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Erdem S, Patel D, Patel SV, Patel S, Patel S, Kanwar A. Streptococcus pneumoniae Serotype 23B Causing Asymptomatic Sinusitis Complicated by Endocarditis and Meningitis: Sequela of a Non-vaccine Serotype. Cureus 2023; 15:e41892. [PMID: 37581129 PMCID: PMC10423637 DOI: 10.7759/cureus.41892] [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: 07/14/2023] [Indexed: 08/16/2023] Open
Abstract
We describe a rare case of a Streptococcus pneumoniae (S. pneumoniae) infection causing mitral valve endocarditis and bacterial meningitis in a previously healthy young adult male in his 20s who presented with altered mentation. Though our patient did not endorse any respiratory issues, we suspected the paranasal sinuses to have been the cryptic primary source of disseminated infection into the respiratory system and meninges due to incidental mucosal thickening being found on imaging. Blood and cerebrospinal fluid analyses and cultures revealed the proliferation of S. pneumoniae serotype 23B, despite our patient having previously received appropriate pneumococcal vaccinations in his childhood without delinquency. Ultimately, surgical replacement of the mitral valve, as well as a course of ceftriaxone, was indicated for this patient, in which full resolution of symptoms was achieved upon discharge.
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Affiliation(s)
- Saliha Erdem
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Dhruvil Patel
- Internal Medicine, Wayne State University School of Medicine, Detroit, USA
| | - Suraj V Patel
- Internal Medicine, Ross University School of Medicine, Miramar, USA
| | - Shlok Patel
- Medical School, University of Michigan, Ann Arbor, USA
| | - Shivam Patel
- Medical School, University of South Florida, Tampa, USA
| | - Amrit Kanwar
- Cardiology, Detroit Medical Center, Detroit, USA
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Bouhdadi H, Rhissassi J, Wazaren H, Idrissa M, Benlafqih C, Sayah R, Laaroussi M. Pulmonary and aortic endarteritis revealing a patent ductus arteriosus in an adult. J Surg Case Rep 2022; 2022:rjab565. [PMID: 35035877 PMCID: PMC8755632 DOI: 10.1093/jscr/rjab565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 11/26/2021] [Indexed: 11/13/2022] Open
Abstract
Abstract
The ductus arteriosus, an essential fetal structure, normally closes spontaneously soon after birth. Its persistence into late adulthood is considered to be rare; infective endarteritis (IE) complicating a patent ductus arteriosus (PDA) is an even rarer event. The clinical picture of an infected PDA could be subtle, and the diagnosis is frequently delayed. We present the case of a young woman who presented with prolonged fever for whom we made the diagnosis of a PDA complicated by IE, with vegetations in both pulmonary and aortic walls with mycotic aneurysms of the descending aorta. She underwent surgery and the post-operative course was uneventful. To our knowledge, this is the first reported case of a PDA complicated with both pulmonary and aortic endarteritis.
