RESUMO
BACKGROUND: Isolated pulmonary valve endocarditis (IPE) accounts for less than 2% of all infective endocarditis patients. It is commonly associated with several predisposing factors, including intravenous drug use (IVDU) and congenital heart disease. The most common causative pathogens of IPE are Staphylococcus aureus and Streptococcus viridans. We report a Down's syndrome patient with IPE and with no standard risk factors caused by the rare pathogen Acinetobacter spp. This led to respiratory failure and systemic infection due to septic pulmonary emboli. Early elective surgery was decided upon as the patient was no longer responding to medical therapy, and his clinical condition was worsening over time. CASE PRESENTATION: A 15-year-old male with Down syndrome and no underlying heart defect presented with a 3-month history of episodic fever, nausea, vomiting, and diarrhea. Transthoracic echocardiography (TTE) revealed large vegetation on the pulmonary valve leaflet, another mobile mass at the pulmonary artery bifurcation, and severe pulmonary regurgitation. Serial blood cultures isolated Acinetobacter spp. Despite initial antibiotic therapy, the patient continued to have sepsis, unresolved vegetations, and developed life-threatening complications and respiratory distress, which convinced us to perform a pulmonary valve replacement surgery with a homograft. After surgery, the patient recovered and was discharged on the ninth postoperative day (POD). CONCLUSION: This report highlights IPE's diagnostic and therapeutic challenges, alongside the importance of a comprehensive cardiopulmonary workup in patients with unexplained fever, sepsis, and pulmonary symptoms, even without typical risk factors. Based on the patient's aggravating condition despite medical treatment, early surgical intervention and pulmonary valve replacement were deemed crucial. However, there still needs to be a definitive guideline on when and how surgery should be performed in patients with complicated IPE, especially in pediatric patients.
Assuntos
Síndrome de Down , Endocardite Bacteriana , Valva Pulmonar , Humanos , Síndrome de Down/complicações , Masculino , Valva Pulmonar/cirurgia , Valva Pulmonar/microbiologia , Adolescente , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/cirurgia , Ecocardiografia , Implante de Prótese de Valva CardíacaRESUMO
Infective endocarditis caused by Mycobacterium abscessus is an uncommon event that, when it does occur, usually requires surgical valve replacement. The pulmonary valve is the least common heart valve involved in infective endocarditis. We present a rare case of isolated pulmonary valve endocarditis with Mycobacterium abscessus in a patient with recurrent sternal infections following repeated coronary artery bypass.
Assuntos
Endocardite Bacteriana , Endocardite , Mycobacterium abscessus , Valva Pulmonar , Humanos , Valva Pulmonar/cirurgia , Valva Pulmonar/microbiologia , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/cirurgia , Endocardite Bacteriana/microbiologia , Ponte de Artéria CoronáriaRESUMO
BACKGROUND: Isolated pulmonary valve endocarditis (IPE) is rare, accounting for 1.5-2% of all cases of infective endocarditis. Herein, we describe a case of isolated pulmonary valve endocarditis with rapid progression in a 28-year-old male. Unlike most patients reported previously who were cured with only anti-infective therapy, without surgery at an early stage, multiple complications occurred in this patient in less than 2 weeks. CASE PRESENTATION: The patient was diagnosed with pulmonary valve endocarditis with blood cultures showing Staphylococcus aureus and echocardiography revealing 2 masses (measuring 14*13 mmã11*16 mm in size). Only 12 days later, acute massive pulmonary embolism occurred. Then, repeated echocardiography revealed multiple masses attached to the pulmonary valve with severe pulmonary insufficiency and the possibility of pulmonary valve destruction. Finally, pulmonary valve replacement, vegetation removal, and right pulmonary thromboendarterectomy together with resection of the middle and lower lobes of the right lung were performed. CONCLUSIONS: The role of surgery at an early stage might need to be reconsidered, and it may be viable to combine medical and surgical approaches.
