Staphylococcus aureus infective endocarditis and septic pulmonary embolism after septic abortion

Unusual Case of Right-Side Infective Endocarditis in a 40-Year-Old Woman with Postpartum Endometritis: A Case Report

Rarely observed during pregnancy and the postpartum period, right side infective endocarditis (IE) is particularly uncommon among non-drug-addicted individuals. Nonetheless, if it does occur, it poses significant health risks for both the mother and the fetus, even in the absence of pre-existing heart diseases. This case report describes a rare presentation of right-sided IE (IE) in a 40-year-old woman from rural Ethiopia with postpartum endometritis. The patient presented with atypical symptoms, making it challenging to identify the underlying cause. Through careful diagnostic evaluation and a multidisciplinary approach, the team successfully diagnosed and treated the patient, highlighting the importance of swift and accurate diagnosis for managing uncommon right-sided IE cases.

Native Tricuspid Valve Infective Endocarditis After Breast Skin Abscess

Tricuspid valve infective endocarditis is a rare disease in non-intravenous drug users. It can occur with congenital heart disease, foreign bodies such as central venous catheters and intracardiac devices, and in immunocompromised patients. In the present case, there was a left-sided breast abscess associated with tricuspid valve endocarditis in a patient without any apparent underlying causative factors. We present a case of a young female in her early 20s who arrived at the emergency department with complaints of fever, epistaxis, and vomiting. On clinical examination, she was found to have a fading 2 cm pinkish left breast skin lesion, which had formed on her breast 10 days ago. Blood cultures identified methicillin-resistant Staphylococcus aureus in the blood. A CT scan of the chest, abdomen, and pelvis revealed splenomegaly and an infective focus in the spleen. Subsequent echocardiography confirmed the diagnosis of infective endocarditis of the native tricuspid valve, which was treated with intravenous vancomycin. There was no history of intravenous drug abuse, congenital heart disease, placement of an intracardiac device, central venous catheter, or an immunocompromised state in this patient. Therefore, the diagnosis of infective endocarditis, characterized by a native tricuspid valve vegetation identified as a consequence of a left breast skin abscess, was made. A high index of suspicion is required for a non-specific presentation of tricuspid valve infective endocarditis and in the absence of any prior history of risk factors for right-sided infective endocarditis. Timely initiation of antibiotics depends on a preliminary clinical diagnosis.

Group B Streptococcus tricuspid valve endocarditis with subsequent septic embolization to the pulmonary artery: A case report following elective abortion

Background

Tricuspid valve endocarditis caused by Group B streptococcus is a rare clinical entity with poor prognosis and has been previously reported following gynecologic procedures.

Case summary

We report a case of an 18-year-old female diagnosed with Group B streptococcus tricuspid valve endocarditis with septic emboli following an elective therapeutic abortion. After six weeks of treatment with ceftriaxone, she returned with recurrent symptoms and was found to have embolized a sizable vegetation to the pulmonary artery with probable lung infarction. She underwent surgical embolectomy and was treated with antibiotics and anticoagulation and was subsequently discharged in stable condition.

Conclusion

Group B streptococcus endocarditis is a serious complication of gynecologic procedures. The role of preoperative antibiotics, postoperative clinical suspicion of endocarditis based on respiratory symptoms and a multidisciplinary approach may lead to enhanced patient outcomes.

A massive haemothorax as an unusual complication of infective endocarditis caused by Streptococcus sanguinis

OBJECTIVE AND IMPORTANCE

Infective endocarditis involving the tricuspid valve is an uncommon condition, and a consequent haemothorax associated with pulmonary embolism is extremely rare. Particularly, there are no guidelines for the management of this complication. We describe a rare case of pulmonary embolism and infarction followed by a haemothorax due to infective endocarditis of the tricuspid valve caused by Streptococcus sanguinis.

CLINICAL PRESENTATION

A 25-year-old man with a ventricular septal defect (VSD) presented with fever. On physical examination, his body temperature was 38.8 °C, and a grade III holosystolic murmur was heard. A chest X-ray did not reveal any specific findings. A transoesophageal echocardiogram showed a perimembranous VSD and echogenic material attached to the tricuspid valve. All blood samples drawn from three different sites yielded growth of pan-susceptible S. sanguinis in culture bottles. On day 12 of hospitalization, the patient complained of pleuritic chest pain without fever. Physical examination revealed reduced breathing sounds and dullness in the lower left thorax. On his chest computed tomography scan, pleural effusion with focal infarction and pulmonary embolism were noted on the left lower lung. Thoracentesis indicated the presence of a haemothorax.

INTERVENTION

Our case was successfully treated using antibiotic therapy alone with adjunctive chest tube insertion, rather than with anticoagulation therapy for pulmonary embolism or cardiac surgery.

