Bartonella quintana Endocarditis in a Homeless Man with Cat Exposure in San Diego, California.

We report a case of Bartonella quintana endocarditis in a homeless man with congenital bicuspid aortic valve and significant cat exposure living in downtown San Diego, California.

Prosthetic Valve Endocarditis with Bartonella washoensis in a Human European Patient and Its Detection in Red Squirrels (Sciurus vulgaris).

Members of the genus Bartonella are fastidious Gram-negative facultative intracellular bacteria that are typically transmitted by arthropod vectors. Several Bartonella spp. have been found to cause culture-negative endocarditis in humans. Here, we report the case of a 75-year-old German woman with prosthetic valve endocarditis due to Bartonella washoensis The infecting agent was characterized by sequencing of six housekeeping genes (16S rRNA, ftsZ, gltA, groEL, ribC, and rpoB), applying a multilocus sequence typing (MLST) approach. The 5,097 bp of the concatenated housekeeping gene sequence from the patient were 99.0% identical to a sequence from a B. washoensis strain isolated from a red squirrel (Sciurus vulgarisorientis) from China. A total of 39% (24/62) of red squirrel (S. vulgaris) samples from the Netherlands were positive for the B. washoensisgltA gene variant detected in the patient. This suggests that the red squirrel is the reservoir host for human infection in Europe.

First reported detection of biofilm formation by Campylobacter fetus during investigation of a case of prosthetic valve endocarditis.

AIMS: Campylobacter fetus subsp fetus (CFF) can cause intestinal illness, particularly in immunocompromised humans, with the potential to cause severe systemic infections. CFF is a zoonotic pathogen with a broad host range among farm animals and humans, inducing abortion in sheep and cows. The current paper describes a strain of CFF isolated from a patient with prosthetic valve endocarditis in Mercy University Hospital, Cork, Ireland, during 2017. Only five cases of C. fetus as a cause of prosthetic valve endocarditis have been reported in the literature, with no reports of biofilm formation within the species. METHODS: The aetiological strain was speciated and subspeciated by the VITEK 2 NH card and matrix-assisted laser desorption ionisation time-of-flight mass spectrometry. CFF biofilm formation was analysed using a crystal violet staining method. C. jejuni National Collection of Type Cultures (NCTC) 11168 was used as a positive control organism. Strains were incubated statically in Mueller-Hinton broth and Mueller-Hinton broth supplemented with 0.025% sodium deoxycholate for 3 and 7 days at 37°C, microaerobically. RESULTS: The CFF strain formed stronger attached biofilms on polystyrene plates on day 3 (72 hours) than the C. jejuni NCTC 11168 control strain, but were weaker than the control strain on day 7 in Mueller-Hinton broth. Monoculture of this C. fetus isolate was found to exist in three defined forms of biofilms (attached, air-liquid interface and floccules). CONCLUSIONS: This clinically significant C. fetus isolate showed considerable biofilm-forming capability, which we suggest conferred a survivalist advantage, contributing to the genesis of infective prosthetic valve endocarditis.

A Case Report: Organs From a Donor With Highly Virulent Zoonotic Outbreak Strain of Streptococcus agalactiae Serotype III, Multilocus Sequence Type 283 Infective Endocarditis Did Not Result in Transmission With Adequate Prophylactic Antibiotic Cover.

In 2015, an outbreak involving a highly virulent zoonotic outbreak strain of Streptococcus agalactiae serotype III, multilocus sequence type 283 occurred in Singapore with increased neurologic complications, septic arthritis, and spinal infections in healthier patients. We report a case of a successful dual kidney transplant from a deceased donor with infective endocarditis and disseminated infection with the same strain of S agalactiae and we review the current literature.

Mycobacterium chimaera infections associated with heater-cooler units in cardiac surgery.

