relapse of IE was observed during five-month follow-up.

Cryptosporidium spp. and Blastocystis spp. coinfection as a reason of an acute diarrhea in a young healthy veterinary Polish student - Case report.

OBJECTIVES: Cryptosporidium belongs to enteric parasites responsible for prolonged symptoms in the gastrointestinal tract, both in immunocompetent and immunocompromised individuals. One of the risk factors of infection is contact with an infected person or animals (cattle). The case is described of a young man admitted to the Department of Tropical and Parasitic Diseases of the Medical University in Poznan, Poland, because of watery diarrhea with high fever and in whom symptomatic treatment did not produce any improvement. MATERIAL AND METHODS: A 21-year -old male was examined and his epidemiologic history obtained. Primary blood test, anti- Toxocara IgG (ELISA) and anti-Toxoplasma gondii IgG and IgM (ELISA) were performed. PCR detected 16 enteropathogens in a stool sample. Microscopic parasitic stool examination was also performed based on Ziehl-Neelsen method, which allowed the assessment of the presence of cryptosporidium life stages. RESULTS: Epidemiology data provided information that the patient was a veterinary student who therefore had many contacts with domestic animals. Multiplex PCR detected a genetic material of Cryptosporidium. The result was confirmed with repeated positive direct stool examinations which gave the evidence of Cryptosporidium spp. oocysts and vacuolar forms of Blastocystis spp.. CONCLUSIONS: 1) Cryptosporidium is responsible for watery diarrhea in healthy individuals. 2) Contact with animals (cattle) is a potential risk factor for infection. 3) Protozoan co-infection should be treated to shorten the symptomatic period and to avoid post-infection complications. 4) Different diagnostic methods increase the possibility to establish appropriate diagnosis.

Concomitance of COVID-19 and legionnaires' disease - a case series.

Coronavirus disease-2019 (COVID-19) and legionnaires disease (LD) caused by Gram-negative water-born bacteria Legionella pneumophila show certain similarities, including a predisposition to pulmonary involvement and extrapulmonary manifestations in some of the patients infected. One disease can mimic the other, both can rarely coexist. CASE SERIES REPORT: The authors describe 7 such cases (5 females), aged 51-90 years (mean 69.7 years) detected while screening 133 subjects with moderate to severe pneumonia and confirmed COVID- 19, which constituted 5.3% of the patients in whom urinary antigen test (UAT) for L. pneumophila was performed. The patients had multiple concomitant disorders: hypertension (6), heart failure (4), diabetes (4), obesity (4), coronary heart disease (3), chronic kidney disease (3), chronic obstructive pulmonary disease (3), anemia (3). Positive UAT was obtained at admission in 4 patients, and on 3rd, 11th and 14th days of hospitalization in the remaining 3 patients. One patient also had positive UAT for Streptococcus pneumoniae. We analyzed: radiological imaging, laboratory data (CRP, interleukin-6, procalcitonin, troponin I, BNP), ECG, echocardiography, treatment and outcome. Three patients required a modification of initial antibiotic therapy, two developed Clostridioides difficile infection. The duration of hospitalization ranged from 13 to 59 days (mean 24.3 days); two patients died. CONCLUSIONS: The authors suggest that the coexistence of COVID- 19 and LD may result in prolonged hospitalization, in increased mortality risk and in subsequent cardiovascular complications, including takotsubo syndrome (TTS) which was found in 2 cases, both presented as focal TTS (fTTS).

Takotsubo cardiomyopathy triggered by influenza B.