Assuntos
Procedimentos Cirúrgicos Cardíacos/métodos , Endocardite Bacteriana/diagnóstico , Valva Pulmonar/microbiologia , Infecções Estafilocócicas/diagnóstico , Staphylococcus aureus/isolamento & purificação , Adulto , Progressão da Doença , Ecocardiografia , Endocardite Bacteriana/patologia , Endocardite Bacteriana/cirurgia , Humanos , Masculino , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/patologia , Valva Pulmonar/cirurgia , Infecções Estafilocócicas/patologia , Infecções Estafilocócicas/cirurgiaRESUMO
Brucellosis is one of the most frequent zoonotic infections. Cardiac involvement is rare and when involved, affects aortic valve the most. The appearance of a new murmur on clinical examination during sepsis should suspect seeding on valves. Our patient had pulmonary valve endocarditis secondary to brucellosis which was managed with pharmacotherapy as there was no valvular pathology. Triple therapy is standard of care and usually given for months, non-response to pharmacological treatment warrants surgical intervention. Our patient completed the triple-drug regimen at 3 months and is asymptomatic at present.
Assuntos
Brucelose/microbiologia , Endocardite Bacteriana/microbiologia , Valva Pulmonar/microbiologia , Adolescente , Antibacterianos/uso terapêutico , Brucella/isolamento & purificação , Brucelose/diagnóstico , Brucelose/tratamento farmacológico , Doxiciclina/uso terapêutico , Ecocardiografia Transesofagiana , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Humanos , Masculino , Valva Pulmonar/diagnóstico por imagem , Rifampina/uso terapêutico , Estreptomicina/uso terapêuticoRESUMO
BACKGROUND: Pulmonary valve infective endocarditis is a rare diagnosis that is usually associated with immunocompromised states or structurally abnormal hearts. It is unusual for it to occur in structurally normal hearts or to cause recurrent symptoms after targeted antibiotics. Although guidelines suggest follow-up with repeat echocardiography and inflammatory marker surveillance, this case demonstrates that these are not always useful investigations, and instead imaging of the chest may be more appropriate. CASE PRESENTATION: We describe a case of a 74-year-old man who presented with respiratory symptoms and was originally misdiagnosed with pneumonia but later found to have a large pulmonary valve vegetation caused by Streptococcus mitis. Despite initially responding to antibiotic therapy, the vegetation continued to cause pulmonary emboli and cavitating lung abscesses months later, necessitating pulmonary valve replacement. CONCLUSIONS: This case demonstrates that pulmonary valve endocarditis can present atypically with recurrent respiratory symptoms, and in such cases, echocardiography should be considered to investigate for right-sided infective endocarditis. In addition, despite correct treatment, with normalization of inflammatory markers and improvement in vegetation size, infective endocarditis can continue to cause systemic symptoms. Finally, clinicians should consider chest computed tomography routinely as part of right-sided infective endocarditis follow-up.
Assuntos
Diagnóstico Tardio/efeitos adversos , Endocardite Bacteriana/diagnóstico por imagem , Valva Pulmonar/diagnóstico por imagem , Idoso , Antibacterianos/uso terapêutico , Ecocardiografia , Endocardite Bacteriana/complicações , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Humanos , Abscesso Pulmonar/diagnóstico por imagem , Abscesso Pulmonar/etiologia , Masculino , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/etiologia , Valva Pulmonar/microbiologia , Valva Pulmonar/cirurgia , Streptococcus mitis/isolamento & purificação , Tomografia Computadorizada por Raios XRESUMO
Ross procedure has been found to have a lower incidence of infective endocarditis compared to other aortic replacement procedure using prosthetic valves. We report a case of 25-year-old man who underwent Ross procedure for congenital aortic stenosis and regurgitation when he was 7 years old. He presented with fever and was highly suspected of infective endocarditis. All sets of blood cultures were positive for Heamophilus parainfluenzae. Autologous pericardial pulmonary valve was severely stenotic and computed tomography (CT) scan and radio isotope (RI) scan revealed infection at the stenotic valve. We performed right ventricle (RV)-pulmonary artery (PA) conduit replacement and he was discharged after completion of intravenous antibiotic treatment. We experienced a rare case of infective endocarditis in a patient late after Ross procedure. Prophylaxis against infective endocarditis is mandatory even in patients with infection resistant Ross procedure.
