1
|
Cetera V, Cantinotti M, Barberi E, Pak V. Huge, invasive, and destructive Abiotrophia defectiva endocarditis of the aortic valve and the aortic wall: a case report of an emergency but successful Ross-Konno operation in a child. Eur Heart J Case Rep 2024; 8:ytae356. [PMID: 39132299 PMCID: PMC11310689 DOI: 10.1093/ehjcr/ytae356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 02/28/2024] [Accepted: 07/17/2024] [Indexed: 08/13/2024]
Abstract
Background Abiotrophia defectiva forms Gram-positive cocci, is part of normal oropharyngeal and gastrointestinal flora, and is rarely involved in endocarditis in children population. Its special nutritional requirements and subacute clinical course may delay diagnosis and proper treatment, leading to life-threatening consequences. Case summary We report a rare case of huge and destructive A. defectiva infective endocarditis (IE) of the aortic valve and the aortic wall in a 3-year-old child, in follow-up after surgical valvuloplasty for congenital aortic stenosis. The child presented at our department with signs of left side hemiplegia. Transthoracic echocardiography showed severe aortic regurgitation due to large vegetation extending to the aortic wall up to the aortic arch. Blood cultures resulted positive for A. defectiva. He was initially treated conservatively with antibiotic therapy. Ten days after admission, because of clinical deterioration, he required intubation and an emergency Ross-Konno operation. Despite the critical conditions and highly risky surgery, the child recovered well and was discharged home 5 weeks after the operation. Discussion Abiotrophia defectiva IE is rare in children. Since 1995, only 16 cases of A. defectiva IE have been reported in children, including our case. This pathogen has a higher rate of complications when affecting children rather than adult population. Our case demonstrates that conservative strategy with antibiotics is rarely resolutive in the case of IE caused by A. defectiva. Whenever one or more indications for surgery are present, surgical intervention should always be taken into consideration, even if clinical conditions are prohibitive and surgery is at very high risk.
Collapse
Affiliation(s)
- Vera Cetera
- Fondazione Toscana Gabriele Monasterio, Heart Hospital, Via Aurelia Sud, Massa 54100, Italy
| | | | - Elisa Barberi
- Fondazione Toscana Gabriele Monasterio, Heart Hospital, Via Aurelia Sud, Massa 54100, Italy
| | - Vitali Pak
- Fondazione Toscana Gabriele Monasterio, Heart Hospital, Via Aurelia Sud, Massa 54100, Italy
| |
Collapse
|
2
|
Suzuki F, Tsutsui M, Isa H, Kunioka S, Kamiya H. Abiotrophia defectiva Endocarditis: A Case Diagnosed Incidentally Due to Multi-organ Embolism. Cureus 2024; 16:e63146. [PMID: 39055428 PMCID: PMC11272385 DOI: 10.7759/cureus.63146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/21/2024] [Indexed: 07/27/2024] Open
Abstract
Abiotrophia defectiva, often referred to as nutritionally variant streptococci, is generally a benign part of human microflora, primarily found in the oral cavity, digestive tract, and genitourinary system. However, it can have a significant role in infectious endocarditis (IE). We discuss a case involving a 53-year-old male who displayed serious signs indicative of IE. The individual, who had a history of IgA nephropathy, underwent successful surgical and antibiotic intervention. Given the challenge in treating A. defectiva due to its high antibiotic resistance and the tendency for embolic events and treatment failure, a multidimensional approach involving surgical intervention and specific antibiotic therapy resulted in a successful outcome. This case underlines the need for early identification, immediate treatment, and additional research to understand better and manage A. defectiva endocarditis.
Collapse
Affiliation(s)
- Fumitaka Suzuki
- Cardiac Surgery, Asahikawa Medical University, Asahikawa, JPN
| | | | - Hideki Isa
- Cardiac Surgery, Asahikawa Medical University, Asahikawa, JPN
| | - Shingo Kunioka
- Cardiac Surgery, Asahikawa Medical University, Asahikawa, JPN
| | - Hiroyuki Kamiya
- Cardiac Surgery, Asahikawa Medical University, Asahikawa, JPN
| |
Collapse
|
3
|
Dong W, Wu S, Zhou J. A rare association of invasive infective endocarditis due to Abiotrophia defectiva with ventricular septal defect and recurrent Henoch-Schonlein purpura in a child. J Cardiothorac Surg 2022; 17:320. [PMID: 36528593 PMCID: PMC9758810 DOI: 10.1186/s13019-022-02092-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Henoch-Schonlein purpura is the most common vasculitis in childhood, usually triggered by an upper respiratory tract infection and rarely observed in infective endocarditis patients. Abiotrophia defectiva is a rare causative agent of infective endocarditis associated with pre-existing heart disease, immunocompromised and prosthetic valves. Dental procedures are also a common predisposing factor. CASE PRESENTATION We present the first pediatric congenital heart disease case of infective endocarditis caused by Abiotrophia defectiva combined with recurrent Henoch-Schonlein purpura. A 10-year-old girl with uncorrected congenital heart defects and Henoch-Schonlein purpura developed a purple petechial rash again. Transthoracic echocardiography evaluation revealed multiple irregular vegetations on the right ventricular side of the ventricular septal defect and on the tricuspid valve leaflets. Blood cultures grew Abiotrophia defectiva. The girl received cardiac surgery for vegetation resection as well as congenital heart defect correction and tricuspid valve replacement. Five months after the surgery, the patient was in satisfactory condition without any signs of endocarditis or valve insufficiency and her purpuric rash disappeared. CONCLUSIONS The coexistence of recurrent Henoch-Schonlein purpura and infective endocarditis is possible. Abiotrophia defectiva belongs to the streptococcus with a high virulence. In addition, cardiovascular surgery is often required for pediatric infective endocarditis associated with Abiotrophia defectiva, and bioprosthetic valve replacement is considered feasible for irreparable tricuspid valve in children.