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Affiliation(s)
- H Bouhdadi
- Cardiovascular Surgery Department A, Ibn Sina Hospital, Rabat, Morocco
| | - J Rhissassi
- Cardiovascular Surgery Department A, Ibn Sina Hospital, Rabat, Morocco
| | - H Wazaren
- Cardiovascular Surgery Department A, Ibn Sina Hospital, Rabat, Morocco
| | - M Idrissa
- Cardiovascular Surgery Department A, Ibn Sina Hospital, Rabat, Morocco
| | - C Benlafqih
- Cardiovascular Surgery Department A, Ibn Sina Hospital, Rabat, Morocco
| | - R Sayah
- Cardiovascular Surgery Department A, Ibn Sina Hospital, Rabat, Morocco
| | - M Laaroussi
- Cardiovascular Surgery Department A, Ibn Sina Hospital, Rabat, Morocco
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3
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Infective endocarditis caused by Streptococcus pneumoniae from sinusitis: A case report. J Cardiol Cases 2021; 25:279-281. [DOI: 10.1016/j.jccase.2021.11.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Revised: 09/10/2021] [Accepted: 11/08/2021] [Indexed: 11/21/2022] Open
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4
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Vareechon C, Bender JM, Zhou S, Dien Bard J. Infective Endocarditis in a Pediatric Patient. J Appl Lab Med 2019; 3:720-723. [PMID: 31639739 DOI: 10.1373/jalm.2018.027722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 11/09/2018] [Indexed: 11/06/2022]
Affiliation(s)
- Chairut Vareechon
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA
| | - Jeffrey M Bender
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA.,Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Shengmei Zhou
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA.,Keck School of Medicine, University of Southern California, Los Angeles, CA
| | - Jennifer Dien Bard
- Department of Pathology and Laboratory Medicine, Children's Hospital Los Angeles, Los Angeles, CA; .,Keck School of Medicine, University of Southern California, Los Angeles, CA
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Ratsimandresy M, Hadeed K, Acar P, Cuttone F. A case report of mycotic pseudoaneurysm in childhood: an unusual complication of coarctation of the aorta. EUROPEAN HEART JOURNAL-CASE REPORTS 2019; 3:yty170. [PMID: 31020245 PMCID: PMC6439392 DOI: 10.1093/ehjcr/yty170] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Accepted: 12/23/2018] [Indexed: 11/23/2022]
Abstract
Background We report on an unusual case of a 3 year-old girl with coarctation of the aorta complicated by mycotic pseudoaneurysm and infected with Streptococcus pneumoniae. Case summary The only symptoms and signs were fever and weak femoral pulses. The echocardiography confirmed a localised isthmic's coarctation. In order to complete the evaluation, a CT scan was performed. This proved crucial in terms of the diagnosis and decision to perform emergency surgery. The diagnosis was confirmed surgically. An aortic rupture was contained by the parietal pleura. Bacteriological analysis of surgical specimens revealed bacterial DNA that tested positive for Streptococcus pneumoniae. The post-operative course was free from any cardiovascular or neurological complications after six weeks of antibiotic therapy. Discussion Surgical repair of coarctation of the aorta is frequently performed in children. However, complicated forms are less common with a potentially fatal outcome. Indeed, there are no recommendations concerning the management and surgical timing of mycotic pseudoaneurysm. These rare complications should be kept in mind. Although short- and medium-term follow-up of these children is good, caution should be exercised with long-term follow-up because of complications in childhood and adulthood.
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Affiliation(s)
- Miarisoa Ratsimandresy
- Department of Pediatric Cardiology, Toulouse University Hospital, 330 avenue de grande Bretagne Toulouse, France
| | - Khaled Hadeed
- Department of Pediatric Cardiology, Toulouse University Hospital, 330 avenue de grande Bretagne Toulouse, France
| | - Philippe Acar
- Department of Pediatric Cardiology, Toulouse University Hospital, 330 avenue de grande Bretagne Toulouse, France
| | - Fabio Cuttone
- Department of Congenital Cardiac Surgery, Toulouse University Hospital, 330 avenue de grande Bretagne Toulouse, France
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Mohapatra S, Doulah A, Brown E. Pneumococcal meningitis and endocarditis in an infant: possible improved survival with factor V Leiden mutation. Eur J Pediatr 2017; 176:1439-1442. [PMID: 28801724 PMCID: PMC5602074 DOI: 10.1007/s00431-017-2973-1] [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: 03/02/2016] [Revised: 07/08/2017] [Accepted: 07/24/2017] [Indexed: 11/28/2022]
Abstract
UNLABELLED Streptococcus pneumoniae infections continue to remain associated with high morbidity and mortality. Although the incidence of invasive meningeal and/or lung disease are not uncommon, Streptococcus pneumoniae endocarditis is rare especially in healthy pediatric population. New studies have suggested a strong association between factor V leiden (FVL) mutation and favorable outcomes in critically ill children. A healthy 10 month old presented with sepsis and meningeal signs, was later confirmed to have Streptococcus pneumoniae meningitis and endocarditis. She was found to have factor V leiden mutation and made a complete recovery despite initial complications. CONCLUSION Presence of factor V leiden mutation in critically ill children with severe septicaemia possibly contributes to better outcomes. What is known: • Mortality and morbidity remain high with invasive pneumococcal disease. • Pneumococcal endocarditis is rare in healthy pediatric population and results in significant morbidity and mortality What is new: • New studies have suggested a strong association between factor V leiden (FVL) mutation and favorable outcomes in critically ill children. • The presence of factor V mutation in children with extensive invasive pneumococcal disease possibly contributes to a better outcome.
