enalapril and Endocarditis--Bacterial

Topics: Acute Disease; Anemia; Anti-Bacterial Agents; Aortic Valve; Child; Combined Modality Therapy; Diagnosis, Differential; Drug Therapy, Combination; Enalapril; Endocarditis, Bacterial; Female; Furosemide; Granulomatosis with Polyangiitis; Heart Rupture; Humans; Immunosuppressive Agents; Mitral Valve; Oxygen Inhalation Therapy; Respiration Disorders; Rickettsia Infections; Rupture, Spontaneous; Ultrasonography; Vasculitis, Leukocytoclastic, Cutaneous

We have found that Streptococcus gordonii FSS2, an infective endocarditis (IE) isolate, expresses a dipeptidyl-carboxypeptidase with activity homologous to angiotensin-converting enzyme (ACE). The carboxypeptidase activity was purified to homogeneity as a complex/aggregate from a bacterial surface extract and was also active as a 165 kDa monomer. The specific activity for the carboxypeptidase activity was eightfold higher than that for recombinant human ACE. Selected ACE inhibitors, captopril, lisinopril and enalapril, did not inhibit the ACE activity. The carboxypeptidase also hydrolysed the Aα and Bβ-chains of human fibrinogen, which resulted in impaired fibrin formation by thrombin. The gene encoding ACE carboxypeptidase activity was sequenced and the inferred polypeptide product showed 99 % amino acid homology to SGO_0566, sgc, 'challisin' of S. gordonii CL1 Challis, and had no significant amino acid sequence homology to human ACE. Homologues of challisin ACE activity were commonly detected among the viridans group streptococci most often associated with IE.

Topics: Angiotensin I; Angiotensin II; Angiotensin-Converting Enzyme Inhibitors; Base Sequence; Captopril; Carboxypeptidases; Chromatography, High Pressure Liquid; Electrophoresis, Polyacrylamide Gel; Enalapril; Endocarditis, Bacterial; Fibrinogen; Humans; Lisinopril; Molecular Sequence Data; Peptidyl-Dipeptidase A; Sequence Analysis, DNA; Streptococcal Infections; Streptococcus gordonii

Primary actinomycotic endocarditis is extremely rare. The author reported a case who suffered from endocarditis due to Actinomyces georgiae which the portal of entry for the organism could not be determined The author also reviewed the literature which described similar conditions. In addition, to the author's knowledge, there have been no reported cases of actinomyces georgiae endocarditis. Thus, this is the first report in the world. Clinical features of this rare condition are indistinguishable from other bacterial endocarditis. Actinomyces spp. is usually susceptible to a wide range of antibiotics, and endocarditis caused by this genus needs a prolonged course of antimicrobial treatment. However the optimal duration of therapy is still unknown. Prognosis is good with early detection and proper management.

Topics: Actinomyces; Actinomycosis; Amoxicillin; Ampicillin; Anti-Bacterial Agents; Antihypertensive Agents; Ceftriaxone; Enalapril; Endocarditis, Bacterial; Humans; Male; Middle Aged; Penicillin G