Case Of Prosthetic Valve Endocarditis Research Articles

Fatal Scopulariopsis brevicaulis infection in a paediatric stem-cell transplant patient treated with voriconazole and caspofungin and a review of Scopulariopsis infections in immunocompromised patients

Scopulariopsis brevicaulis is an airborne mould that causes 1–10% of cases of onychomycosis, 1. Tosti A. Piraccini B.M. Stinchi C. Lorenzi S. Onychomycosis due to Scopulariopsis brevicaulis: clinical features and response to systemic antifungals. Br J Dermatol. 1996; 135: 799-802 Crossref PubMed Scopus (102) Google Scholar , 2. Tosti A. Piraccini B.M. Lorenzi S. Onychomycosis caused by nondermatophytic molds: clinical features and response to treatment of 59 cases. J Am Acad Dermatol. 2000; 42: 217-224 Abstract Full Text Full Text PDF PubMed Scopus (270) Google Scholar cutaneous lesions, 3. Cox N.H. Irving B. Cutaneous ‘ringworm’ lesions of Scopulariopsis brevicaulis. Br J Dermatol. 1993; : 129 Google Scholar or severe soft tissue infection following traumatic or surgical injury in immunocompetent patients. 4. Migrino R.Q. Hall G.S. Longworth D.L. Deep tissue infections caused by Scopulariopsis brevicaulis: report of a case of prosthetic valve endocarditis and review. Clin Infect Dis. 1995; 21: 672-674 Crossref PubMed Scopus (39) Google Scholar , 5. Sekhon A.S. Willars D.J. Hawey J.H. Deep Scopulariopsis: a case report and sensitivity studies. J Clin Pathol. 1974; 27: 837-843 Crossref PubMed Scopus (23) Google Scholar In this case we describe another dramatic presentation of Scopulariopsis species infection, widely disseminated infection, in a child after stem-cell transplantation with graft versus-host-disease who failed lipid amphotericin B therapy as well as voriconazole plus caspofungin combination therapy. We also review 12 cases of Scopulariopsis species infection in immunocompromised patients.

Bacteriological outcome of combination versus single-agent treatment for staphylococcal endocarditis.

To analyse the bacteriological outcome of combination versus single-agent antimicrobial treatment in staphylococcal endocarditis. Retrospective review of 152 episodes: 91 cases of native valve endocarditis (NVE), 74 due to Staphylococcus aureus and 17 due to coagulase-negative staphylococci (CoNS); and 61 cases of prosthetic valve endocarditis (PVE), 29 due to S. aureus and 32 due to CoNS. Valves from patients with S. aureus NVE treated with any kind of combination antibiotic treatment were no more likely to be culture-negative than those treated with a single agent [19 (45%) of 42 versus 13 (41%) of 32; P = 0.69]. This finding remained unchanged when cases of CoNS NVE were added to the S. aureus group. In PVE, after adjusting for duration of treatment, valves from patients receiving any kind of combination treatment were 5.9 times (95% confidence interval 1.3-27.5) more likely to be culture-negative than those receiving monotherapy (P = 0.024). Patients treated for >14 days were more likely to be culture-negative than those treated for <or=14 days [49 (83%) of 59 versus 29 (31%) of 93; P < 0.001]. In staphylococcal NVE, combination treatment is not superior to monotherapy in sterilizing infected valves, but in PVE combination treatment confers an advantage.

Invasive Infection due to Penicillium Species other than P. marneffei

Infection caused by Penicillium spp. due to species other than P. marneffei is rare. We present three such cases of invasive disease. The first had chronic granulomatous disorder (CGD) with pulmonary infection caused by Penicillium spp. and he responded to amphotericin B therapy. Cases two and three were not known to be immunocompromised and both failed to respond to therapy. Case two had cerebral disease from an unknown source caused by P. chrysogenum. Case three probably acquired infection caused by P. decumbens peri-operatively and presented with paravertebral infection. The pertinent literature on invasive infections of Penicillium spp. other than P. marneffei is reviewed. From 1951 onwards, 31 reported cases of invasive disease included 12 cases of pulmonary infection (six in non-immunocompromised patients), four cases of prosthetic valve endocarditis, six cases of CAPD peritonitis, five cases of endophthalmitis, individual cases of fungemia and oesophagitis (both in AIDS), upper urinary tract infection and intracranial infection. Trauma, surgery or prosthetic material is commonly implicated in the non-pulmonary cases. Superficial infection (keratitis and otomycosis) is commonly caused byPenicillium spp. Allergic pulmonary disease, often occupational (such as various cheeseworkers' diseases), is also common. Optimal therapy for invasive infection is not established, but surgery may be advisable if possible. Amphotericin B may be the most effective antifungal drug.