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Affiliation(s)
- Sitikant Mohapatra
- Paediatric Intensive Care Unit, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX, UK.
| | - Assaf Doulah
- 0000 0000 9965 1030grid.415967.8Paediatric Intensive Care Unit, Leeds Teaching Hospitals NHS Trust, Leeds, LS1 3EX UK
| | - Elspeth Brown
- 0000 0000 9965 1030grid.415967.8Paediatric Cardiology, Leeds Teaching Hospitals, Leeds, LS1 3EX UK
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de Egea V, Muñoz P, Valerio M, de Alarcón A, Lepe JA, Miró JM, Gálvez-Acebal J, García-Pavía P, Navas E, Goenaga MA, Fariñas MC, Vázquez EG, Marín M, Bouza E. Characteristics and Outcome of Streptococcus pneumoniae Endocarditis in the XXI Century: A Systematic Review of 111 Cases (2000-2013). Medicine (Baltimore) 2015; 94:e1562. [PMID: 26426629 PMCID: PMC4616835 DOI: 10.1097/md.0000000000001562] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 08/18/2015] [Accepted: 08/18/2015] [Indexed: 12/22/2022] Open
Abstract
Streptococcus pneumoniae is an infrequent cause of severe infectious endocarditis (IE). The aim of our study was to describe the epidemiology, clinical and microbiological characteristics, and outcome of a series of cases of S. pneumoniae IE diagnosed in Spain and in a series of cases published since 2000 in the medical literature. We prospectively collected all cases of IE diagnosed in a multicenter cohort of patients from 27 Spanish hospitals (n = 2539). We also performed a systematic review of the literature since 2000 and retrieved all cases with complete clinical data using a pre-established protocol. Predictors of mortality were identified using a logistic regression model. We collected 111 cases of pneumococcal IE: 24 patients from the Spanish cohort and 87 cases from the literature review. Median age was 51 years, and 23 patients (20.7%) were under 15 years. Men accounted for 64% of patients, and infection was community-acquired in 96.4% of cases. The most important underlying conditions were liver disease (27.9%) and immunosuppression (10.8%). A predisposing heart condition was present in only 18 patients (16.2%). Pneumococcal IE affected a native valve in 93.7% of patients. Left-sided endocarditis predominated (aortic valve 53.2% and mitral valve 40.5%). The microbiological diagnosis was obtained from blood cultures in 84.7% of cases. In the Spanish cohort, nonsusceptibility to penicillin was detected in 4.2%. The most common clinical manifestations included fever (71.2%), a new heart murmur (55%), pneumonia (45.9%), meningitis (40.5%), and Austrian syndrome (26.1%). Cardiac surgery was performed in 47.7% of patients. The in-hospital mortality rate was 20.7%. The multivariate analysis revealed the independent risk factors for mortality to be meningitis (OR, 4.3; 95% CI, 1.4-12.9; P < 0.01). Valve surgery was protective (OR, 0.1; 95% CI, 0.04-0.4; P < 0.01). Streptococcus pneumoniae IE is a community-acquired disease that mainly affects native aortic valves. Half of the cases in the present study had concomitant pneumonia, and a considerable number developed meningitis. Mortality was high, mainly in patients with central nervous system (CNS) involvement. Surgery was protective.
