ro13-9904 and Heart-Valve-Diseases

Enterococcus hirae is rarely identified in humans and may be a commensal pathogen in psittacine birds. We present the fifth known case of E. hirae endocarditis.. A 64-year-old Caucasian female presented with fever, hypotension, atrial fibrillation with rapid ventricular response, and a two-week history of lightheadedness. Her previous medical history included COPD, recurrent DVT, atrial fibrillation (on warfarin), hypertension, hypothyroidism, and Hodgkin's lymphoma. Physical exam was notable for expiratory wheezes and a 2/6 systolic ejection murmur at the right sternal border. 2D echocardiogram revealed severe aortic stenosis. The patient underwent right and left heart catheterization, where she was found to have severe aortic stenosis and mild pulmonary hypertension. She subsequently underwent minimally invasive aortic valve replacement with a bovine pericardial valve, bilateral atrial cryoablation, and clipping of the left atrial appendage. Her aortic valve was found to have a bicuspid, thickened appearance with calcifications, multiple small vegetations, and a root abscess beneath the right coronary cusp. With a new suspicion of infective endocarditis, the patient was placed on broad-spectrum IV antibiotics. Intra-operative blood cultures were negative. A tissue culture from the aortic valve vegetations identified Enterococcus hirae susceptible to ampicillin through MALDI-TOF. Antibiotic treatment was then switched to IV ampicillin and ceftriaxone; she declined aminoglycoside treatment due to toxicity concerns. The patient had an uncomplicated postoperative course and was discharged with 6 weeks of antibiotics. To date, she continues to be followed with no signs of relapsing disease.. To our knowledge, this case constitutes the fifth known case of E. hirae endocarditis, and the second case to have been identified with MALDI-TOF and treated with ampicillin and ceftriaxone. This case reinforces the efficacy of ampicillin and ceftriaxone for the treatment of E. hirae endocarditis.

Topics: Aminoglycosides; Ampicillin; Animals; Anti-Bacterial Agents; Cattle; Ceftriaxone; Endocarditis, Bacterial; Enterococcus hirae; Female; Gram-Positive Bacterial Infections; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Middle Aged; Transcatheter Aortic Valve Replacement

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Endocarditis, Bacterial; Gram-Negative Bacterial Infections; Heart Valve Diseases; Humans; Male; Metronidazole; Risk Factors; Substance Abuse, Intravenous; Veillonella

Salmonella are a rare cause of infective endocarditis. This report describes a case where Salmonella typhi was isolated from the blood and urine of a patient with echocardiographically documented aortic valve disease and endocarditis. The patient was treated with two weeks of ceftriaxone (3 g/day) and amikacin (15 mg/kg/day), followed by a further two weeks of ceftriaxone (3 g/day) alone. He made a complete recovery.

Topics: Adult; Amikacin; Aortic Valve; Ceftriaxone; Drug Therapy, Combination; Echocardiography; Endocarditis, Bacterial; Heart Valve Diseases; Humans; Male; Salmonella typhi; Typhoid Fever

Topics: Aged; Anti-Bacterial Agents; Aortic Valve; Aortic Valve Insufficiency; Ceftriaxone; Echocardiography, Transesophageal; Endocarditis, Subacute Bacterial; Fatal Outcome; Heart Valve Diseases; Heart Valve Prosthesis; Humans; Male; Shock, Cardiogenic; Streptococcal Infections; Vasculitis, Leukocytoclastic, Cutaneous; Viridans Streptococci

A 43-year-old male with a history of bioprosthetic aortic valve replacement and tricuspid valve annuloplasty presented with vertigo and was found to have an acute infarct in the left superior cerebellum, as well as a left-middle cerebral artery mycotic aneurysm. Blood cultures grew Cardiobacterium hominis and bioprosthetic aortic valve vegetation was found on transthoracic echocardiogram.

Topics: Adult; Aneurysm, Infected; Anti-Bacterial Agents; Aortic Valve; Bicuspid Aortic Valve Disease; Bioprosthesis; Cardiobacterium; Ceftriaxone; Cerebral Infarction; Endocarditis, Bacterial; Gram-Negative Bacterial Infections; Heart Defects, Congenital; Heart Valve Diseases; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Intracranial Aneurysm; Male; Postoperative Complications; Tomography, X-Ray Computed; Treatment Outcome

The best treatment for Tropheryma whipplei infections is controversial. We report a patient who suffered from T. whipplei aortic native valve endocarditis that relapsed despite surgery and four weeks of intravenous ceftriaxone followed by several months of oral trimethoprim/sulfamethoxazole. Cure was achieved after replacement of the prosthesis with a homograft and 18 months of oral doxycycline-hydroxychloroquine. We discuss the need for a change in treatment guidelines for T. whipplei infections.