Assuntos
Endocardite Bacteriana/diagnóstico , Infecções por Haemophilus/diagnóstico , Complicações Pós-Operatórias/diagnóstico , Estenose da Valva Pulmonar/cirurgia , Valva Pulmonar , Adulto , Insuficiência da Valva Aórtica/congênito , Insuficiência da Valva Aórtica/cirurgia , Estenose da Valva Aórtica/congênito , Estenose da Valva Aórtica/cirurgia , Endocardite Bacteriana/microbiologia , Haemophilus parainfluenzae/isolamento & purificação , Ventrículos do Coração/cirurgia , Humanos , Masculino , Complicações Pós-Operatórias/microbiologia , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/microbiologia , Estenose da Valva Pulmonar/diagnóstico por imagem , Resultado do TratamentoRESUMO
BACKGROUND Infective endocarditis (IE) has a high mortality rate, even when treated with appropriate antibiotic therapy and surgical intervention. Right-sided endocarditis is in itself rare, with some studies reporting an incidence of 5-10%. The majority of these cases involve the tricuspid valve, and isolated pulmonary valve endocarditis (PVE) is an extremely rare entity affecting less than 2% of patients with infective endocarditis. Identification and early management are crucial to prevent long-term complications and reduce mortality. CASE REPORT We present a patient with a history of essential hypertension and no underlying valvular disease, who underwent dental cleaning and subsequently developed low-grade fever, myalgia, and malaise. This occurred during the flu season, and was initially diagnosed and treated as flu, without any improvement. The patient was later found to be bacteremic with S. mitis, with no identifiable source, and a normal transthoracic echocardiogram (TTE). He was later hospitalized, had a transesophageal echocardiogram, and was found to have a large pulmonic valve vegetation. CONCLUSIONS This case presents an interesting and rare finding of endocarditis, isolated to the pulmonic valve, in an otherwise healthy individual with no predisposing risk factors. The lack of peripheral stigmata, as well as an unremarkable initial outpatient TTE, made the diagnosis more difficult. It should also be noted that current guidelines do not specifically address right-sided endocarditis, and do not specify the role of surgical intervention.
Assuntos
Endocardite Bacteriana/diagnóstico , Valva Pulmonar/microbiologia , Profilaxia Dentária , Ecocardiografia , Endocardite Bacteriana/microbiologia , Humanos , Masculino , Pessoa de Meia-Idade , Valva Pulmonar/diagnóstico por imagem , Infecções Estreptocócicas/complicações , Streptococcus mitis/isolamento & purificaçãoAssuntos
Endocardite Bacteriana/microbiologia , Staphylococcus aureus Resistente à Meticilina/isolamento & purificação , Embolia Pulmonar/microbiologia , Valva Pulmonar/microbiologia , Sepse/microbiologia , Infecções Estreptocócicas/microbiologia , Idoso , Antibacterianos/uso terapêutico , Técnicas Bacteriológicas , Ecocardiografia Transesofagiana , Endocardite Bacteriana/complicações , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/tratamento farmacológico , Feminino , Humanos , Staphylococcus aureus Resistente à Meticilina/efeitos dos fármacos , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/tratamento farmacológico , Valva Pulmonar/diagnóstico por imagem , Sepse/diagnóstico por imagem , Sepse/tratamento farmacológico , Infecções Estreptocócicas/complicações , Infecções Estreptocócicas/diagnóstico por imagem , Infecções Estreptocócicas/tratamento farmacológico , Tomografia Computadorizada por Raios X , Resultado do TratamentoAssuntos
Endocardite Bacteriana/diagnóstico , Valva Pulmonar/diagnóstico por imagem , Infecções Estreptocócicas/diagnóstico , Diagnóstico Diferencial , Ecocardiografia Transesofagiana , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Imagem Cinética por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valva Pulmonar/microbiologia , Valva Pulmonar/cirurgia , Infecções Estreptocócicas/microbiologia , Infecções Estreptocócicas/cirurgia , Streptococcus gallolyticus/isolamento & purificação , Tomografia Computadorizada por Raios XAssuntos
Endocardite Bacteriana/etiologia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Valva Pulmonar/cirurgia , Aorta/cirurgia , Valva Aórtica/microbiologia , Valva Aórtica/cirurgia , Ecocardiografia , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/microbiologia , Humanos , Masculino , Artéria Pulmonar/cirurgia , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/microbiologia , Infecções Estreptocócicas/etiologia , Estreptococos Viridans , Adulto JovemRESUMO