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Affiliation(s)
- Viviana de Egea
- From the Microbiology and Infectious Diseases Department, Hospital General Universitario Gregorio Marañón (VDE, PM, MV, MM, EB); Department of Medicine, Universidad Complutense, Madrid (UCM), Spain (PM, MM, EB); CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III (CIBERES), Madrid, Spain (PM, MM, EB); Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM) Madrid, Spain (PM, MV, MM, EB); Microbiology and Infectious disease department, Hospital Universitario Virgen del Rocio, Sevilla (ADA, JAL); Infectious Diseases Department. Hospital Clinic-IDIBAPS, University of Barcelona (Barcelona) (JMM); Department of Medicine, Unidad Clínica Intercentros de Enfermedades Infecciosas, Microbiolo gía y Medicina Preventiva Hospital Universitario Virgen Macarena. Departamento de Medicina. Universidad de Sevilla (JG-A); Department of Cardiology, Hospital Universitario Puerta de Hierro Majadahonda, Madrid (PG-P); Hospital Ramón y Cajal, Madrid (EN); UEI HU Donostia, San Sebastián (MAG); Hospital Marqués de Valdecilla, University of Catabria, Santander (MCF); and Hospital Clínico Universitario Virgen de la Arrixaca, Instituto Murciano de Investigación Biosanitaria (IMIB), Facultad de Medicina-Universidad de Murcia, Spain (EGV)
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8
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Abstract
Infective endocarditis is relatively uncommon in the pediatric population, but when it does occur, results in substantial morbidity and mortality. Children at risk for endocarditis are typically those with an underlying congenital heart condition. Furthermore, an endocardial abscess is a very rare yet serious complication of infective endocarditis. We describe a case of a 23-month-old previously healthy male infant with no known congenital heart disease who returned to the emergency department after a recent hospitalization for pneumococcal bacteremia, presenting acutely ill but without fever. He was found to be in congestive heart failure due to endocarditis and an aortic root abscess.
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Utilidad del screening ecocardiográfico en las infecciones neumocócicas invasivas. Enferm Infecc Microbiol Clin 2015; 33:363-4. [PMID: 25444039 DOI: 10.1016/j.eimc.2014.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 06/04/2014] [Accepted: 06/30/2014] [Indexed: 11/20/2022]
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Amador Solorio G, Oyervides García C, Romo Almanza M. Endocarditis por Streptococcus pneumoniae en un escolar sano. An Pediatr (Barc) 2008; 69:366-8. [DOI: 10.1157/13126563] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
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Ishiwada N, Niwa K, Tateno S, Yoshinaga M, Terai M, Nakazawa M. Pneumococcal endocarditis in children: A nationwide survey in Japan. Int J Cardiol 2008; 123:298-301. [PMID: 17383029 DOI: 10.1016/j.ijcard.2006.12.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2006] [Revised: 11/22/2006] [Accepted: 12/11/2006] [Indexed: 11/27/2022]
Abstract
BACKGROUND Infective endocarditis (IE) due to Streptococcus pneumoniae (S. pneumoniae) carries a high mortality rate. However, little is known about pneumococcal IE in children and no optimal therapy has been established. Thus, we attempted to identify the clinical features of this disorder through a Japanese nationwide survey. METHODS Members of the Japanese Society of Pediatrics Cardiology and Cardiac Surgery registered 170 pediatric patients with IE diagnosed during a 5-year period (1997-2001). Nine of these patients (5.3%) had pneumococcal IE. The clinical course, treatment and outcome of these 9 patients, aged 7 months to 4 years, were analyzed. RESULTS Pneumococcal IE was associated with congenital heart disease in 7 patients and accompanied by other systemic infections including meningitis, pneumonia and otitis media, in 4 patients. Five of the 9 (55.6%) strains isolated by blood culture were penicillin-resistant S. pneumoniae strains. Seven patients were treated with carbapenem. Three underwent cardiac surgery due to cardiac failure and/or vegetation. One died due to septic shock on the first day of hospitalization. CONCLUSIONS In children, pneumococcal endocarditis is often accompanied by severe systemic infections. The majority of pediatric cases are caused by penicillin-resistant S. pneumoniae strains. Carbapenem is an effective for IE caused by penicillin-resistant S. pneumoniae. This survey might be helpful to establish proper management strategies for pediatric pneumococcal IE.