Prosthetic Valve Endocarditis Caused by Pasteurella dagmatis

This case of prosthetic valve endocarditis due to Pasteurella dagmatis is the first to be reported in the English language medical literature. The two reported cases of native valve endocarditis due to P dagmatis are reviewed, and the treatment of Pasteurella-induced endocarditis is discussed.

Pronóstico a corto y largo plazo de la endocarditis sobre prótesis en pacientes no drogadictos

Prosthetic valve infective endocarditis is a complication of valvular replacement surgery with a high morbimortality during the in-hospital phase and an important risk of complications during follow-up. The objective of the present study is to assess the clinical features and the short and long-term prognosis of this disease. A prospective study of 43 consecutive cases of prosthetic valve endocarditis in non-addict patients from January 1987 to March 1997. The mean age was 51 +/-16 years. Eight patients (19%) had early prosthetic valve endocarditis (two months following heart surgery), fourteen patients (32%) had intermediate (between 2 and 12 months post surgery) and twenty-one (49%) had late prosthetic valve endocarditis (more than one year after heart surgery). Transesophageal echocardiography was performed in 32 patients with a sensibility of 81%. Complications occurred in 86% of patients and 53% of patients underwent surgery during the active phase (25% was emergency surgery). Inpatient mortality was 23% (50% in early prosthetic valve endocarditis). After a mean follow-up of 56 months there were 5 cases of recurrence, four patients required late surgery and 5 patients died. Survival (excluding early mortality) was 82% at 5 years with no significant differences among patients who received only medical treatment and those who underwent surgery in the active phase. Early mortality of prosthetic valve endocarditis is, according to our experience of 20%. The prognosis of survivors to the active phase is favourable in the majority. Early prosthetic valve endocarditis still causes a high mortality rate despite the use of combined medical surgical treatment in most cases.

Long-Term Follow-Up of St. Jude Medical Prosthesis in a Young Rheumatic Population Using Low-Level Warfarin Anticoagulation: An Analysis of the Temporal Distribution of Causes of Death

This study assesses the long-term (mean 52 ± 24 months) performance of the St. Jude Medical (SJM) valve in 200 young (mean age 31 ± 13 years) rheumatic patients on low-level warfarin anticoagulation combined with dipyridamole. Follow-up was 95% complete and comprised 867 patient-years. There were 33 deaths (3.8%/patient-year). Death was valve related in 12 cases and due to left ventricular dysfunction in 10. Death due to left ventricular dysfunction occurred earlier after surgery than death due to other causes (10 ± 7 vs 29 ± 18 months, p <0.005); these patients had larger preoperative left ventricular dimensions than the rest of the group (end-systolic diameter 51 ± 13 vs 37 ± 16 mm, end-diastolic diameter 66 ± 13 vs 50 ± 19 mm, p = 0.006). Actuarial probability of survival was 81% at 86 months and probability of event-free survival was 71%. The median international normalized ratio was 1.88 ± 0.54. Thromboembolism (13 events) occurred at a linearized rate of 1.5%/patient-year. There were 11 major bleeding episodes (1.3%/patient-year), 4 cases of prosthetic valve endocarditis (0.8%/patient-year), and 12 paraprosthetic leaks (1.4%/patient-year). No valve obstructions or reoperations occurred. Thus, the SJM valve performs well on low-level anticoagulation combined with dipyridamole. Left ventricular dysfunction was a common cause of death in the early postoperative period.

An evaluation of the Duke criteria in 25 pathologically confirmed cases of prosthetic valve endocarditis.

Six studies have compared the sensitivity of the Duke criteria with that of the Beth Israel criteria for the diagnosis of infective endocarditis without attempting to distinguish between native valve and prosthetic valve cases. After reviewing clinical data from 372 cases of suspected prosthetic valve endocarditis, we selected 25 cases in which pathological confirmation of prosthetic valve endocarditis was obtained. By using the Duke criteria and then the Beth Israel criteria, we reassigned a diagnostic classification to these 25 cases on the basis of clinical parameters alone. Using the Duke criteria, we correctly classified 19 cases (76%) as definite endocarditis and rejected none, while the Beth Israel criteria correctly classified six cases as probable endocarditis (24%) and rejected five cases (20%). Similar to previous investigators who examined the diagnostic sensitivity of the Duke criteria and Beth Israel criteria, we found that the Duke criteria appear more sensitive than the Beth Israel criteria in pathologically confirmed cases of prosthetic valve endocarditis.

