Isolated pulmonary native valve infectious endocarditis due to Enterococcus faecalis

[Acute pulmonic valve endocarditis]

L'endocardite du cœur droit touche dans la plupart des cas la valve tricuspide, notamment chez les toxicomanes. L'infection isolée de la valve pulmonaire est rarement retrouvée. Nous rapportons dans cette observation le cas d'une jeune femme âgée de 32 ans chez quile diagnostic d'endocardite communautaire de la valve pulmonaire a été confirmé. Cette observation est d'autant plus intéressante qu'elle survient chez une patiente sans antécédents de toxicomanie, avec néanmoins la notion de communication interventriculaire restrictive. La patiente a été opérée en urgence devant l'image de grosse végétation très mobile sur les données de l'échographie cardiaque transthoracique. La chirurgie a été pratiquée sous circulation extracorporelle et la valve pulmonaire a été remplacée par une bioprothèse. Les hémocultures et la culture de la valve ont retrouvé un staphylococcus aureus sensible à la Méticilline. L'évolution postopératoire a été favorable avec un recul de 06 mois sans récurrence infectieuse.

Clinical classification and prognosis of isolated right-sided infective endocarditis

From an epidemiologic point of view, right-sided infective endocarditis (RSIE) affects different types of patients: intravenous drug users (IDUs), cardiac device carriers (pacemakers and implantable automatic defibrillators), and the "3 noes" endocarditis group: no left-sided, no IDUs, no cardiac devices. Our objective is to describe and compare the clinical profile and outcome of these groups of patients. Every episode of infective endocarditis (IE) consecutively diagnosed in 3 tertiary centers from 1996 to 2012 was included in an ongoing multipurpose database. We assessed 85 epidemiologic, clinical, echocardiographic, and outcome variables in patients with isolated RSIE. A bivariated comparative analysis between the 3 groups was conducted.Among 866 IE episodes, 121 were classified as isolated RSIE (14%): 36 IDUs (30%), 65 cardiac device carriers (54%), and 20 "3 noes" group (16%). IDUs were mainly young men (36 ± 7 years) without previous heart disease, few comorbidities, and frequent previous endocarditis episodes (28%). Human immunodeficiency virus infection was frequent (69%). Cardiac device carriers were older (66 ± 15 years) and had less comorbidities (34%). Removal of the infected device was performed in 91% of the patients without any death. The "3 noes" endocarditis group was composed mainly by middle-age men (56 ± 18 years), health care related infections (50%), and had many comorbidities (75%). Whereas Staphylococcus aureus were the most frequent cause in IDUs (72% vs 34% in device carriers and 34% in the "3 noes" group, P = 0.001), coagulase negative Staphylococci predominated in the device carriers (58% vs 11% in drug users and 35% in the "3 noes", P < 0.001). Significant differences in mortality were found (17% in drug users, 3% in device carriers, and 30% in the "3 noes" group; P < 0.001). These results suggest that RSIE should be separated into 3 groups (IDUs, cardiac device carriers, and the "3 noes") and considered as independent entities as there are relevant epidemiologic, clinical, microbiological, echocardiographic, and prognostic differences among them.

Isolated pulmonary valve infective endocarditis in a middle aged man caused by Candida albicans: a case report

Background

Pulmonary valve endocarditis without the involvement of other valves represents 1.5-2% of all cases of infective endocarditis. Isolated pulmonary valve endocarditis caused by Candida is extremely rare with only one reported case in the literature and none reported in the United States. Guidelines for management of Candida endocarditis recommend a combination of medical and surgical therapy.

Case presentation

A 61-year-old homeless male presented with fever, cough and shortness of breath. He was urgently intubated for hypoxia. He was initially diagnosed with pneumonia but did not improve with empiric antibacterial therapy. Candida species were isolated from bronchoalveolar lavage fluid and the patient eventually developed persistent C. albicans bloodstream infection. On further workup he was found to have infective endocarditis with a large vegetation across the pulmonary valve. No other valves were involved. He was treated with intravenous antifungal therapy for eight weeks. Valvular surgery was not performed. Follow up echocardiography after completion of therapy did not show any vegetations and the patient clinically improved.

Conclusion

This is the second reported case of isolated pulmonary valve endocarditis caused by Candida and the first to be successfully managed with antifungal therapy alone. Pulmonary valve endocarditis should be considered in cases of pneumonia with Candida and persistent fungemia. While surgery should be considered in all cases of Candida endocarditis, cure may be achieved with antifungal therapy alone.

Electronic supplementary material

The online version of this article (doi:10.1186/s12879-014-0557-5) contains supplementary material, which is available to authorized users.

Isolated pulmonary valve endocarditis in a normal heart

Isolated pulmonary valve endocarditis is a very rare entity, usually associated with intravenous drug abuse. We describe a case of isolated pulmonary valve endocarditis in a diabetic patient with no apparent precipitating factors besides a lesion on the right hallux. The clinical course was favorable and he was discharged home after a six-week course of antibiotic therapy.

Enterococcal endocarditis on native and prosthetic valves: a review of clinical and prognostic factors with emphasis on hospital-acquired infections as a major determinant of outcome

Enterococci are the third leading cause of infectious endocarditis, and despite advances in diagnosis and treatment, the mortality of enterococcal endocarditis has not changed in recent decades. Although variables such as advanced age, cardiac failure, and brain emboli have been recognized as risk factors for mortality, cooperative multi-institutional studies have not assessed the role of other variables, such as nosocomial acquisition of infection, the presence of comorbidities, or the changing antimicrobial susceptibility of enterococci, as factors determining prognosis.We conducted the current study to determine the risk factors for mortality in patients with enterococcal endocarditis in a single institution. We reviewed 47 consecutive episodes of enterococcal endocarditis in 44 patients diagnosed according to the modified Duke criteria from a retrospective cohort study of cases of infectious endocarditis. The main outcome measure was inhospital mortality. We applied stepwise logistic regression analysis to identify risk factors for mortality.Predisposing heart conditions were observed in 86.3% of patients, and 17 had prosthetic valve endocarditis. A portal of entry was suspected or determined in 38.2%; the genitourinary tract was the most common source of the infection (29.7%). Comorbidities were present in 52.2% of cases. Twelve episodes (25.5%) were acquired during hospitalization. Only 3 isolates of Enterococcus faecalis were highly resistant to gentamicin. Eighteen patients (40.9%) needed valve replacement due to cardiac failure or relapse. Comparing cases of native valve and prosthetic valve endocarditis, we found no differences regarding complications, the need for surgical treatment, or mortality. Eight of 44 (18%) episodes were fatal. Age over 70 years (p = 0.05), heart failure (odds ratio [OR], 1.61; 95% confidence interval [CI], 1.15-2.25; p = 0.001), presence of 1 or more comorbidities (OR, 3.2; 95% CI, 1.11-9.39; p = 0.02), and nosocomial acquisition (OR, 8.05; 95% CI, 1.50-43.2; p = 0.01) were associated with mortality. In the multivariate analysis, only nosocomial acquisition increased the risk of mortality. In patients with enterococcal endocarditis, nosocomial acquisition of infection is an important factor determining outcome. As the incidence of bacteremia and the population of elderly people at risk continue to grow, the hazard of acquiring nosocomial enterococcal endocarditis may increase; hence, major emphasis must be put on prevention.