CONCLUSION

When treating infective endocarditis caused by S. sanguinis, clinicians should include haemothorax in the differential diagnosis of patients complaining of sudden chest pain.

Cardiac septic pulmonary embolism: A retrospective analysis of 20 cases in a Chinese population

Based on the source of the embolus, septic pulmonary embolism (SPE) can be classified as cardiac, peripheral endogenous, or exogenous. Cardiac SPEs are the most common.We conducted a retrospective analysis of 20 patients with cardiac SPE hospitalized between 1991 and 2013 at a Chinese tertiary referral hospital.The study included 14 males and 6 females with a median age of 38.1 years. Fever (100%), cough (95%), hemoptysis (80%), pleuritic chest pain (80%), heart murmur (80%), and moist rales (75%) were common clinical manifestations. Most patients had a predisposing condition: congenital heart disease (8 patients) and an immunocompromised state (5 patients) were the most common. Staphylococcal (8 patients) and Streptococcal species (4 patients) were the most common causative pathogens. Parenchymal opacities, nodules, cavitations, and pleural effusions were the most common manifestations observed via computed tomography (CT). All patients exhibited significant abnormalities by echocardiography, including 15 patients with right-sided vegetations and 4 with double-sided vegetations. All patients received parenteral antimicrobial therapy as an initial treatment. Fourteen patients received cardiac surgery, and all survived.Among the 6 patients who did not undergo surgery, only 1 survived. Most patients in our cardiac SPE cohort had predisposing conditions. Although most exhibited typical clinical manifestations and radiography, they were nonspecific. For suspected cases of SPE, blood culture, echocardiography, and CT pulmonary angiography (CTPA) are important measures to confirm an early diagnosis. Vigorous early therapy, including appropriate antibiotic treatment and timely cardiac surgery to eradicate the infective source, is critical.

Pregnancy and postpartum infective endocarditis: a systematic review

The objective of this review was to describe the clinical characteristics, risk factors, and outcomes of infective endocarditis (IE) in pregnancy and the postpartum period. We conducted a systematic review of Ovid MEDLINE, Ovid Embase, Web of Science, and Scopus from January 1, 1988, through October 31, 2012. Included studies reported on women who met the modified Duke criteria for the diagnosis of IE and were pregnant or postpartum. We included 72 studies that described 90 cases of peripartum IE, mostly affecting native valves (92%). Risk factors associated with IE included intravenous drug use (14%), congenital heart disease (12%), and rheumatic heart disease (12%). The most common pathogens were streptococcal (43%) and staphylococcal (26%) species. Septic pulmonary, central, and other systemic emboli were common complications. Of the 51 pregnancies, there were 41 (80%) deliveries with survival to discharge, 7 (14%) fetal deaths, 1 (2%) medical termination of pregnancy, and 2 (4%) with unknown status. Maternal mortality was 11%. Infective endocarditis is a rare, life-threatening infection in pregnancy. Risk factors are changing with a marked decrease in rheumatic heart disease and an increase in intravenous drug use. The cases reported in the literature were commonly due to streptococcal organisms, involved the right-sided valves, and were associated with intravenous drug use.

"Removal without Replacement" Strategy for Uncontrolled Prosthetic Tricuspid Valve Endocarditis Associated with Abortion Sepsis

Isolated tricuspid valve (TV) endocarditis associated with abortion is a rare entity with a poor prognosis. We report the case of a 22-year-old woman with a diagnosis of isolated prosthetic TV endocarditis secondary to recurrent abortion. The patient had progressed to multiorgan failure and disseminated intravascular coagulation during her clinical course. Because of the high operative risk and uncontrolled infection, we performed an unusual surgical approach that has not previously been reported. Resection of infected valvular tissue without replacement of the prosthesis led to a rapid convalescence period and complete cure.

Our patients do not need endocarditis prophylaxis for genitourinary tract procedures: insights from the 2007 American Heart Association guidelines

The 2007 American Heart Association guidelines for the prevention of infective endocarditis have dramatically reduced both the types of eligible procedures and the types of eligible cardiac lesions that require prophylaxis. Antibiotic prophylaxis to prevent infective endocarditis is not indicated for any patient undergoing obstetric and/or gynaecological procedures, not even for patients with underlying cardiac lesions with the highest risk of developing complications from endocarditis. This sharp departure from previously published guidelines relies on the recognition that endocarditis is more likely to develop from "randomly occurring" bacteremia (e.g., from brushing teeth) than from invasive procedures and that antibiotic prophylaxis has not been proven to be effective. A short discussion on enterococcal infections associated to obstetric and gynaecological procedures and therapeutic implications is presented.