BACKGROUND: Endocarditis has emerged as one of the most concerning adverse outcomes in patients with congenital anomalies involving the right ventricular outflow tract (RVOT) and prosthetic valves. OBJECTIVES: The aim of this study was to evaluate rates and potential risk factors for endocarditis after transcatheter pulmonary valve replacement in the prospective Melody valve trials. METHODS: All patients in whom a transcatheter pulmonary valve (TPV) was implanted in the RVOT as part of 3 prospective multicenter studies comprised the analytic cohort. The diagnosis of endocarditis and involvement of the TPV were determined by the implanting investigator. RESULTS: A total of 309 patients underwent transcatheter pulmonary valve replacement (TPVR) and were discharged with a valve in place. The median follow-up duration was 5.1 years, and total observation until study exit was 1,660.3 patient-years. Endocarditis was diagnosed in 46 patients (median 3.1 years after TPVR), and a total of 35 patients were reported to have TPV-related endocarditis (34 at the initial diagnosis, 1 with a second episode). The annualized incidence rate of endocarditis was 3.1% per patient-year and of TPV-related endocarditis was 2.4% per patient-year. At 5 years post-TPVR, freedom from a diagnosis of endocarditis was 89% and freedom from TPV-related endocarditis was 92%. By multivariable analysis, age ≤12 years at implant (hazard ratio: 2.3; 95% confidence interval: 1.2 to 4.4; p = 0.011) and immediate post-implant peak gradient ≥15 mm Hg (2.7; 95% confidence interval: 1.4 to 4.9; p = 0.002) were associated with development of endocarditis and with development of TPV-related endocarditis (age ≤12 years: 2.8; 95% confidence interval: 1.3 to 5.7; p = 0.006; gradient ≥15 mm Hg: 2.6; 95% confidence interval: 1.3 to 5.2; p = 0.008). CONCLUSIONS: Endocarditis is an important adverse outcome following TVPR in children and adults with post-operative congenital heart disease involving the RVOT. Ongoing efforts to understand, prevent, and optimize management of this complication are paramount in making the best use of TPV therapy. (Melody Transcatheter Pulmonary Valve [TPV] Study: Post Approval Study of the Original Investigational Device Exemption [IDE] Cohort; NCT00740870; Melody Transcatheter Pulmonary Valve Post-Approval Study; NCT01186692; and Melody Transcatheter Pulmonary Valve [TPV] Post-Market Surveillance Study; NCT00688571).
Assuntos
Endocardite Bacteriana/etiologia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/efeitos adversos , Complicações Pós-Operatórias/etiologia , Insuficiência da Valva Pulmonar/cirurgia , Valva Pulmonar/cirurgia , Adolescente , Adulto , Criança , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/epidemiologia , Contaminação de Equipamentos , Feminino , Seguimentos , Doenças das Valvas Cardíacas/diagnóstico por imagem , Doenças das Valvas Cardíacas/epidemiologia , Implante de Prótese de Valva Cardíaca/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/diagnóstico por imagem , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/microbiologia , Insuficiência da Valva Pulmonar/diagnóstico por imagem , Insuficiência da Valva Pulmonar/epidemiologia , Adulto JovemRESUMO
An 11 yr old female spayed golden retriever weighing 30.3 kg presented for evaluation of progressive lethargy, anorexia, tachypnea, stiff gait, and nonlocalized pain. On physical exam, the patient was febrile and tachycardic, and an arrhythmia with pulse deficits was noted. Clinicopathological abnormalities included thrombocytopenia, leukocytosis, nonregenerative anemia, and mild hypoalbuminemia. The patient progressed overnight to develop a productive cough, and an echocardiogram performed the next morning revealed irregular proliferative lesions of the pulmonic valve with moderate pulmonic regurgitation. Subsequent blood cultures grew two organisms: alpha-hemolytic streptococci spp. and Empedobacter brevis. The dog was treated with appropriate intravenous antibiotics for 2 wk and then switched to oral therapy. The clinicopathologic abnormalities, fever, and clinical signs resolved with oral antibiotic treatment. To the authors' knowledge, this case report represents the first detailed published case of bacterial endocarditis with E brevis bacteremia involving the pulmonic valve. The clinical presentation, diagnosis, treatment, and follow-up are discussed.