Topics: Anti-Bacterial Agents; Aortic Valve; Ceftriaxone; Doxycycline; Drug Therapy, Combination; Endocarditis, Bacterial; Heart Valve Diseases; Humans; Hydroxychloroquine; Male; Middle Aged; Recurrence; Trimethoprim, Sulfamethoxazole Drug Combination; Tropheryma; Whipple Disease

Topics: Aged; Anti-Bacterial Agents; Aortic Valve; Bicuspid Aortic Valve Disease; Ceftriaxone; Endocarditis; Heart Defects, Congenital; Heart Valve Diseases; Humans; Male; Streptococcal Infections; Streptococcus oralis; Treatment Outcome

Topics: Anti-Bacterial Agents; Anticoagulants; Arteriovenous Fistula; Atrial Fibrillation; Bacteremia; Ceftriaxone; Combined Modality Therapy; Coronary Disease; Coronary Sinus; Coronary Vessel Anomalies; Endocarditis, Bacterial; Heart Valve Diseases; Humans; Ligation; Male; Middle Aged; Mitral Valve; Pulmonary Embolism; Streptococcal Infections; Streptococcus mitis; Tricuspid Valve; Ultrasonography

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".

Topics: Animals; Anti-Bacterial Agents; Bacteremia; Bacteriological Techniques; Ceftriaxone; Echocardiography, Transesophageal; Emigrants and Immigrants; Endocarditis, Bacterial; Erysipeloid; Erysipelothrix; Female; Finger Injuries; Follow-Up Studies; Food Microbiology; Heart Valve Diseases; Holidays; Humans; Infusions, Intravenous; Meat; Microbial Sensitivity Tests; Middle Aged; Mitral Valve; Penicillin G; Sheep; Switzerland; Turkey

Culture-negative endocarditis is most often the result of prior antimicrobial therapy. Tropheryma whipplei is the etiologic agent of Whipple's disease, which is typically characterized by diarrhea, weight loss, and intra-abdominal lymphadenopathy. We present the case of a 48-year-old male with Whipple's endocarditis of the aortic valve who did not develop signs of systemic Whipple's disease. Our patient was treated with a regimen that included ceftriaxone for 6 weeks prior to his cardiac surgery, yet valve pathology demonstrated abundant T. whipplei, suggesting that a prolonged antibiotic course is necessary for the treatment of Whipple's endocarditis.

Topics: Anti-Bacterial Agents; Aortic Valve; Ceftriaxone; Endocarditis, Bacterial; Heart Valve Diseases; Humans; Lymphatic Diseases; Male; Middle Aged; Tropheryma; Whipple Disease

The bacterial species Erysipelothrix rhusiopathiae is found worldwide as a commensal or a pathogen in a variety of animals. One well-defined pattern of human infection is an uncommon bacteremic form, with or without cutaneous involvement, usually complicated by endocarditis. We report the case of a 38-year-old male butcher with E. rhusiopathiae bacteremia, native aortic valve endocarditis and perivalvular abscess. The patient was released after six weeks of intravenous ceftriaxone and aortic valve replacement because of severe regurgitation.

Topics: Abscess; Adult; Aortic Valve; Aortic Valve Insufficiency; Bacteremia; Ceftriaxone; Cephalosporins; Endocarditis, Bacterial; Erysipelothrix Infections; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Humans; Male

The emergence of antibiotic resistance in Streptococcus pneumoniae poses a particular threat to HIV-infected patients. These patients are at increased risk of invasive pneumococcal disease and may respond poorly to pneumococcal vaccination. We describe an HIV-infected patient with recurrent aortic valve endocarditis due to the same serotype of S. pneumoniae (19A) despite appropriate treatment with penicillin and immunoprophylaxis. The pneumococcus responsible for the second episode of endocarditis was susceptible to cefotaxime (MIC of 0.06 microg/ml), but was no longer susceptible to penicillin (MIC of 0.25 microg/ml). The patient was treated successfully with 4 weeks of intravenous ceftriaxone.

Topics: Aortic Valve; Bacterial Vaccines; Ceftriaxone; Echocardiography; Endocarditis, Bacterial; Heart Valve Diseases; HIV Infections; Humans; Male; Middle Aged; Penicillin G; Penicillin Resistance; Penicillins; Pneumococcal Infections; Pneumococcal Vaccines; Recurrence; Streptococcus pneumoniae