rifampin and Aortic-Valve-Insufficiency

Herein, we describe a rare case of Corynebacterium jeikeium endocarditis that silently progressed in a 65-year-old man undergoing hemodialysis. Because routine monthly blood examination revealed high C-reactive protein levels, blood cultures were collected, although he had no symptom and was afebrile. After 2 days, a Gram-positive rod was detected in one set of the blood culture. Furthermore, transthoracic echocardiography revealed new aortic regurgitation (AR) and vegetations, and, therefore, infective endocarditis was suspected. Transesophageal echocardiography showed vegetations with a maximum diameter of 8 mm on his aortic valve, with some valve destruction. C. jeikeium was identified in three sets of blood cultures. Administration of daptomycin was started because he had vancomycin allergy. Judging from the high risk of embolization due to vegetations, emergency aortic valve replacement was performed on the second day. C. jeikeium was detected in a resected cardiac valve specimen and blood. This case emphasizes that physicians should always consider the possibility of infective endocarditis even in hemodialysis patients without any symptoms.

Topics: Aged; Anti-Bacterial Agents; Antibiotics, Antitubercular; Aortic Valve; Aortic Valve Insufficiency; Blood Culture; C-Reactive Protein; Combined Modality Therapy; Corynebacterium; Daptomycin; Diagnostic Tests, Routine; Echocardiography; Echocardiography, Transesophageal; Endocarditis, Bacterial; Hematologic Tests; Humans; Incidental Findings; Male; Renal Dialysis; Rifampin; Treatment Outcome

The cytochrome P450 is a superfamily of isoenzymes that are responsible for the metabolism of many drugs. Significant changes in pharmacokinetics and drug interactions may be due to induction of hepatic cytochrome P450 enzymes. Rifampicin is a common inducer of CYP3A4. We report a case of a 57-year-old woman who was suspected for endocarditis and therefore treated with rifampicin. Due to previous mechanical aortic valve replacement, she also received phenprocoumon for anticoagulation. Although continuing anticoagulant therapy, antibiotic coadministration led to normal international normalised ratio (INR) level. Fifteen days after the treatment with rifampicin ended, INR returned to therapeutic level.

Topics: Anti-Bacterial Agents; Anticoagulants; Aortic Valve Insufficiency; Cytochrome P-450 Enzyme System; Drug Interactions; Endocarditis; Female; Heart Valve Prosthesis Implantation; Humans; International Normalized Ratio; Middle Aged; Phenprocoumon; Rifampin; Treatment Outcome; Vitamin K

Topics: Abscess; Adolescent; Allografts; Aorta; Aortic Rupture; Aortic Valve; Aortic Valve Insufficiency; Bicuspid Aortic Valve Disease; Cardiac Surgical Procedures; Chest Pain; Drug Resistance, Bacterial; Dyspnea; Endocarditis; Gentamicins; Heart Murmurs; Heart Valve Diseases; Humans; Male; Nafcillin; Pericardial Effusion; Rifampin; Staphylococcal Infections; Staphylococcus lugdunensis; Vancomycin; Vascular Grafting

Topics: Acute Disease; Anti-Bacterial Agents; Aortic Valve Insufficiency; Corynebacterium Infections; Humans; Male; Middle Aged; Rifampin; Subarachnoid Hemorrhage; Treatment Outcome

Kytoccoccus schroeteri is an emerging pathogen found mainly in association with prosthetic valve endocarditis. A striking aspect of this species is its resistance to penicillins, including isoxazolylpenicillins, making glycopeptide administration and valve replacement the treatment of choice. We present the case of a 38-year-old female diabetic patient with fever up to 39.1 degrees C for two months. Infection of her prosthetic aortic valve was suspected clinically. Repeated blood cultures revealed growth of K. schroeteri. Transesophageal echocardiography demonstrated a vegetation on the prosthetic aortic valve. Antibiotic treatment with vancomycin, rifampin and gentamicin was started and this regimen led to complete resolution of symptoms and disappearance of the vegetation. It is of particular interest that the patient recovered without further surgical procedures. Since the first description of K. schroeteri in 2002, four cases of endocarditis have been published, suggesting antecedent and continuing underdiagnosis.