PURPOSE OF REVIEW: Mycobacterium chimaera infections following cardiac surgery have been reported from an increasing number of countries. These infections are characterized by a poor prognosis with a case fatality rate around 50% despite treatment. Since the first description in 2013, our understanding has grown steadily. Several outbreak investigations, case series, and experiments with heater-cooler units (HCUs) have been published. This review summarizes the current knowledge. RECENT FINDINGS: M. chimaera transmission occurs during cardiopulmonary bypass via bioaerosols emitted from contaminated HCU water systems. Manifestations of M. chimaera infection comprise endocarditis, vascular graft infections, surgical site infections, and dissemination. So far, all cases were exposed to a single HCU brand. Samples from the manufacturing site as well as clonality of M. chimaera strains isolated from HCUs and patients suggest a contamination already at time of delivery representing the main source for the outbreak. Nevertheless, HCU contamination in hospitals cannot be excluded. SUMMARY: Improved awareness of physicians of M. chimaera infection is crucial to prompt adequate diagnostic workup in patients that have been exposed to HCU presenting with compatible symptoms. For risk mitigation, strict separation between the air volume in contact with HCUs and critical clinical areas such as operating rooms is essential.

Rhizobium radiobacter Endocarditis in an Intravenous Drug User: Clinical Presentation, Diagnosis, and Treatment.

Rhizobium radiobacter, a soil-based organism, is not, usually, pathogenic unless in the immunecompromised. Endocarditis, in the immunocompromised, is a typical presentation generally as a result of catheter-based infections. We describe the presentation of R. radiobacter prosthetic valve endocarditis and the inherent challenges in its presentation and diagnosis. A patient presented with acute limb ischemia secondary to R. radiobacter-mediated endocarditis and subsequent thromboembolization of the distal superior femoral and proximal popliteal arteries in the left lower limb. He underwent an uneventful thrombolectomy that restored blood flow distal to the occlusion and restored the patency of the affected arteries. Postoperatively, the patient maintained several unexplained febrile episodes. Blood cultures remained negative for infection. A cardiac work-up demonstrated the presence of vegetative growth on the prosthetic mitral and native aortic valves. Histopathologic analysis of the extracted thrombus confirmed the presence of R. radiobacter. On further history, it was elucidated that the patient was an intravenous drug user who routinely stored drug paraphernalia in plant beds. The patient recovered uneventfully after Piptazobactam was administered. R. radiobacter, and similarly other soil-based pathogens, should be considered as a potential source of endocarditic infection and thromboembolization in patients who similarly describe a history of intravenous drug use.

The use of whole-genome sequencing for molecular epidemiology and antimicrobial surveillance: identifying the role of IncX3 plasmids and the spread of blaNDM-4-like genes in the Enterobacteriaceae.

AIMS: To characterise the resistome of a multi-drug resistant Klebsiella pneumoniae (Kp0003) isolated from an Australian traveller who was repatriated to a Sydney Metropolitan Hospital from Myanmar with possible prosthetic aortic valve infective endocarditis. METHODS: Kp0003 was recovered from a blood culture of the patient and whole genome sequencing was performed. Read mapping and de novo assembly of reads facilitated in silico multi-locus sequence and plasmid replicon typing as well as the characterisation of antibiotic resistance genes and their genetic context. Conjugation experiments were also performed to assess the plasmid (and resistance gene) transferability and the effect on the antibiotic resistance phenotype. RESULTS: Importantly, and of particular concern, the carbapenem-hydrolysing ß-lactamase gene blaNDM-4 was identified on a conjugative IncX3 plasmid (pJEG027). In this respect, the blaNDM-4 genetic context is similar (at least to some extent) to what has previously been identified for blaNDM-1 and blaNDM-4-like variants. CONCLUSIONS: This study highlights the potential role that IncX3 plasmids have played in the emergence and dissemination of blaNDM-4-like variants worldwide and emphasises the importance of resistance gene surveillance.

Transmission of infection to liver transplant recipients from donors with infective endocarditis: lessons learned.

