ro13-9904 and Mitral-Valve-Insufficiency

A 65-year-old male patient presented with fever, fast atrial fibrillation and frank haematuria on return to Ireland from travel in East Africa. He had a systolic murmur leading to a clinical suspicion of endocarditis. He had no specific clinical features of diphtheria. Blood cultures were taken and empiric therapy commenced with benzylpenicillin, vancomycin and gentamicin.

Topics: Administration, Intravenous; Aged; Anti-Bacterial Agents; Ceftriaxone; Corynebacterium diphtheriae; Corynebacterium Infections; Diphtheria Antitoxin; Foot Ulcer; Humans; Male; Mitral Valve Insufficiency

A 31-year-old Argentinian woman presented with a 3-week history of fever, night sweats, myalgia and lethargy following a work trip to Uganda where she ran a marathon. Malarial screens were negative but C reactive protein, erythrocyte sedimentation rate and neutrophil count were raised and she was anaemic. A new pansystolic murmur was heard over the mitral valve and the transthoracic echocardiogram showed a large vegetation (>1 cm) with at least moderate mitral regurgitation. Blood cultures grew Neisseria elongata, subsp elongata treated initially with ceftriaxone then oral ciprofloxacin to complete 4 weeks of treatment. CT scan revealed a wedge-shaped area of low attenuation in the spleen in keeping with a splenic infarct. Seven days postadmission, the patient underwent a successful mitral valve repair. Recovery was complicated by a likely embolic infarct in the right frontal lobe, but the patient was discharged 12 days postoperative with no neurological sequelae.

Topics: Adult; Anti-Bacterial Agents; Ceftriaxone; Ciprofloxacin; Echocardiography; Endocarditis, Bacterial; Female; Humans; Mitral Valve Annuloplasty; Mitral Valve Insufficiency; Neisseria elongata; Neisseriaceae Infections; Physical Endurance; Running; Splenic Infarction; Travel; Uganda; United Kingdom

A 76-year-old man presented with a 3-week history of intermittent fevers and dyspnoea on exertion after a dental bridge placement 2 months ago. The patient's medical history was significant for mild to moderate mitral valve prolapse. Initial evaluation was notable for a 3/6 systolic apical murmur. Laboratory investigations revealed leucocytosis and elevated erythrocyte sedimentation rate, C reactive protein and cardiac biomarkers. Patient was treated initially for non-ST elevation myocardial infarction. A 2-dimensional echocardiography was concerning for a new mitral regurgitation and a questionable vegetation adjacent to the mitral valve annulus. Transoesophageal echocardiography study confirmed the diagnosis. Subsequent microbial identification was notable for Peptostreptococci and he was started on intravenous penicillin therapy. The unexplained illness with underlying valve disease prompted consideration of infective endocarditis. This case describes a rare occurrence of anaerobic endocarditis imitating an acute coronary event.

Topics: Acute Coronary Syndrome; Aged; Anti-Bacterial Agents; Ceftriaxone; Diagnosis, Differential; Drug Therapy, Combination; Echocardiography, Transesophageal; Endocarditis, Bacterial; Gram-Positive Bacterial Infections; Humans; Male; Mitral Valve Insufficiency; Myocardial Infarction; Peptostreptococcus; Vancomycin

We present the clinical case of a man of 68 years who was admitted for dizziness and sensation of loss of conscience. The clinical examination revealed a body temperature of 37.5 degrees C and a murmur of mitral regurgitation. The echocardiogram showed a severe mitral regurgitation and left cavitie's dilatation; transesophageal echocardiogram showed a vegetation in the anterior leaflet of the mitral valve. In blood cultures grew a Gram-negative bacteria identified as Bartonella spp. A PCR demonstrated that it was a Bartonella quintana. The patient was treated with gentamicin, doxiciclin and ceftriaxone with satisfactory evolution. The remaining mitral insufficiency awaits surgical treatment.

Topics: Aged; Anti-Bacterial Agents; Bartonella quintana; Bartonellaceae Infections; Ceftriaxone; Endocarditis, Bacterial; Gentamicins; Humans; Male; Mitral Valve Insufficiency; Polymerase Chain Reaction

Topics: Adult; Ceftriaxone; Gonorrhea; Heart Valve Prosthesis; Humans; Male; Mitral Valve; Mitral Valve Insufficiency; Neisseria gonorrhoeae; Penicillin Resistance; Penicillins