Assuntos
Antibacterianos/uso terapêutico , Doenças do Cão/diagnóstico , Endocardite Bacteriana/veterinária , Infecções por Flavobacteriaceae/veterinária , Valva Pulmonar/patologia , Infecções Estreptocócicas/veterinária , Animais , Doenças do Cão/tratamento farmacológico , Doenças do Cão/microbiologia , Cães , Endocardite Bacteriana/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Feminino , Flavobacteriaceae/isolamento & purificação , Infecções por Flavobacteriaceae/microbiologia , Valva Pulmonar/microbiologia , Infecções Estreptocócicas/microbiologia , Streptococcus/isolamento & purificaçãoRESUMO
Large septic pulmonary embolus is a rare finding in right-sided endocarditis. The entity represents a challenging diagnosis due to its variable and nonspecific clinical and radiological presentation and similarities with other conditions. We present a case of a 41 year-old woman who developed a large main pulmonary artery embolus and bilateral cavitary lung nodules in the setting of severe sepsis. Pulmonary artery exploration and clot retrieval ultimately revealed a large septic embolus from Streptococcus mutans native pulmonary valve endocarditis. The diagnosis of septic pulmonary emboli from right-sided endocarditis should be considered in patients with ancillary findings of septic embolic phenomenon, particularly the presence of multifocal cavitary nodules and in the setting of appropriate predisposing factors.
Assuntos
Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/microbiologia , Embolia Pulmonar/diagnóstico por imagem , Embolia Pulmonar/microbiologia , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/microbiologia , Streptococcus mutans/isolamento & purificação , Adulto , Angiografia por Tomografia Computadorizada , Meios de Contraste , Diagnóstico Diferencial , Feminino , Humanos , Iohexol , Artéria PulmonarRESUMO
Candida prosthetic endocarditis (CPE) is an uncommon and fatal complication in adults with congenital heart disease. The current guidelines for the management of fungal endocarditis recommend a combination of surgical and medical therapy. However, it still remains uncertain when surgical management in CPE patients should be performed. Therefore, the prognosis of CPE patients is very poor. Here we report a case of CPE in a 31-year-old woman who had undergone surgical repair for tetralogy of Fallot during childhood and pulmonary valve replacement at the age of 21 years. She underwent re-pulmonary valve replacement after being sufficiently sterilized with a 5-week course of antifungal medical therapy, leading to clinical improvement. In CPE patients, it is necessary to perform surgical therapy while suppressing the activity of fungi as much as possible.