Donors not meeting standard criteria, such as those with bacteremia, are now being used in response to the increasing need for organs for transplantation. Recommended strategies to prevent the occurrence of donor-derived bacteremia include the use of directed antibiotic prophylaxis. However, this approach does not eliminate the risk of infection transmission. Similarly, the management of organ recipients from donors with infective endocarditis (IE) remains uncharacterized. We report 2 cases of donor-derived bacterial infections in liver transplant recipients despite pathogen-specific antibiotic prophylaxis. In both instances, the donors had documented IE treated with appropriate antimicrobial therapy and clearance of bacteremia. Recipients had very distinctive clinical outcomes likely related to pathogen virulence and the extent of donor infection. Persistent infection in the transplanted liver should be suspected in organ recipients of a liver from donors with IE, despite the absence of bacteremia at the time of death and organ procurement. For eradication, recipients may require prolonged pathogen-directed antimicrobial therapy, such as is used for endovascular infections. Prompt recognition of donors with IE, appropriate notification, and prolonged antibiotic prophylaxis are key to reducing the risk of such donor-derived infections.

Infective endocarditis in northeastern Thailand.

Despite rigorous diagnostic testing, the cause of infective endocarditis was identified for just 60 (45.5%) of 132 patients admitted to hospitals in Khon Kaen, Thailand, during January 2010-July 2012. Most pathogens identified were Viridans streptococci and zoonotic bacteria species, as found in other resource-limited countries where underlying rheumatic heart disease is common.

[Trends in the profile of infective endocarditis at a university hospital in Tunis]. / Évolution du profil de l'endocardite infectieuse : expérience d'un centre universitaire à Tunis.

UNLABELLED: Infective endocarditis (IE) is a serious disease for which diagnosis and treatment continue to develop. Purpose of work. To analyze trends in its epidemiologic, clinical, and microbiologic characteristics, as well as its treatment and outcome. METHODS: Retrospective review of data of 135 patients admitted to our adult cardiology department from January 1981 through December 2011. IE was diagnosed according to the modified Duke Criteria. We defined 2 groups of patients according to their date of admission: group A (n = 55), patients admitted before 1995, and group B (n = 80), patients admitted in and after 1995. RESULTS: The entire population was predominantly male, and their mean age was 38.5 ± 16 years, 36 years in group A and 44 years in group B. IE affected mainly native valves (90% group A, 74% group B; p<0.05). Prosthetic IE was more frequent in group B (20% vs 10%, p<0.05), and the portal of entry identified more often (59% vs 22%; p = 0.03). Blood cultures were negative in 78% of patients in group A vs 57.5% in group B (p = 0.04). The principal causative microorganism was streptococcus before 1995 and staphylococcus after 1995, but this difference was not significant. Heart failure was more frequent in group A (p = 0.05). Embolic events affected 27% of the patients in group A vs 32.5% in group B (p = 0.05). The rate of surgery (51% in group A vs 62.5% in group B) did not differ significantly. The in-hospital mortality rate was 53% in group A vs 11% in group B (p<0.001); operative mortality was also higher in group A (p<0.001). CONCLUSION: Our work shows changes in the epidemiologic characteristics of IE that parallel changes in demographic and risk factors. The progress of diagnosis and surgery explains the better prognosis for this pathology today.

[Mitral valve endocarditis after Turkish "Festival of Sacrifice"]. / Mitralklappenendokarditis nach türkischem Opferfest.

Erysipelothrix rhusiopathiae is the causative agent of swine erysipelas. Systemic infections caused by E. rhusiopathiae are rare, but often (90%) associated with endocarditis. In about 60% of cases endocarditis develops on normal heart valves, and despite appropriate antibiotic therapy about one-third of the patients requires valve replacement. We report the case of a housewife, who developed a mitral valve endocarditis due to E. rhusiopathiae after preparing meat for the Turkish "Festival of Sacrifice".

[Endocarditis due to meticillin-resistant Staphylococcus aureus originating from pigs]. / Endocarditis door meticillineresistente Staphylococcus aureus afkomstig van varkens.