Suggested Modifications to the Duke Criteria for the Clinical Diagnosis of Native Valve and Prosthetic Valve Endocarditis: Analysis of 118 Pathologically Proven Cases

We analyzed 118 consecutive cases of pathologically proven infective endocarditis (100 cases of native valve endocarditis [NVE] and 18 cases of prosthetic valve endocarditis [PVE]) with use of the Beth Israel criteria, the Duke criteria, and our suggested modifications of the Duke criteria; we found improved diagnostic sensitivity with our modifications. These modifications included the following additional minor criteria: the presence of newly diagnosed clubbing, splenomegaly, splinter hemorrhages, and petechiae; a high erythrocyte sedimentation rate; a high C-reactive protein level; and the presence of central nonfeeding lines, peripheral lines, and microscopic hematuria. Analysis of the pathologically proven cases of NVE showed that 64% were probable by the Beth Israel criteria, 83% were definite by the Duke criteria, and 94% were definite by our modified Duke criteria. For the pathologically proven cases of PVE, 50% were probable by the Beth Israel criteria, 50% were definite by the Duke criteria, and 89% were definite by our modified Duke criteria. All cases of NVE and PVE rejected by the Duke criteria remained rejected by our modifications. Therefore, our modifications improved diagnostic sensitivity while retaining specificity.

A case of prosthetic valve endocarditis caused byCryptococcus neoformansvar.neoformans

A case of prosthetic valve endocarditis caused by Cryptococcus neoformans var. neoformans is described. The infection followed closed mitral valvotomy and insertion of a valvular prosthesis. Infection was manifested 2 weeks after the operation. The diagnosis was based on direct demonstration of the yeast with characteristic morphology in clinical material, isolation from an arterial thrombus and detection of cryptococcal antigen in the serum. The patient's infection could not be resolved despite institution of antifungal therapy.

A Study of 47 Bacteremic Staphylococcus aureus Endocarditis Cases: 23 with Native Valves Treated Surgically and 24 with Prosthetic Valves

A retrospective review of medical records from the Staphylococcus Laboratory, Copenhagen, 1982-1991, was carried out at the Department of Clinical Microbiology, Statens Serum Institut, 1994-1995, to investigate the clinical features and outcome of two subgroups of bacteremic Staphylococcus aureus endocarditis cases in non-drug addicts: patients with prosthetic valve endocarditis (PVE) and patients with native valve endocarditis treated surgically. Twenty-four cases of PVE were included. Six cases were early (within 60 days of valve implantation) and 18 were late. The overall in-hospital mortality was 42%. Surgical treatment resulted in a non-significantly lower mortality as compared with medical treatment alone (0% vs 50%, p = 0.19). Medical treatment of aortic and mitral valve endocarditis resulted in similar mortality rates (44% and 50%, respectively). Twenty-three cases of native valve infective endocarditis had the valve replaced surgically. The in-hospital mortality was 22%, which was significantly lower as compared with medical therapy (69%, p < 0.0001). The treatment changed significantly during the study period: 6 of 112 patients (5%) were treated surgically in the first half of the period (1982-1986) compared to 17 of 124 patients (14%) in the second half (1987-1991, p = 0.049). Severe congestive heart failure was the main indication for cardiac surgery in 21 patients. In conclusion, a shift towards a more aggressive surgical approach has taken place in the 10-year period. This development should be strengthened in the future as surgical intervention may improve survival in patients with infective endocarditis caused by S. aureus whether the infected valve is prosthetic or native.

Case report of Streptomyces endocarditis of a prosthetic aortic valve

We describe the first case of prosthetic valve endocarditis due to a Streptomyces sp. The patient presented with fever, cutaneous embolic lesions, and bacteremia 3 months after aortic valve replacement. Treatment required valve replacement and a long course of parenteral imipenem.

Micrococcus luteus endocarditis: Case report and review of the literature

This paper includes a report on a case of prosthetic valve endocarditis due to Micrococcus luteus and a review of the sixteen cases of endocarditis due to Micrococcus species reported in the literature. The patient was successfully treated with rifampicin combined for two weeks with gentamicin and vancomycin and for another four weeks with teicoplanin. The hospital course was uneventful and no surgery was required.

Propionibacterium acnes as a cause of aggressive aortic valve endocarditis and importance of tissue grinding: case report and review

A case of prosthetic valve endocarditis with Propionibacterium acnes is described. The diagnosis was documented by histology and isolation of P. acnes from both blood and anulus tissue. Grinding of the tissue, which was first omitted to avoid contamination, was indispensable for cultivating the agent. The literature for P. acnes endocarditis is reviewed.

