Gonococcal Endocarditis Research Articles

A Pair of Hearts: Two Cases of Mitral Valve Gonococcal Endocarditis.

Gonorrhea is a sexually transmitted infection. Manifestations include asymptomatic infection and disseminated, life-threatening disease. We present two cases of mitral valve gonococcal endocarditis and discuss epidemiologic trends in disseminated gonococcal infection, acknowledging antimicrobial resistance, genetic variability in gonococcal strains, and contextual factors related to the COVID-19 pandemic and STI control.

Penicillin-resistant gonorrheal endocarditis presenting with large annular abscess and aortic valve destruction

Disseminated gonorrheal infections with cardiac involvement are rare, with fewer than 100 cases reported. The increasing prevalence of gonococcal infections and increasing antibiotic resistance represent a concerning challenge to public health. Here we report a case of antibiotic-resistant gonococcal endocarditis presenting with cardiogenic shock and discuss principles of diagnosis and treatment.

Case Series of Three Patients with Disseminated Gonococcal Infection and Endocarditis.

IntroductionThe increasing incidence of Neisseria gonorrhoeae infections and emergence of cephalosporin-resistant strains means the threat of disseminated gonococcal infection and endocarditis needs to be reimagined into the differential diagnosis for patients treated in the emergency department (ED) for sexually transmitted infections and for endocarditis itself. Only 70 cases of disseminated gonococcal infection (DGI) with endocarditis had been reported through 2014.1–4 In 2019, however, an outbreak of DGI with one case of endocarditis was reported.5 This case series of three patients with DGI and endocarditis, in addition to the recent outbreak, may represent a warning sign for reemergence of this threat.Case ReportWe describe three cases within a recent three-year period of gonococcal endocarditis as seen and treated at our institution. These cases show divergent presentations of this insidious disease with both classical and atypical features. One case displayed a classic migratory rash with positive urine testing and a remote history of sexually transmitted infections, while another patient developed isolated culture-confirmed endocarditis with negative cervical testing and imaging, and the final case was a male patient who presented to the ED with fulminant endocarditis as the first ED presentation of infection.ConclusionSecondary to an overall rise in incidence and possibly due to increasing antibiotic-resistance patterns, gonococcal endocarditis should be included in the differential diagnosis of any case of endocarditis. Reciprocally, increased vigilance should surround the evaluation of any patient for sexually transmitted diseases while in the ED for both the development of DGI and endocarditis.

CASE OF GONOCOCCAL ENDOCARDITIS

TOPIC: Cardiovascular Disease TYPE: Medical Student/Resident Case Reports INTRODUCTION: Gonococcal endocarditis is rare occurrence since the advent of antibiotics. The aortic valve is the most commonly affected. Complications such as valvular abscess require evaluation by cardio-thoracic surgery. CASE PRESENTATION: A 26-year-old African American man with past medical history significant for paroxysmal atrial fibrillation and heart failure with preserved ejection fraction presented as a transfer from an outside hospital to be evaluated by cardiothoracic surgery for aortic valve replacement. He had a recent hospitalization and had blood cultures which revealed Neisseria gonorrhea. His subsequent blood cultures were negative. He received a dose of Azithromycin. He was also treated with Ceftriaxone. Ceftriaxone was changed to Meropenem which he was continued on. He was found to have significant troponin elevation during the recent hospitalization which was thought to be secondary to myocarditis. At the outside hospital during this hospitalization, he developed acute hypoxic respiratory failure and required mechanical ventilation. Cardiac catheterization showed severely elevated filling pressures and severely reduced cardiac output. A coronary angiogram showed worsening of left circumflex artery compression with concern for a hematoma causing compression of the artery. Transthoracic echo showed a grossly normal aortic valve but an adjacent circumferential echo lucent structure suggestive of an abscess or aneurysm. Aortic abscess was confirmed with transesophageal echocardiogram. Cardiothoracic surgery performed an aortic valve replacement. He was found to have pericarditis due to the gonococcal cardiac abscess which prevented successful bypass to the LAD or left circumflex. He was managed in the intensive care unit with inotropic support. Infectious Disease recommended treatment with IV Ceftriaxone for 6 weeks from his operation with transition to oral Cefotaxime. The tip of his central line grew Candida Albicans and he was started on Fluconazole to complete a 3-week course. Subsequent blood cultures remained negative. He also remained off vasopressors and oxygenation requirements were starting to improve. General surgery was consulted for placement of tracheostomy and PEG tube. The patient was then transferred to a specialty hospital. DISCUSSION: Disseminiated gonococcal infection may result in a valvular abscess. Complicatons like valvular abscess can be detected early with transesophageal echocardiography. Clinical deterioraton from valvular destruction is an indcation for early valve replacement. CONCLUSIONS: Our patient is a young sexually active African American man who required surgical intervention for gonococcal endocarditis. This case demonstrates the significance of early diagnosis of valvular abscess with trans esophageal echocardiography and evaluation by cardiothoracic surgery for a rare disease which has an alarming rate of mortality. REFERENCE #1: Prendergast BD, Tornos P. Surgery for infective endocarditis: who and when? Circulation. 2010;121(9):1141-52. https://doi.org/10.1161/CIRCULATIONAHA.108.773598. PMid: [PubMed] [Google Scholar] DISCLOSURES: No relevant relationships by Kristina Akopyan, source=Web Response

