Septic Pulmonary Embolism Research Articles

S4565 Endotipsitis: An Underdiagnosed Complication of Transjugular Intrahepatic Portosystemic Shunt Presenting as Septic Pulmonary Emboli

S4565 Endotipsitis: An Underdiagnosed Complication of Transjugular Intrahepatic Portosystemic Shunt Presenting as Septic Pulmonary Emboli

Delayed Diagnosis of Right-Sided Infective Endocarditis with Septic Pulmonary Emboli in a Dextrocardia Patient During the COVID-19 Pandemic

An adolescent IDU presented with persistent fever and cough. Echocardiography revealed dextrocardia, severe tricuspid regurgitation, and vegetation on the tricuspid leaflet. CT pulmonary angiography identified multiple pulmonary infarcts, and blood cultures confirmed Staphylococcus aureus infection. The patient was diagnosed with right-sided infective endocarditis (IE) complicated by septic pulmonary emboli. She was treated with antibiotics followed by cardiac surgery. While the role of dextrocardia in IE is not well established, it significantly affects the surgical management approach. The diagnosis of right-sided IE and septic pulmonary embolism was delayed during the COVID-19 pandemic due to overlapping symptoms with respiratory infections. Early recognition and prompt investigation in high-risk patients are crucial to address this diagnostic challenge.

Isolated pulmonary valve endocarditis in a pediatric patient with down syndrome

BackgroundIsolated pulmonary valve endocarditis (IPE) accounts for less than 2% of all infective endocarditis patients. It is commonly associated with several predisposing factors, including intravenous drug use (IVDU) and congenital heart disease. The most common causative pathogens of IPE are Staphylococcus aureus and Streptococcus viridans. We report a Down’s syndrome patient with IPE and with no standard risk factors caused by the rare pathogen Acinetobacter spp. This led to respiratory failure and systemic infection due to septic pulmonary emboli. Early elective surgery was decided upon as the patient was no longer responding to medical therapy, and his clinical condition was worsening over time.Case presentationA 15-year-old male with Down syndrome and no underlying heart defect presented with a 3-month history of episodic fever, nausea, vomiting, and diarrhea. Transthoracic echocardiography (TTE) revealed large vegetation on the pulmonary valve leaflet, another mobile mass at the pulmonary artery bifurcation, and severe pulmonary regurgitation. Serial blood cultures isolated Acinetobacter spp. Despite initial antibiotic therapy, the patient continued to have sepsis, unresolved vegetations, and developed life-threatening complications and respiratory distress, which convinced us to perform a pulmonary valve replacement surgery with a homograft. After surgery, the patient recovered and was discharged on the ninth postoperative day (POD).ConclusionThis report highlights IPE’s diagnostic and therapeutic challenges, alongside the importance of a comprehensive cardiopulmonary workup in patients with unexplained fever, sepsis, and pulmonary symptoms, even without typical risk factors. Based on the patient’s aggravating condition despite medical treatment, early surgical intervention and pulmonary valve replacement were deemed crucial. However, there still needs to be a definitive guideline on when and how surgery should be performed in patients with complicated IPE, especially in pediatric patients.

Endogenous endophthalmitis secondary to Lemierre’s Syndrome originating from pharyngotonsillitis

PurposeThe purpose of this article is to report a case of Lemierre’s Syndrome producing unilateral endogenous endophthalmitis in a healthy, young woman with a history of tonsillitis.Case report/observationsA 17-year-old healthy woman developed fever after a few days of sore throat. She later developed pneumonia with septic signs, leading to admission to the Intensive Care Unit. Lemierre Syndrome was diagnosed due to multiple septic pulmonary emboli and signs of sepsis following a recent episode of tonsillitis. During hospitalization, the patient complained of decreased visual acuity and floaters in her left eye. Ophthalmological examination revealed papillary edema, vitritis, foci of chorioretinitis in the macula and Roth’s spots, confirming the diagnosis of endogenous endophthalmitis. Subsequently, she underwent appropriate treatment, progressing satisfactorily.Conclusion and importanceAlthough ophthalmological manifestations are rare, due to the pathophysiological characteristics of Lemierre’s Syndrome, all patients should underwent standard ophthalmologic assessment, even in the absence of ophthalmic symptoms or visible findings, as part of a multidisciplinary management approach.

18F-FDG whole-body PET/CT for the evaluation of suspected native valve infective endocarditis

18F-FDG-PET/CT is indicated in the workup of patients with suspected infective endocarditis to detect intra-cardiac and disseminated infections, as well as its source. We present the case of a 66-year-old female patient known for recurrent diabetic foot infection, with equivocal TTE results and persistent MRSA bacteremia despite medical management. PET/CT revealed evidence of left foot osteomyelitis. Whole body PET/CT diagnosed native mitral valve infective endocarditis (IE) and right lower lobe segmental pulmonary artery uptake, consistent with septic pulmonary embolism (PE).

