P55 CA-MRSA AS A CAUSE OF LEMIERRE'S SYNDROME: FIRST REPORT OF TWO CASES IN ARGENTINA

Abstract

s from 12th ISCVID / International Journal of Antimicrobial Agents 41S1 (2013) S1–S34 S23 isolated in 2/2 blood cultures obtained in this clinical scenario. Nasopharyngeal swab was negative for gonococci. TEE: aortic vegetation and thrombus in ascending aorta. TC scan angiography and cardiac MRI showed mural thrombus and pseudoaneurism of ascendenting aorta. Ceftriaxone 4g/d was started and cardiovascular surgery (ascending aorta replacement) was undertaken. Aortic biopsy was sent to the National Reference Laboratory and PCR confirmed the diagnosis ofN. gonorrhoeae. The patient was discharge in good clinical condition and he is asymptomatic after 1 year of follow up. Comments: Neisseria gonorrhoeae infective endocarditis is a rare complication of DGI and usually occurs in young male adults without previous valve disease. Although often associated with the arthritis– dermatitis syndrome, endocarditis may be the sole manifestation of DGI. Almost 23% had urinary symptoms and in 2/3 of cases arthritis or tenosynovitis precede the clinical picture. Mortality ranges from 20% to >50% (in patients who underwent valve replacement). Mycotic pseudoaneurism is an exceptional but severe complication of N. gonorrheae IE. P54 ECHINOCOCCUS GRANULOSUS INFECTIVE ENDOCARDITIS. A RARE PRESENTATION OF AN HELMINTH INFECTION F. Nacinovich *, P. Fernandez Oses, M.F. Degese, G. Copertari, J.P. Costabel, G. Vaccarino, L. Calanni, S. Moguillansky. Instituto Cardiovascular de Buenos Aires, Buenos Aires, Argentina, Centros Medicos “Dr. Stamboulian”, INE-ANLIS, Argentina E-mail address: nacinovich@intramed.net Background: Echinococcosis is a zoonosis that can cause invasive infection in humans. In Argentina are among the most prevalent helminthiases. The hydatid cysts of E. granulosus usually affect the liver or lungs but may be found in any organ of the body. Although very rare (<2%), when the heart is involved, cardiac wall is the most frequent localization (myocardial cyst). Case report: A 32-year-old woman with a history of treated lungs hydatid cysts in 2006 (surgery and albendazole) presented during pregnancy with progressive dyspnea. Cesarean section was performed after TTE showed a mass in right atrial endocardium and was derived to cardiac surgery. A TEE showed pedicled and mobile mass in the right atrium and PASP = 75mmHg; TC scan angiography with multiple cysts in lungs, pulmonary artery compression by a cyst and calcified liver cysts. Cardiac MRI revealed two pedicled and mobile cysts on right atrial endocardium. Combinated treatment with albendazole plus praziquantel was started; cardiopulmonary surgery was done with atrial and lung cyst squeezing PA excised. No myocardial wall cysts were observed. Histopathologic analysis confirmed the diagnosis of Echinococcus granulosus. The patient was discharged in good clinical condition, with PASP = 50mmHg and under prolonged treatment with combined anthelmintic agents. Comments: Echinococcosis is frequent in rural areaswhere cattle and flesh-eating animals live together. The cyst is usually asymptomatic, but in certain location, as in the heart, can cause high morbility: rupture into the circulation with anaphylactic reaction, damage to the cardiac valves, ischemic syndromes, systemic or pulmonary embolization. Echocardiography is the most reliable test but cardiac MRI is currently a useful complementary diagnostic method. Hydatid cyst must be involved in the differential diagnosis of cardiac cysts in endemic areas. A multidiscipilinary approach should include surgery and combined anthelmintic agents active against this larval