Assuntos
Antifúngicos/administração & dosagem , Candidíase , Endocardite , Implante de Prótese de Valva Cardíaca/efeitos adversos , Próteses Valvulares Cardíacas , Infecções Relacionadas à Prótese , Valva Pulmonar , Reoperação/métodos , Tetralogia de Fallot/cirurgia , Adulto , Candidíase/etiologia , Candidíase/fisiopatologia , Candidíase/cirurgia , Endocardite/etiologia , Endocardite/microbiologia , Endocardite/fisiopatologia , Endocardite/cirurgia , Feminino , Próteses Valvulares Cardíacas/efeitos adversos , Próteses Valvulares Cardíacas/microbiologia , Implante de Prótese de Valva Cardíaca/métodos , Humanos , Prognóstico , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/fisiopatologia , Infecções Relacionadas à Prótese/cirurgia , Valva Pulmonar/microbiologia , Valva Pulmonar/cirurgia , Resultado do TratamentoRESUMO
In this article we report the first case of Q fever endocarditis in a 13 years old child with a percutaneous pulmonary Melody® valve. The patient had a new onset of Melody valve dysfunction associated with the combination of hepatosplenomegaly and pancytopenia but was afebrile. Although blood cultures were negative, we have further investigated in the direction of infective endocarditis by performing PCR detection and the serology of C. burnetii which were positive. A combination antibiotic therapy with doxycycline and hydroxychloroquine was started with good clinical evolution. Our case emphasizes the fact that any Melody valvular dysfuntion should be considered as a potential infective endocarditis despite the absence of typical bacterial features.
Assuntos
Antibacterianos/uso terapêutico , Endocardite Bacteriana/diagnóstico , Infecções Relacionadas à Prótese/diagnóstico , Febre Q/diagnóstico , Adolescente , Coxiella burnetii/genética , Ecocardiografia/métodos , Endocardite Bacteriana/complicações , Endocardite Bacteriana/tratamento farmacológico , Próteses Valvulares Cardíacas/efeitos adversos , Humanos , Masculino , Infecções Relacionadas à Prótese/complicações , Infecções Relacionadas à Prótese/tratamento farmacológico , Valva Pulmonar/microbiologia , Valva Pulmonar/cirurgia , Febre Q/complicações , Febre Q/tratamento farmacológicoRESUMO
Isolated infectious endocarditis of the pulmonary valve is a rare condition and represents 1,5-2% of all cases of infectious endocarditis. We present a case of a 37year-old woman without any relevant medical history. The woman was hospitalized with hallmarks of severe sepsis and bilateral pneumonia; she died several hours after admission with progressive multiorgan failure and disseminated intravascular coagulopathy. Microbiologic examination approved Staphylococcus aureus as the etiological agent. The autopsy showed isolated endocarditis of the pulmonary valve, without any known predisposing factor. Literary data refer single cases or small groups of patients with isolated pulmonary infectious endocarditis. The clinical suspicion of this rare disease in differential diagnosis of febrile conditions is an essential factor in prognosis of afflicted persons. The crucial diagnostic methods for infectious endocarditis are echocardiography and CT examination.
Assuntos
Endocardite Bacteriana , Endocardite , Valva Pulmonar , Infecções Estafilocócicas , Adulto , Ecocardiografia , Endocardite/diagnóstico por imagem , Endocardite Bacteriana/diagnóstico por imagem , Feminino , Humanos , Valva Pulmonar/diagnóstico por imagem , Valva Pulmonar/microbiologia , Infecções Estafilocócicas/diagnóstico por imagemRESUMO
BACKGROUND: Isolated pulmonary valve infective endocarditis caused by Candida is rare in chronic hemodialysis patients. The 2009 Infectious Diseases Society of America guidelines suggest the combined use of surgery and antibiotics to treat candidiasis; however, successful nonsurgical treatment of Candida endocarditis has been reported. CASE PRESENTATION: A 63-year-old woman with end-stage kidney disease was admitted to our hospital after experiencing disorientation for 5 days. The patient was permanently bedridden because of depression, and denied active intravenous drug use. She received maintenance hemodialysis through a tunneled-cuffed catheter. An initial blood culture grew Candida guilliermondii without other bacteria. Subsequent blood cultures and tip culture of tunneled-cuffed catheter also grew C. guilliermondii, even after caspofungin replaced fluconazole. A 1.2-cm mobile mass was observed on the pulmonary valve. Surgical intervention was suggested, but the family of the patient declined because of her multiple comorbidities. The patient was discharged with a prescription of fluconazole, but she died soon after. CONCLUSION: Our patient is the first case with isolated pulmonary valve endocarditis caused by C. guilliermondii in patients with uremia. Hematologic disorders, in addition to long-term central venous catheter use, prolonged antibiotic intravenous injection, and congenital cardiac anomaly, predispose to the condition. The diagnosis "isolated" pulmonary IE is difficult, and combing surgery with antifungal antibiotics is the appropriate therapeutic management for Candida related pulmonary IE.