Endocarditis gonocócica, una rara complicación de la infección gonocócica diseminada

La infección por Neisseria gonorrhoeae tiene una incidencia de 700.000 personas anualmente, sin embargo, la diseminación gonocócica se presenta solo entre el 1% y el 3% de los casos. La endocarditis gonocócica ocurre entre el 1% y 2% de las infecciones gonocócicas diseminadas, ocurre principalmente en hombres jóvenes y tiene alto riesgo de complicaciones y mortalidad. Se reporta el caso de un hombre de 64 años con cuadro de fiebre y dolor articular, se obtuvo hemocultivo positivo para Neisseria gonorrhoeae y en el ecocardiograma se encontró vegetación en la válvula mitral. Se dio manejo antibiótico, con lo cual se resolvió la bacterie mia y la vegetación.

Gonococcal Endocarditis Complicating Disseminated Gonococcal Infection in a Young Aboriginal Woman: A Case Report

Background: Gonococcal endocarditis is a rare but devastating complication of disseminated gonococcal infection (DGI). This paper describes a case of disseminated gonococcal infection (DGI) leading to gonococcal endocarditis in a 19-year-old indigenous woman.

Gonococcal Endocarditis in a 47-year-old Japanese Man

A 47-year-old sexually active Japanese man was admitted with a persistent fever and weight loss. A physical examination revealed a cardiac murmur. A transthoracic echocardiogram was nondiagnostic, although blood cultures grew Neisseria gonorrhoeae. Gonococcal endocarditis was diagnosed based on the modified Duke criteria. The administration of antimicrobial therapy resulted in an adequate initial resolution; however, two months after completing the therapy, the patient developed cardiac failure. Severe aortic regurgitation was identified, and the patient underwent emergent aortic valve replacement. Despite the rarity of gonococcal endocarditis, this disease should nevertheless be considered in patients presenting with a fever, cardiac murmur and a consistent sexual history.

Gonococcal endocarditis: a case report and review of the literature

A 59-year-old Caucasian male presented with progressive dyspnea, arthralgias and fever for three days. A diastolic regurgitation murmur was detected in the aortic area. A transesophageal echocardiograph showed several vegetations and severe aortic regurgitation. Blood cultures yielded Neisseria gonorrhoeae beta-lactamase negative. The patient had not noticed any urogenital discomfort or urethral discharge. The patient successfully underwent surgery for septal abscess debridement. The patient received ceftriaxone 2 g bid for eight weeks and the clinical follow-up was uneventful. The review of the literature revealed a total of the 38 additional cases reported between 1980 and the present. The majority of the patients were young, male and with native valve involvement. There has been a clear tendency for left-sided valve involvement (especially in the aortic valve). All valve cultures were reported negative despite, in most cases, the marked tissue destruction. Polymerase chain reaction was performed in two patients and positive results were shown in both. Cultures of exudates from other locations were negative in most cases. One striking fact is the high proportion of patients who underwent surgery (72 %). Information regarding antibiotic sensitivity was available in 28 cases, with penicillin resistance reported in six patients (21 %) and intermediate sensitivity in four patients (14 %). Resistance to ciprofloxacin was reported in two cases (7 %). A rapid increase and distribution of isolates resistant to third generation cephalosporins have been recently detected. The mortality is high, particularly taking into account that most were young patients who had not presented previous heart disease.

Gonococcal endocarditis: a case report and literature review

Gonococcal endocarditis is rarely encountered in the post-antibiotic era. This case report describes a case of a previously healthy male who presented with double quotidian fever, chills, cough, and urethral symptoms. The presence of a cardiac mitral valvular vegetation along with positive blood cultures for Neisseria gonorrhoeae were diagnostic for gonococcal endocarditis. This case was, to our knowledge, the first reported gonococcal endocarditis case in China.

A Case of Gonococcal Endocarditis in the 21st Century

In the antibiotic era, gonococcal endocarditis is extremely rare with only a handful of cases reported in the literature. This case report describes a case of aortic valve endocarditis due to Neisseria gonorrhoeae in a somewhat unexpected patient, illustrating the importance of considering this pathogen in all sexually active patients who present febrile with a new murmur.