A 63-year-old woman with a kidney transplant was admitted with endocarditis caused by meticillin-resistant Staphylococcus aureus (MRSA). Once her antibiotic therapy had been adjusted to the sensitivity-pattern of the bacterial strain she recovered, without the need for surgical intervention. The isolated S. aureus was typed by multi-locus sequence typing as sequence type 398, a MRSA-strain that has recently been isolated from a high percentage of Dutch pigs. This is the first report of a life-threatening infection with this pig MRSA. This strain is genetically different from the globally dispersed nosocomial MRSA-strains, and also from the strains that have been epidemic for several years in the USA as the causative agent ofcommunity-acquired skin infections. The Dutch Working Group on Infection Prevention (WIP) has recently adjusted its guidelines to halt further spread of this strain, and advises that the population at risk (pig breeders, slaughterhouse personnel and veterinarians) be held in isolation when hospitalised until MRSA colonisation has been excluded. The patient described here, however, did not belong to this population at risk.

A case of polymicrobial endocarditis caused by anaerobic organisms in an injection drug user.

Endocarditis is a serious complication of injection drug use most commonly caused by Staphylococcus aureus. We report a case of tricuspid valve polymicrobial bacterial endocarditis in an injection drug user from 3 oral anaerobes: Actinomyces odontolytica, Veillonella species, and Prevotella melaninogenica. The patient was believed to have acquired these organisms from his habit of licking the needle in order to gauge the strength of the cocaine prior to injection. The patient was successfully treated with a 6-week course of penicillin G and metronidazole. This case demonstrates the importance of a detailed history in designing empiric therapy.

[Q fever with endocarditis: clinical presentation and serologic follow-up of 21 patients]. / Fièvre Q avec endocardite: présentation clinique et suivi sérologique de 21 patients.

AIM OF THE STUDY: The purpose of this study was to analyse the clinical and serological follow-up in 21 patients with Q fever endocarditis in Switzerland from 1981 to 1993. PATIENTS AND METHODS: Criteria for Q fever endocarditis were the following: Coxiella burnetii phase I IgG > 1 : 2560 and IgA > 1 : 20 by indirect immunofluorescence. Methods to confirm the diagnosis include immunohistochemical demonstration of C. burnetii by microscopy in valvular material (1 case) and inoculation of this material in experimental animals (10 cases). Information on clinical course of the disease, laboratory abnormalities and treatment were obtained by chart review and a questionnaire sent to physicians who requested the serological tests for Q fever. RESULTS: The average age of the patients was 47 years (15 men and 6 women). 64% of patients had a history of environmental exposure to C. burnetii. The median time of symptomatology before diagnosis was 5 months (1-108). 19/21 patients had valvular lesions, and 2/21 vascular Dacron prosthesis. Most patients presented with fever (18/21), congestive cardiac failure (14/21), weight loss (12/21), anemia (6/19), or thrombocytopenia (6/19). All the patients required antibiotic treatment. Cardiac surgery was performed in 15/21 patients. For 10 patients the geometric mean serological follow-up included at least titers at time of diagnosis (IgG anti-phase I antibodies 1 : 27024, IgA anti-phase I antibodies 1 : 685), at the end of therapy (IgG anti-phase I antibodies 1 : 2941, IgA anti-phase I antibodies 1 : 153) and 6 months after the end of therapy (IgG anti-phase I antibodies 1 : 368, IgA anti-phase I antibodies 1 : 40). The fall in anti-phase I titers was significant. During the clinical and serological outcome (median of 60 months and 69 months respectively) there was no recurrence of endocarditis and antibody titers to C. burnetii phase I remained low. Two patients died during the observation period, one from lung cancer, while the cause of death in the other was unknown. CONCLUSIONS: Serology is the key to Q fever diagnosis. The duration of treatment, and the values to be used to establish cure of endocarditis, are not clearly defined. During the clinical and serological outcome (median of 60 months and 69 months respectively) there was no recurrence of endocarditis and antibody titers to C. burnetii phase I remained low.

Molecular analysis provides evidence for human to human transmission of Staphylococcus aureus endocarditis in non-drug abusers.

Two cases of invasive Staphylococcus aureus are reported in which human to human transmission resulted in primary bacteremia and endocarditis. The identity of the organism was confirmed by phage typing, antibiograms, coagulase gene polymorphisms and ribotyping. This is the first documented case of such transmission not involving an intravenous drug abuser.