Collapse
Affiliation(s)
- Wenpeng Dong
- grid.412679.f0000 0004 1771 3402Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Shushan District, Hefei, 230032 China
| | - Shuibi Wu
- grid.412679.f0000 0004 1771 3402Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Shushan District, Hefei, 230032 China
| | - Jing Zhou
- grid.460068.c0000 0004 1757 9645Department of Cardiovascular Surgery, The Third People’s Hospital of Chengdu, Chengdu, China
| |
Collapse
|
4
|
Torres-Burgos I, Mendez-Castro L, Alkon J. A Common Defect With a Not So Common Complication: Abiotrophia Defectiva Endocarditis in a Child With Unrepaired Ventricular Septal Defect. CASE (PHILADELPHIA, PA.) 2022; 6:454-457. [PMID: 36589346 PMCID: PMC9794499 DOI: 10.1016/j.case.2022.08.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
IE should be suspected in children with unrepaired CHD and prolonged fever. Vegetation location may be atypical in patients with unrepaired CHD. TTE is an essential diagnostic tool in establishing endocarditis.
Collapse
Affiliation(s)
- Ileana Torres-Burgos
- Leonard Miller School of Medicine, Division of Pediatric Cardiology, University of Miami, Miami, Florida
- Department of Pediatric Cardiology, Jackson Memorial Hospital, Miami, Florida
| | | | - Jaime Alkon
- Leonard Miller School of Medicine, Division of Pediatric Cardiology, University of Miami, Miami, Florida
- Department of Pediatric Cardiology, Jackson Memorial Hospital, Miami, Florida
| |
Collapse
|
5
|
Bonura ED, Sutherell JS, King W. Abiotrophia defectiva Endocarditis With Septic Emboli and an Enlarging Subaortic Pseudoaneurysm: A Novel Application for Ferumoxytol Cardiac Magnetic Resonance. Circ Cardiovasc Imaging 2022; 15:e014192. [PMID: 35862017 DOI: 10.1161/circimaging.122.014192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Affiliation(s)
- Erica D Bonura
- Saint Louis University School of Medicine, MO (E.D.B., J.S.S., W.K.)
| | - Jamie S Sutherell
- Saint Louis University School of Medicine, MO (E.D.B., J.S.S., W.K.).,SSM Health Cardinal Glennon Children's Hospital, Saint Louis, MO (J.S.S., W.K.)
| | - Wilson King
- Saint Louis University School of Medicine, MO (E.D.B., J.S.S., W.K.).,SSM Health Cardinal Glennon Children's Hospital, Saint Louis, MO (J.S.S., W.K.)
| |
Collapse
|
6
|
Li J, Zhou L, Gong X, Wang Y, Yao D, Li H. Abiotrophia Defectiva as a Rare Cause of Mitral Valve Infective Endocarditis With Mesenteric Arterial Branch Pseudoaneurysm, Splenic Infarction, and Renal Infarction: A Case Report. Front Med (Lausanne) 2022; 9:780828. [PMID: 35360716 PMCID: PMC8962948 DOI: 10.3389/fmed.2022.780828] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 02/11/2022] [Indexed: 01/13/2023] Open
Abstract
Introduction Abiotrophia defectiva (A. defectiva) is a rare species leading to infective endocarditis (IE) with a poor prognosis. We describe a previously healthy patient with mitral valve infective endocarditis caused by A. defectiva. Case report A young man was admitted with intermittent fever. Echocardiography confirmed vegetation on the mitral valve with evidence of valve perforation and severe mitral regurgitation. Three sets of blood cultures became positive for A. defectiva. As he presented with manifestations of mesenteric arterial branch pseudoaneurysm, splenic and renal infarction, mitral valve replacement, and embolization of superior mesenteric aneurysm were operated during 8 weeks' targeted antibiotic therapy. Conclusion This case study emphasizes the importance of considering A. defectiva as a rare but important cause of IE and of performing blood culture to make its accurate diagnosis and timely anti-infective treatment. Early surgical management and active prevention of complications have been associated with a favorable prognosis.