Influenza is associated with a high prevalence of cardiac complications, including myocarditis and exacerbation of ischemic heart disease or heart failure (HF). However, only four cases of stress-induced takotsubo cardiomyopathy (TC), all of them triggered by virus A influenza, have been reported so far. Another two TC cases after anti-influenza vaccination are also available in the literature. The authors describe a new case of TC, this time provoked by influenza B. An 89-year-old female with a history of hypertension and chronic obstructive pulmonary disease (COPD) was admitted due to a fever (39oC), muscle aches and cough. Pneumonia was excluded in chest X-ray while the test for influenza confirmed virus B infection, so she was given oseltamivir. On the second day of hospitalization, she developed severe HF. ECG showed new negative T waves in inferior and anterolateral leads coexisting with a moderate troponin I and marked brain natriuretic peptide release, while echocardiography revealed left ventricular (LV) apical ballooning with decreased ejection fraction (EF 24%) and global longitudinal strain (GLS -8.1%). Symptomatic treatment of HF was initiated. The symptoms of influenza resolved after 5 days. LV function began to improve after 4 days and became normal after 6 days (EF 58%, GLS -18.1%). Despite an advanced age and the coexisting disorders (COPD, mild cognitive impairment, possible neoplastic disease), the patient was discharged in stable clinical condition on day 10. The authors conclude that in the evaluation of cardiac complications of influenza, TC should be taken into account.

Lactobacillus gasseri endocarditis on the aortic valve bioprosthesis - a case report.

Lactobacillus is a genus of Gram-positive, facultative anaerobic/ microaerophilic, rod-shaped bacteria. Lactobacilli constitute a significant component of the human microbiota in the oral cavity, gastrointestinal tract and female urogenital tract. They are also widely used as probiotics. Rarely, especially in patients with impaired immunity or with structural heart disease, do Lactobacilli become the pathogen responsible for serious infections, e.g. infective endocarditis (IE). CASE REPORT: The authors describe a case of an 80-year-old female with a past history of aortic valve replacement, mitral annuloplasty and pacemaker implantation admitted to hospital due to weakening, subfebrile state and chills. In transesophageal echocardiography vegetations on the aortic valve bioprosthesis were found, while pacemaker electrodes and mitral annulus were not involved in the endocarditis process. Bacteriological work-up revealed growth of L. gasseri. The patient was successfully treated with amoxicillin/clavulanate acid (six weeks) and with gentamycin (two weeks). No recurrence of the disease was observed during a six-month posthospital follow-up. Among different species of Lactobacillus, L. gasseri has not been reported as an IE pathogen so far. Lack of unequivocal data as to whether using probiotics may be responsible for infections, including IE, in patients with predisposing conditions.

Fatal course of takotsubo cardiomyopathy in a female with recurrent Clostridium difficile infection.

Among diverse triggering factors of stress-induced takotsubo cardiomyopathy (TC), a viral or bacterial infection is rarely observed. Sepsis is an exception, regardless of the etiologic pathogen, in which case an excess of catecholamines may result in acute left ventricular dysfunction. TC precipitated by Clostridium difficile infection (CDI) has been reported only in two patients so far. A CASE REPORT: The authors describe another case of TC triggered this time by recurrent C. difficile colitis which occurred in a 72-yearold female. Severe heart failure developed on the second day of a new episode of diarrhea. Echocardiography revealed apical ballooning, a typical form of TC, while the coronary arteries in coronary angiography were normal. Despite proper treatment of CDI, the course of the disease was fatal due to heart failure progression. In considerations of TC pathogenesis in the case presented, the impact of C. difficile toxins should be taken into account. One should remember about the potential extraintestinal complications of CDI, including sudden myocardial depression.

[Microbiological diagnostics of infective endocarditis in the light of the new guidelines of the European Society of Cardiology with particular focus on the molecular methods].

The authors describe the presentday possibilities of routine and molecular microbiologic diagnostics of infective endocarditis (IE). Routine diagnostics employs automated microbial growth and biochemical detection systems. Molecular methods are based on polymerase chain reaction (PCR) and matrix assisted laser desorption/ ionization time of flight mass spectrometry (MALDI-TOF MS). MALDI-TOF MS first appeared in the new guidelines for the management of IE of the European Society of Cardiology published in 2015. The greatest benefit of MALDITOF MS is the short time of pathogen identification. The main disadvantages are the necessity of routine agar cultures and lack of antimicrobial susceptibility estimation. So far, there has been no Polish literature report on MALDI-TOF MS used for pathogen identification in suspected IE. This may well result from scarce accessibility of the method in Poland. The paper aims to stress the importance of an up-todate technology in the diagnostics of difficult, blood culture negative cases of IE. It also takes into consideration the limitations of mass spectrometry in the ESC diagnostic scheme of IE.