Campylobacter fetus Endocarditis: Two Case Reports and Review

We report two cases of Campylobacter fetus endocarditis. The first case involved a bicuspid native aortic valve in a 60-year-old woman, and the second involved a prosthetic aortic valve in a 76-year-old woman. No source of infection was identified in either case. Despite antibiotic therapy, hemodynamic deterioration necessitated valve replacement; both patients recovered completely. C. fetus is an uncommon cause of human infection but may be responsible for severe illnesses such as endocarditis and thrombophlebitis because of its tendency to attack the vascular endothelium. Review of the literature revealed 21 cases of endocarditis caused by this organism, usually involving the aortic valve. To our knowledge, there are only two reported cases of prosthetic valve endocarditis. Our second patient is the oldest one encountered so far with this condition.

Utility of Transesophageal Echocardiography in the Conservative Management of Prosthetic Valve Endocarditis

Prosthetic valve endocarditis is a formidable complication following cardiac valve replacement. Surgical intervention has resulted in a significant reduction in mortality when certain complications prevail. We report two such cases of prosthetic valve endocarditis in which the use of transesophageal echocardiography permitted close surveillance during medical therapy and thus avoided the need for surgical intervention. Therefore, with the improved ability to monitor disease progression with transesophageal echocardiography, nonsurgical management of prosthetic valve endocarditis remains an option.

Prosthetic valve endocarditis caused by corynebacterium pilosum

A case of prosthetic valve endocarditis caused by Corynebacterium pilosum in a 79-year-old woman developed eighty years after aortic valve replacement with bovine pericardium bioprosthesis is described. In spite of the antibiotic therapy she presented an unfavourable course that led to her death.

Prosthetic valve endocarditis: a continuing challenge for infection control

Conventional medical thought accepts the risks of nosocomial prosthetic valve endocarditis (PVE) to be between 0·7 and 1·4%, the incidence within several months after surgery. More careful actuarial analysis of recent series suggests the risk of nosocomial PVE is 1·4–3·0%, with cases occurring throughout the year after surgery. Methicillin-resistant coagulase-negative staphylococci are the predominant cause of nosocomial PVE and account for 60% of cases. Intraoperative contamination by Staphylococcus epidermidis of nosocomial origin has led to small epidemics of PVE. Aside from the fundamental elements of aseptic surgical technique, studies have failed to identify elements of intraoperative or postoperative care that might be modified to reduce the incidence of sporadic cases of nosocomial PVE. Prophylactic antibiotics have become an essential element in the effort to prevent PVE. Some recent studies have advocated using cefamandole or cefuroxime for prophylaxis; however, other studies have failed to find these agents more effective than cefazolin. The use of vancomycin for prophylaxis requires additional study. Intensive studies are needed to define elements of perioperative and postoperative care that can be modified to reduce the frequency of nosocomial PVE.

Prosthetic valve endocarditis due to Cardiobacterium hominis occurring after upper gastrointestinal endoscopy

Bacterial endocarditis secondary to endoscopic procedures has been convincingly documented in only four cases. We describe a case of prosthetic valve endocarditis due to Cardiobacterium hominis that developed after upper gastrointestinal endoscopy. Because of this, we recommend subacute bacterial endocarditis prophylaxis in patients who have a prior history of endocarditis or valve replacement.

The pericardial valve in the aortic position ten years later

To assess the behavior of the pericardial valve at 10 years after implantation, the cases of 240 patients who had undergone aortic valve replacement with the standard Ionescu-Shiley (Shiley, Inc., Irvine, Calif.) bovine pericardial valve between February 1977 and December 1983 were reassessed. Follow-up of the 224 hospital survivors was 99.6% complete. Fifty-seven valve-related events occurred. Fourteen were thrombotic events (1.2%/patient-year), 28 were intrinsic tissue failures (2.4%/patient-year), 13 were cases of prosthetic valve endocarditis (1.1%/patient-year), and 2 were paravalvular leaks (0.17%/patient-year). The linearized rate for death, reoperation, or both resulting from valve-related events was 3.6%/patient-year. Time-related hazard function for the instantaneous risk of death and/or reoperation resulting from valve-related events demonstrated an exponential increase after 80 months. These data, in conjunction with our previous reports on the histologic changes in pericardial collagen and the incidence of calcification (26/28), should be considered regarding new and future generations of pericardial bioprostheses. Although this device provides good hemodynamics and carries a low incidence of thromboembolism, it has a limited durability. New generations of pericardial valves may have improved structural features, but the behavior of glutaraldehyde-fixed, formaldehyde-stored bovine pericardium as currently selected and prepared is unlikely to change.

Native Valve Endocarditis Due to Pseudallescheria boydii in a Patient with AIDS: Case Report and Review

A 53-year-old man with AIDS developed mitral valve endocarditis due to infection with the fungus Pseudallescheria boydii. A limited number of cases of prosthetic valve endocarditis caused by this organism have been described. We report a unique case of pseudallescheria infection of a native valve and describe this disease in a patient with AIDS.