Assuntos
Candida/isolamento & purificação , Candidíase/diagnóstico por imagem , Endocardite/diagnóstico por imagem , Valva Pulmonar/diagnóstico por imagem , Diálise Renal/efeitos adversos , Insuficiência Renal Crônica/diagnóstico por imagem , Antifúngicos/uso terapêutico , Candidíase/tratamento farmacológico , Candidíase/etiologia , Endocardite/tratamento farmacológico , Endocardite/etiologia , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , Valva Pulmonar/microbiologia , Diálise Renal/tendências , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/terapiaAssuntos
Abscesso/diagnóstico por imagem , Aspergilose/diagnóstico por imagem , Candidíase/diagnóstico por imagem , Endocardite/diagnóstico por imagem , Valva Mitral/diagnóstico por imagem , Mucormicose/diagnóstico por imagem , Imagem Multimodal/métodos , Valva Pulmonar/diagnóstico por imagem , Valva Tricúspide/diagnóstico por imagem , Abscesso/microbiologia , Abscesso/terapia , Adulto , Idoso , Antifúngicos/uso terapêutico , Aspergilose/microbiologia , Aspergilose/terapia , Biópsia , Candidíase/microbiologia , Candidíase/terapia , Desbridamento , Ecocardiografia Doppler em Cores , Ecocardiografia Transesofagiana , Endocardite/microbiologia , Endocardite/terapia , Evolução Fatal , Feminino , Implante de Prótese de Valva Cardíaca , Humanos , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Valva Mitral/efeitos dos fármacos , Valva Mitral/microbiologia , Valva Mitral/cirurgia , Mucormicose/microbiologia , Mucormicose/terapia , Tomografia por Emissão de Pósitrons , Valor Preditivo dos Testes , Valva Pulmonar/efeitos dos fármacos , Valva Pulmonar/microbiologia , Valva Pulmonar/cirurgia , Resultado do Tratamento , Valva Tricúspide/microbiologia , Valva Tricúspide/cirurgiaRESUMO
OBJECTIVES: This study compared the risk of infective endocarditis (IE) after percutaneous pulmonary valve implantation (PPVI) with the Sapien and Melody valves. BACKGROUND: The incidence of IE after PPVI is estimated at 3% per year with the Melody valve. The Sapien valve is a more recently marketed valve used for PPVI. METHODS: We retrospectively included consecutive patients who underwent PPVI at a single center between 2008 and 2016. IE was diagnosed using the modified DUKE criteria. RESULTS: PPVI was performed in 79 patients (Melody valve, 40.5%; Sapien valve, 59.5%). Median age was 24.9 years (range 18.1 to 34.6). IE occurred in 8 patients (10.1%) at a median of 1.8 years (minimum: 1.0; maximum: 5.6) after surgery. Causative organisms were methicillin-sensitive Staphylococcus aureus (n = 3), Staphylococcus epidermidis (n = 1), Streptococcus mitis (n = 1), Aerococcus viridans (n = 1), Corynebacterium striatum (n = 1), and Haemophilus influenzae (n = 1). All 8 cases occurred after Melody PPVI (25.0% vs. 0.0%). The incidence of IE was 5.7% (95% confidence interval: 2.9% to 11.4%) per person-year after Melody PPVI. The Kaplan-Meier cumulative incidence of IE with Melody PPVI was 24.0% (95% confidence interval: 12.2% to 43.9%) after 4 years and 30.1% (95% confidence interval: 15.8% to 52.5%) after 6 years, compared with 0.0% with the Sapien PPVI after 4 years (p < 0.04 by log-rank test). There was a trend toward a higher incidence of IE in the first 20 patients with Melody PPVI (who received prophylactic antibiotics during the procedure only) and in patients who had percutaneous interventions, dental care, or noncardiac surgery after PPVI. CONCLUSIONS: IE after PPVI may be less common with the Sapien compared with the Melody valve.