The prevalence, risk factors, and outcomes of acute pulmonary embolism complicating sepsis and septic shock: a national inpatient sample analysis

The study aimed to evaluate the prevalence, risk factors, and clinical outcomes of pulmonary embolism in patients diagnosed with sepsis with and without shock. The National Inpatient Sample was used to identify adults with sepsis with and without shock between 2017 and 2019. The prevalence of acute pulmonary embolism and the association of acute pulmonary embolism with in-hospital mortality, hospital length of stay for survivors, and overall costs of hospitalization were evaluated. Multivariable logistic and linear regression analyses, adjusted for various parameters, were used to explore these associations. Of the estimated 5,019,369 sepsis hospitalizations, 1.2% of patients with sepsis without shock and 2.3% of patients with septic shock developed pulmonary embolism. The odds ratio for in-hospital mortality was 1.94 (95% confidence interval (CI) 1.85–2.03, p < 0.001). The coefficient for hospital length of stay was 3.24 (95% CI 3.03–3.45, p < 0.001). The coefficient for total costs was 46,513 (95% CI 43,079–49,947, p < 0.001). The prevalence of pulmonary embolism in patients diagnosed with sepsis with and without shock was 1.2 and 2.3%, respectively. Acute pulmonary embolism was associated with higher in-hospital mortality, longer hospital length of stay for survivors, and higher overall costs of hospitalization.

Lemierre’s syndrome as a rare cause of septic pulmonary embolism (case report)

Objectives. The purpose of this work is to provide a clinical case study of Lemierre’s syndrome (LS) in order to raise awareness amongst doctors of various medical specialties regarding this rare cause of septic pulmonary embolism (SPE).Materials and methods. The patient in clinical case is a 25-year-old female who was hospitalized due to SPE, which had been complicated by respiratory distress, pneumothorax and septic shock. The initial source of embolus lung damage was the septic thrombosis of both the internal and external jugular veins. This thrombosis occurred against the backdrop of a carbuncle of the lower lip, an inflammatory infiltrate at the bottom of the mouth, an abscess in the soft tissue of the chin and neck cellulitis, which correspond to the diagnostic criteria for Lemierre Syndrome.Results. The literature data of the epidemiology, etiology, pathogenic mechanisms of the venous thrombosis, embolic and septic complications among patients with LS are presented. The article discusses the clinical features and course of the disease, as well as key aspects of diagnosis, including current diagnostic criteria, with regard to the typical and atypical variants of LS. The principles of antibiotic therapy and the possibility of anticoagulation therapy in cases of septic pulmonary emboli associated with head and neck vein thrombosis are also considered.Conclusion. LS is a rare, but clinically significant condition characterized by the development of septic thrombosis in the internal jugular vein in response to acute suppurative inflammation of the head and neck. In typical cases, the causative organism is Fusobacterium necrophorum, or other anaerobic bacteria. This pathological condition is often accompanied by multiple other septic complications, with the most significant being the development of septic pulmonary embolism. Clinical observation indicates the necessity for including LS in the differential diagnosis among causes of the septic pulmonary embolism, and for adopting a multidisciplinary approach in the treatment of these patients in a specialized multifield hospital. Identification and diagnosis of Lemierre Syndrome can be challenging due to its low incidence and variable clinical presentation. Although the condition is not widely recognized among physicians, an understanding of the basic principles of its diagnosis and management can significantly improve treatment outcomes and patients prognosis.

Outcomes in patients with definite and possible infective endocarditis related to a cardiac implantable electronic device.

Diagnosing lead‑related infective endocarditis (LRIE) often poses a substantial challenge. Current diagnostic criteria include definite and possible LRIE. The aim of this study was to compare the outcomes of patients with definite and possible LRIE undergoing transvenous lead extraction (TLE) procedures. A retrospective analysis of data from 3782 patients undergoing TLE between 2006 and 2023 was performed. The study included 838 patients with definite and possible LRIE, whose clinical data on short- and long‑term survival were evaluated. The comparison of clinical data showed more frequent occurrences of vegetations (81.58% vs 37.21%; P <0.001), positive blood cultures (66.12% vs 51.64%; P <0.001), and septic pulmonary embolism (40.14% vs 13.78%; P <0.001) in the patients with definite LRIE. Long‑term mortality of patients with definite and possible LRIE (median [interquartile range] follow-up, 4.61 [1.04-9.4] and 5.06 [2.07-8.75] years, respectively) was 61.14% and 49.29% (P <0.001). Predictors of mortality in patients with definite LRIE included: advanced age, low left ventricular ejection fraction (LVEF), comorbidities, septic pulmonary embolism, positive blood culture, and presence of an abandoned lead. In possible LRIE, only the influence of advanced age, low LVEF, and comorbidities was demonstrated. There was no documented evidence of a direct impact of a delayed diagnosis on the long‑term survival of patients after TLE. The study showed better survival in patients with possible LRIE than with definite LRIE, which confirms the need to extend the diagnostic criteria. Introducing appropriate treatment at an early stage of infection improves the prognosis.

