Case Study: Pneumococcal Prosthetic Valve Endocarditis with Mitral Annular Abscess Fistulised in the Left Atrium: An Uncommon Germ with Dramatic End
Downloads
Background:
Streptococcus pneumoniae is an infrequent cause of infectious endocarditis. Several case series have underscored the aggressive course of Streptocoque Pneumiae with acute clinical presentation, rapid valvular destruction, and high mortality despite appropriate antibiotic therapy.
Case summary:
We present a 74-year-old woman with previous aortic and mitral valve replacement 12 years ago, presented with a 5 days history of persistent fever and a red, hot, and swollen right knee. Atrial fibrillation was demonstrated on a 12-lead electrocardiogram. The initial echocardiography did not show any sign of endocarditis but in front of the clinical symptomatology the patient was put under probabilistic antibiotic therapy. in the meantime blood culture grew Streptocoque Pneumiae and then the antibiotic treatment was adapted. The sudden deterioration of the patient brought us back to control the heart by a transthoracic echocardiography, which revealed a mitral annular abscess fistulizing to the left atrium. the patient expired 30 days after admission from presumed severe sepsis and cardiogenic choc.
Conclusion:
Pneumococcal endocarditis in prosthetic valve is associated with very high mortality, especially when complicated by paravalvular abscess and other comorbidities. This case highlights the need for a carefull considered approach for fast and efficient care.
S. I. Aronin, S. K. Mukherjee, J. C. West, and E. L. Cooney, “Review of pneumococcal endocarditis in adults in the penicillin era,” Clin. Infect. Dis., vol. 26, no. 1, pp. 165–171, 1998.
P. Fefer, D. Raveh, B. Rudensky, Y. Schlesinger, and A. Yinnon, “Changing epidemiology of infective endocarditis: a retrospective survey of 108 cases, 1990–1999,” Eur. J. Clin. Microbiol. Infect. Dis., vol. 21, no. 6, pp. 432–437, 2002.
W. G. Powderly, S. L. Stanley Jr, and G. Medoff, “Pneumococcal endocarditis: report of a series and review of the literature,” Rev. Infect. Dis., vol. 8, no. 5, pp. 786–791, 1986.
J. M. Aguado et al., “Endocarditis por neumococos sensibles y resistentes a penicilina: perspectivas actuales de la enfermedad,” Med. Clin. (Barc)., vol. 100, no. 9, pp. 325–328, 1993.
V. Ugolini, A. Pacifico, T. C. Smitherman, and P. A. Mackowiak, “Pneumococcal endocarditis update: analysis of 10 cases diagnosed between 1974 and 1984,” Am. Heart J., vol. 112, no. 4, pp. 813–819, 1986.
N. A. Buchbinder and W. C. Roberts, “Alcoholism: an important but unemphasized factor predisposing to infective endocarditis,” Arch. Intern. Med., vol. 132, no. 5, pp. 689–692, 1973.
A. E. Good, J. M. Hague, and C. A. Kauffman, “Streptococcal endocarditis initially seen as septic arthritis,” Arch. Intern. Med., vol. 138, no. 5, pp. 805–806, 1978.
C. J. Mathews et al., “Management of septic arthritis: a systematic review,” Ann. Rheum. Dis., vol. 66, no. 4, pp. 440–445, 2007.
E. by the E. S. of C. M. and I. D. (ESCMID) and by the I. S. of C. (ISC) for I. and Cancer et al., “Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009) The Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC),” Eur. Heart J., vol. 30, no. 19, pp. 2369–2413, 2009.
G. Habib et al., “Recommendations for the practice of echocardiography in infective endocarditis,” Eur. J. Echocardiogr., vol. 11, no. 2, pp. 202–219, 2010.
A. Nagpal, M. Sohail, and J. Steckelberg, “Prosthetic valve endocarditis: state of the heart,” Clin. Investig. (Lond)., vol. 2, no. 8, pp. 803–817, 2012.
W. R. WILSON, P. M. JAUMIN, G. K. DANIELSON, E. R. GIULIANI, J. A. WASHINGTON, and J. E. GERACI, “Prosthetic valve endocarditis,” Ann. Intern. Med., vol. 82, no. 6, pp. 751–756, 1975.
T. E. Paterick, T. J. Paterick, R. A. Nishimura, and J. M. Steckelberg, “Complexity and subtlety of infective endocarditis,” in Mayo Clinic Proceedings, 2007, vol. 82, no. 5, pp. 615–621.
All Content should be original and unpublished.