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Gonococcal endocarditis: forgotten but not quite gone

Gonococcal endocarditis: forgotten but not quite gone

Gonococcal endocarditis: Assessment by transesophageal echocardiography

Gonococcal endocarditis is a rare but aggressive infection that has an alarming rate of perivalvular abscess and mortality. We present a case of gonococcal endocarditis with intracardiac abscess and fistula diagnosed by transesophageal echocardiography. Given the often acute nature of gonococcal endocarditis and its propensity toward abscess formation, transesophageal echocardiography should be considered early in the course of this infection. (J Am Soc Echocardiogr 1997;10:767-70.)

Recurrent pericardial effusion as a complication of gonococcal salpingitis in a teenager

Pericardial effusion and pericarditis are rare complications of disseminated gonococcal disease and gonococcal endocarditis, which usually present with mild and self-limited symptomatology. We present the case of a 14-year-old female in which symptomatic pericardial effusion was the dominant feature associated with gonococcal salpingitis. This association has not been previously described.

Gonococcal Endocarditis: Twenty-Five Year Experience

Gonococcal endocarditis is a devastating albeit rare complication of disseminated gonorrhea. It virtually disappeared as a disease entity with the advent of antibiotic therapy. Recently, it has reappeared with surprisingly high frequency for unclear reasons. Since 1983, the authors have observed six episodes of this disease in five patients, the largest series reported to date. It is predominantly a disease of young people without underlying valvular heart disease. Characteristic clinical features include a high frequency of congestive heart failure and nephritis and a proclivity for aortic valve involvement, commonly with associated ring abscess, and large vegetations. Genitourinary symptoms, arthralgias, and rash are uncommon. Previously undescribed features include involvement of all four valves simultaneously, recurrence on an aortic valve prosthesis, and a high frequency of terminal complement deficiencies. Precipitous hemodynamic deterioration despite appropriate therapy is not uncommon, and overall mortality rate remains an alarming 19%.

Gonococcal Endocarditis

Despite the increasing incidence of gonococcal urethritis and cervicitis, endocarditis has become an infrequent consequence of infection with Neisseria gonorrhoeae. However, we recently had the opportunity to diagnose and treat a patient with this uncommon infection. He presented with febrile illness and a history of dysuria. After six days of incubation, cultures of blood yielded an isolate of N. gonorrhoeae. Treatment with penicillin plus streptomycin led to rapid resolution of the fever. Sequelae included left ventricular dilatation and aortic valve insufficiency. The latter was corrected by surgery. Our experience with this patient, as well as the 33 other cases reported in the literature since 1949, indicate that the diagnosis of gonococcal endocarditis should be suspected for any sexually active adult who presents with fever and a heart murmur.

Gonococcal endocarditis: A case series demonstrating modern presentation of an old disease

Gonococcal endocarditis appeared with striking frequency in the preantibiotic era compared with its surprising rarity today. We present a series of four episodes of gonococcal endocarditis, which presented to our institution in the last 2 years, after no cases in the previous decade. Three episodes involved the aortic valve and required emergency aortic valve replacement. One episode involved the tricuspid valve and was successfully cured with antibiotic infusion alone. Combining our four patients with the available 25 well-documented gonococcal endocarditis cases reported in the English medical literature during the antibiotic era, we demonstrated that the disease incidence may be increasing, that infections more often involve left-sided cardiac structures (particularly the aortic valve), and that the association with a quotidian fever curve, rash and arthritis, and overt gonococcal infection is less common than previously reported. These patients frequently present with fulminant and dramatic valvular insufficiency without immediately positive blood cultures and complete echocardiographic evaluation seems to provide a valuable aid in making a presumptive diagnosis of endocarditis and directing appropriate clinical management.

Gonococcal Endocarditis With Penicillin-Induced Bone Marrow Hypoplasia

ENDOCARDITIS is a rare complication of gonococcal infection.1We describe an unusual case in which treatment was complicated by two severe episodes of drug-induced neutropenia. This report emphasizes the important role of echocardiography in the diagnosis and management of endocarditis. Report of a Case An 18-year-old woman was admitted with a three-week history of fever, chest pain, and painful swellings on the left index finger and thumb. One week previously, her right knee had been swollen and painful. Her temperature was 38 °C, splinter hemorrhages were noted, and Osler's nodes were present on the left index finger and thumb. The carotid pulse was regular with a sharp upstroke. The blood pressure was 150/60 mm Hg. There were no signs of heart failure. An ejection systolic murmur and a loud early diastolic murmur were audible over the precordium. The ECG showed sinus rhythm and widespread nonspecific T-wave flattening. The chest

Gonococcal endocarditis with penicillin-induced bone marrow hypoplasia. Role of echocardiography

Gonococcal endocarditis with penicillin-induced bone marrow hypoplasia. Role of echocardiography

Early echocardiographic changes in a patient with gonococcal endocarditis

Early echocardiographic changes in a patient with gonococcal endocarditis