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Affiliation(s)
- Naruhiko Ishiwada
- Department of Pediatrics, Chiba University Graduate School of Medicine, Chiba, Japan.
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12
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Weisberg SS. Pneumococcus. Dis Mon 2007. [DOI: 10.1016/j.disamonth.2007.09.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Murillo Vallés M, Cañadas Palazón S, Domínguez Sampedro P, Soler Palacín P, Bonjoch Marí C, Roqueta Mas J. Endocarditis neumocócica en niño de 17 meses previamente sano. An Pediatr (Barc) 2007; 66:615-8. [PMID: 17583625 DOI: 10.1157/13107398] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Invasive pneumococcal infection is a severe disease and its incidence may be increasing. Endocarditis due to Streptococcus pneumoniae is uncommon, particularly in children without risk factors. Etiologic diagnosis is difficult when cultures are negative. We report the case of a previously healthy, 17-month-old boy not vaccinated against pneumococcus who, during the course of pneumonia treated with beta-lactam antibiotics, developed cardiorespiratory deterioration and heart murmur. Mitral valve vegetation was identified by transthoracic echocardiography. Endocarditis was diagnosed and new antibiotics were given for 6 weeks (cefotaxime, gentamycin and vancomycin). Cultures were negative. Because of lack of improvement, prosthetic mitral replacement was indicated. S. pneumoniae was identified by polymerase chain reaction (PCR) in the pathological specimen. Outcome was favorable, and the patient remained symptom-free after 6 months of follow-up. The possibility of endocarditis as an invasive pneumococcal infection should be considered in children without risk factors. PCR is a useful technique to establish the etiology when cultures are negative.
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Affiliation(s)
- M Murillo Vallés
- Unidades de Cuidados Intensivos Pediátricos, Hospital Universitario Materno-Infantil Vall d'Hebron, Universidad Autónoma de Barcelona, España
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Abstract
OBJECTIVES To determine the clinical features at presentation of children with infective endocarditis to a tertiary centre and review the role of the emergency department in these cases. The subsequent course and outcomes are briefly discussed. METHODS Retrospective audit of children with endocarditis presenting to a tertiary children's hospital over a 16-year period. RESULTS Twenty-three cases of infective endocarditis were identified. Initial presentation via the paediatric emergency department occurred in 78% of cases and was associated with the least delay to commencement of appropriate treatment. The average duration of illness at the time of presentation was 6 days. Prior medical care had been sought in 65% of the cases, with antibiotics prescribed for an alternate diagnosis in 73%. Children with and without cardiac anomalies were equally represented. Of the group with normal cardiac anatomy, 45% presented without a murmur. Staphylococcus aureus was the most frequent causative organism (43%) and accounted for 64% of cases in children with no pre-existing cardiac abnormalities. Permanent sequelae were more likely to occur with S. aureus. The overall mortality rate was 9%. CONCLUSIONS Infective endocarditis is a rare illness in children and represents a diagnostic challenge. The majority of cases will present via the paediatric emergency department with a non-specific febrile illness, having frequently commenced antibiotics for an alternate diagnosis. Specific expertise in paediatric emergency care can assist in early diagnosis and management. Morbidity remains significant, particularly in cases caused by S. aureus.
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Affiliation(s)
- Stuart Lewena
- Princess Margaret Hospital for Children, Perth, Western Australia, Australia.
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