&lt;i&gt;Burkholderia pseudomallei&lt;/i&gt; - an unusual cause of septic embolism

Melioidosis is an infection caused by the Gram-negative bacterium Burkholderia pseudomallei. It is endemic in many regions, including Southeast Asia, Northern Australia, South Asia (including India), and China. The presentation of melioidosis varies from localized infection to systemic sepsis. The most common causes of septic emboli are Staphylococcus aureus, Klebsiella pneumoniae, Pseudomonas aeruginosa, Escherichia coli, and the Salmonella group, but here we reported a case of pulmonary septic emboli, necrotizing pneumonia, and septic arthritis in case of systemic melioidosis infection.

Aortic endocarditis with septic pulmonary embolism as a manifestation of silent congenital heart disease

Aortic endocarditis with septic pulmonary embolism as a manifestation of silent congenital heart disease

Osteomyelitis in a Paediatric Patient with Sub-periosteal Abscess, Septic Pulmonary Emboli and Pneumothorax: A Case Report

Osteomyelitis is an inflammatory disorder affecting bone and adjacent tissue that primarily arises from pyogenic bacteria, often involving the metaphysis of long bones in pediatric patients through hematogenous spread with the common pathogen being Staphylococcus aureus. Complications such as pathological fractures, sinus formation, and abscesses, may occur. Septic pulmonary embolism (SPE), a rare complication, can lead to infarctions and abscesses in pulmonary vessels. Pneumothorax secondary to SPE can also occur, emphasizing the importance of considering these complications in patients with features of sepsis.

Infective Endocarditis on Ventricular Septal Defect Complicated by Septic Pulmonary Embolism: Case Report

Ventricular septal defect (VSD) is a congenital heart disease most likely to cause infective endocarditis. Pulmonary embolism constitutes one of its main complications. Treatment is mostly based on effective antibiotic therapy but can sometimes require additional surgical intervention. We report a case of infectious endocarditis in a 20-year-old patient followed for congenital heart disease in the form of a ventricular septal defect. This was complicated by septic pulmonary embolism due to a right heart vegetation, with a good clinical-biological resolutionunder medical treatment only.

Aortic endocarditis with septic pulmonary embolism as a manifestation of silent congenital heart disease.

Aortic endocarditis with septic pulmonary embolism as a manifestation of silent congenital heart disease.

Recurrent, ICD-associated L. monocytogenes bacteraemia with multiple septic pulmonary embolisms over a 2-year period

BackgroundListeria monocytogenes is a bacterial pathogen known for causing listeriosis, a foodborne illness with a wide spectrum of clinical presentations ranging from mild gastroenteritis to severe invasive disease, particularly affecting immunocompromised individuals, pregnant women, newborns, and the elderly. Successful treatment of patients with recurring listeria episodes due to colonised foreign material is often challenging, typically requiring a combination of antimicrobial treatment and surgical removal.Case presentationHere, we present a particularly complex case of chronic invasive listeriosis with a total of six relapses. After extensive investigations, the patient's ICD device was identified as the focus of infection.ConclusionThe confirmation of relapses through cgMLST analysis highlights the persistence of Listeria monocytogenes and the potential for recurrence even after apparent resolution of symptoms in patients with foreign material. It emphasises the necessity for a comprehensive assessment to identify and mitigate the risk of relapses, thereby ensuring optimal management and outcomes.

An alternative surgical approach for isolated pulmonary valve infective endocarditis secondary to restrictive ventricular septal defect: a case report

BackgroundNative pulmonary valve (PV) infective endocarditis (IE) is a rare condition with an incidence of 1.5–2%. Although medical therapy is the mainstay of treatment, surgical intervention is still indicated in cases that fail to respond to antibiotics. To date, there is lack of consensus about the best surgical approach for isolated native PV IE. While valve repair is sometimes feasible, most of the cases require valve replacement depending on the extent of tissue damage. A stented bioprosthesis can be used when infection is confined to the valve leaflets. However, extension of damage to the pulmonary root or right ventricular outflow tract usually requires debridement and root replacement.Case presentationA 30-year-old lady with a long history of restrictive ventricular septal defect (VSD) presented with fever and shortness of breath shortly after vaginal delivery that was diagnosed as isolated PV IE with pulmonary septic emboli. After 1 week of antibiotic therapy, there was no response with persistent infection and complete valve destruction. Heart team discussion recommended PV replacement using a Freestyle valve along with VSD repair. On follow-up after 1 year, she was doing fine with well-functioning Freestyle valve.ConclusionUnrepaired restrictive VSD can be a predisposing factor for native PV IE. A Freestyle valve in the pulmonary position is a valid option for such cases, with good early outcomes and reasonable durability, particularly when there is extensive tissue infection and homograft is not available. More evidence is still required to evaluate the long-term outcomes of PV Freestyle in cases of IE.