Topics: Actinomycetales; Actinomycetales Infections; Adult; Aortic Valve Insufficiency; DNA, Bacterial; Drug Administration Schedule; Drug Resistance, Multiple, Bacterial; Drug Therapy, Combination; Echocardiography, Transesophageal; Endocarditis, Bacterial; Female; Gentamicins; Heart Valve Prosthesis; Humans; Microbial Sensitivity Tests; Ofloxacin; Polymerase Chain Reaction; Rifampin; Vancomycin

Brucella infective endocarditis is an uncommon, but serious complication of brucellosis. The aortic valve is the most commonly affected cardiac valve. Due to characteristics of the infection, medical therapy alone is not sufficient in treating the disease and best results are obtained with surgery combination. We describe a case of Brucella endocarditis involving the aortic valve suspected in front of the clinical data and the results of serology, confirmed by the culture of the native valves. In association with the medical treatment, management valve replacement lead to a favorable medium-term evolution.

Topics: Anti-Bacterial Agents; Aortic Valve; Aortic Valve Insufficiency; Brucellosis; Doxycycline; Endocarditis, Bacterial; Follow-Up Studies; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Rifampin

The incidence of acute rheumatic fever has seen a dramatic decline over the last 15 to 20 years in most developed countries and treatment of this disease has changed little since. The ease of travel and immigration and the cosmopolitan nature of many cities mean that occasionally the disease will come to the attention of clinicians not familiar with its presentation, resulting in delayed diagnosis and treatment. We present a case of recurrent acute rheumatic fever in a patient who was initially thought to be suffering from acute bacterial endocarditis on her previously diseased rheumatic aortic valve. This culminated in her undergoing urgent aortic valve replacement during a phase of the illness that should have been treated with high dose anti-inflammatory medication. Therefore, clinicians should be aware of this condition and include it in their differential diagnosis of the febrile patient with a previous history of rheumatic fever. We briefly discuss the diagnostic dilemma of patients suffering from this condition and in differentiating it from acute endocarditis.

Topics: Acute Disease; Adult; Amoxicillin; Anti-Inflammatory Agents; Aortic Valve; Aortic Valve Insufficiency; Arthralgia; Bangladesh; Clarithromycin; Diagnosis, Differential; Diagnostic Errors; Drug Therapy, Combination; Emigration and Immigration; Endocarditis, Bacterial; England; Female; Fever; Gentamicins; Heart Failure; Heart Valve Prosthesis Implantation; Humans; Penicillin G; Penicillin V; Pericarditis; Pharyngitis; Prednisone; Recurrence; Rheumatic Fever; Rheumatic Heart Disease; Rifampin; Unnecessary Procedures; Vancomycin

Brucella endocarditis is a rare, but often fatal, complication of brucellosis. A 32 year old man acquired brucellosis while on a visit to his former home in Greece and presented six months later with malaise, fever and aortic regurgitation. Blood cultures grew Brucella melitensis biotype 1. Combined chemotherapy with streptomycin, tetracycline and rifampin sterilized his blood; however, his aortic valve was replaced owing to recurrent emboli and cardiac failure. Over the next 18 months the patient's antibody titer to Brucella fell and his blood reamined sterile. Cure was achieved by resection of the infected aortic valve and 10 weeks of bactericidal therapy for B. melitensis.

Topics: Adult; Aortic Valve Insufficiency; Brucellosis; Drug Therapy, Combination; Endocarditis, Bacterial; Heart Valve Prosthesis; Humans; Male; Rifampin; Streptomycin; Tetracycline

Topics: Aortic Valve; Aortic Valve Insufficiency; Chlamydia; Complement Fixation Tests; Endocarditis; Heart Valve Prosthesis; Humans; Male; Microscopy, Electron; Middle Aged; Rifampin; Tetracycline