Collapse
Affiliation(s)
- Jiayu Li
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Li Zhou
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Xuhe Gong
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yuan Wang
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Daokuo Yao
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Hongwei Li
- Department of Cardiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Internal Medical, Medical Health Center, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Beijing Key Laboratory of Metabolic Disorder Related Cardiovascular Disease, Beijing, China
| |
Collapse
|
7
|
Du Y, Zhang Z, Chen C, Xia H, Zhang H, Guo Z, Wang Y. Case Report: Report of Infective Endocarditis Caused by Abiotrophia defectiva and Literature Review. Front Pediatr 2022; 10:894049. [PMID: 35874573 PMCID: PMC9299070 DOI: 10.3389/fped.2022.894049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/30/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE To report the clinical features of the first child with infective endocarditis (IE) caused by Abiotrophia defectiva in mainland China and to raise awareness of the disease. METHODS The clinical data of a child with IE caused by A. defectiva admitted to Xi'an Children's Hospital in July 2021 were collected, and the relevant literature was reviewed. RESULTS The child was a female, 8 years old, admitted with fever for 4 days and right-sided limb weakness for 3 days. The illness started with suppurative tonsillitis, followed by headache, fatigue, right-sided mouth, slurred speech, right limb weakness, and unstable holding. Transthoracic echocardiography showed that the mitral valve vegetation was formed and vegetation could also be seen at the entrance of the pulmonary vein at the posterior wall of the left atrium. Cranial contrast-enhanced MRI + magnetic resonance angiography showed multiple intracranial pseudoaneurysm formation and pontine infarction. After A. defectiva was detected by metagenomic next-generation sequencing (mNGS) in cerebrospinal fluid and blood detected, the infection was controlled by anti-infective treatment with meropenem and vancomycin. On the 36th day after admission, due to severe headache and slurred speech, the head CT showed hemorrhage of right parietal pseudoaneurysm and cerebral sickle hernia, and right temporo-occipital hematoma evacuation, cerebrovascular malformation resection, and cranial decompression were performed immediately. After the surgery, her speech ability gradually recovered, the muscle strength of her left upper limb was about grade III, while the muscle strength of the rest of the limbs was normal. After a total of 60 days of hospitalization, her family requested to be discharged. CONCLUSION This pediatric patient is the first case of childhood IE caused by A. defectiva in mainland China, and the first time in the world that A. defectiva was detected by mNGS in patients with IE.
Collapse
Affiliation(s)
- Yanqiang Du
- Department of Pediatric Intensive Care Unit of Xi'an Children's Hospital, National Children's Regional Medical Center (Northwest), Children's Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Zhan Zhang
- Department of Ultrasound of Xi'an Children's Hospital, National Children's Regional Medical Center (Northwest), Children's Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Chao Chen
- Imaging Department of Xi'an Children's Hospital, National Children's Regional Medical Center (Northwest), Children's Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Han Xia
- Hugobiotech Co., Ltd., Beijing, China
| | - Hua Zhang
- Department of Pediatric Intensive Care Unit of Xi'an Children's Hospital, National Children's Regional Medical Center (Northwest), Children's Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Zhangyan Guo
- Department of Pediatric Intensive Care Unit of Xi'an Children's Hospital, National Children's Regional Medical Center (Northwest), Children's Hospital, Xi'an Jiaotong University, Xi'an, China
| | - Yi Wang
- Department of Pediatric Intensive Care Unit of Xi'an Children's Hospital, National Children's Regional Medical Center (Northwest), Children's Hospital, Xi'an Jiaotong University, Xi'an, China
| |
Collapse
|
8
|
Forde G, Lucey M, O'Shea PM, Okiro J, Shatwan R, Mulkerrin EC. Atypical presentation of Abiotrophia defectiva infective endocarditis in an octogenarian. Clin Case Rep 2021; 9:891-897. [PMID: 33598267 PMCID: PMC7869387 DOI: 10.1002/ccr3.3653] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 11/13/2020] [Indexed: 12/23/2022] Open
Abstract
Blood cultures should be performed in non-specifically unwell older adults following nonspecific presentations. Prompt diagnosis and commencement of targeted antimicrobial therapy are essential in older patients with A. defectiva IE.
Collapse
Affiliation(s)
- Gerard Forde
- Department of Geriatric MedicineUniversity HospitalGalwayIreland
| | - Mary Lucey
- Department of MicrobiologyUniversity HospitalGalwayIreland
| | - Paula M. O'Shea
- Department of Clinical BiochemistryUniversity HospitalGalwayIreland
| | - Julie Okiro
- Department of Geriatric MedicineUniversity HospitalGalwayIreland
| | | | | |
Collapse
|