Severe Pulmonic Valve Endocarditis with Septic Pulmonary Embolism in a Teenager: Case Report

A 14-year-old boy with an uneventful past history suffered from one week of high-grade fever and progressive dyspnea. The patient developed necrotizing pneumonia with massive loculated pleural effusion and septic shock. Echocardiogram revealed a small perimembranous VSD with multiple vegetations at pulmonic valve and both pulmonary arteries. Intravenous antibiotic therapy, mechanical ventilatory support, chest tube placement, and intrapleural fibrinolytic therapy were performed. He was clinically improved after eight weeks of antibiotic therapy. Keywords: Septic pulmonary embolism; Pulmonic valve endocarditis; Infective endocarditis

Omadacycline for the treatment of severe pneumonia caused by Chlamydia psittaci complicated with acute respiratory distress syndrome during the COVID-19 pandemic.

Chlamydia psittaci infection in humans is a rare cause that mainly present as community-acquired pneumonia. Severe Chlamydia psittaci pneumonia can lead to acute respiratory distress syndrome (ARDS), septic shock, or multiple organ dysfunction with a mortality rate of 15%-20% before accurate diagnosis and targeted treatment. Metagenomic next-generation sequencing (mNGS) has an advantage in achieving early diagnosis. In the study, omadacycline implementation was described to provide a better understanding of effectiveness in severe psittacosis pneumonia with ARDS. Sixteen patients with severe psittacosis pneumonia with ARDS were selected between September 2021 and October 2022. They were diagnosed using mNGS and treated with omadacycline. Retrospective analysis of clinical manifestations, laboratory data, disease progression, diagnostic tool, treatment, and prognosis was summarized. Common symptoms included fever, dyspnea, and cough. All patients developed ARDS, accompanied by septic shock (43.7%) and pulmonary embolism (43.7%). Laboratory data showed normal leucocytes, increased creatine kinase isoenzyme, and decreased albumin with liver dysfunction in most patients. All patients had increased neutrophils, C-reactive protein, procalcitonin, and D-dimer with decreased lymphocytes. Airspace consolidation, ground glass opacity, and pleural effusion were found on chest CT. mNGS results were obtained in 24-48 h to identify the diagnosis of Chlamydia psittacosis. All patients received mechanical ventilation with omadacycline treatment. Fourteen patients experienced complete recovery, while the other two patients died from multidrug-resistant bacterial infection and renal failure. mNGS has a significant value in the diagnosis of Chlamydia psittaci infection. Timely treatment of omadacycline can improve prognosis and provide a promising new option for the treatment of severe Chlamydia psittaci pneumonia with ARDS.

Case report of septic pulmonary embolism caused by Staphylococcus aureus combined with multidrug-resistant pulmonary tuberculosis and bronchial tuberculosis

This case report describes the presence of septic pulmonary embolism (SPE) in an older woman with diabetes whose initial manifestation was acute sepsis. She underwent computed tomography (CT) imaging, blood metagenomic next-generation sequencing (mNGS), and bronchoscopy, and was diagnosed with SPE secondary to Staphylococcus aureus-positive bacterial infection, combined with multidrug-resistant pulmonary tuberculosis and bronchial tuberculosis. In this case report, we focused on the clinical presentation and CT imaging features of SPE, and the application value of mNGS. This case study suggests that CT combined with mNGS has value in the timely diagnosis and management of SPE in patients with diabetes with severe pneumonia caused by mixed infection with multiple pathogenic pathogens.

Infective Endocarditis in a Patient of End-stage Kidney Disease and the Nuances of Management

ABSTRACT Nontunneled central venous catheters remain an irreplaceable tool for initiation of haemodialysis in most patients with end-stage kidney disease (ESKD) in the developing and underdevelpoed countries. The low cost and convenience of insertion outweigh their disadvantage of higher rates of infection and mortality. We report a case of right-sided infective endocarditis (IE) in a ESKD patient secondary to uncuffed dialysis catheter and the challenges faced with respect to diagnosing and managing IE in such population. This case is unique because it demonstrates septic pulmonary emboli secondary to tricuspid valve Staphylococcus aureus IE in a patient with ESKD.

Septic Pulmonary Embolism Due to Dialysis Catheter

Septic Pulmonary Embolism Due to Dialysis Catheter