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Benjanuwattra J, Bell AL, Yang MV, Mora BL, Jenkins LA, Sethi P. An enigmatic presentation of Escherichia coli endocarditis: Emphasizing the role of brain magnetic resonance imaging. Clin Case Rep 2023; 11:e7878. [PMID: 37705583 PMCID: PMC10495614 DOI: 10.1002/ccr3.7878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/16/2023] [Accepted: 08/22/2023] [Indexed: 09/15/2023] Open
Abstract
Key Clinical Message Infective endocarditis should be considered in any febrile individual with acute onset neurological symptoms. If suspicion is high, a negative brain computed tomography does not virtually exclude embolism, and magnetic resonance imaging is warranted. Abstract A diagnosis of infective endocarditis (IE) is often delayed, particularly in those infected with unusual organisms. Hereby, we report a case of a female patient presented with dysarthria, confusion, and altered mental status after being treated for Escherichia coli bacteremia. Computed tomography of the brain was unrevealing; however, scattered embolic phenomena were visualized on magnetic resonance imaging (MRI). The case underscores the importance of clinical awareness, particularly in the setting of unusual microorganisms, and the role of brain MRI in the diagnosis of IE.
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Affiliation(s)
- Juthipong Benjanuwattra
- Department of Internal Medicine Texas Tech University Health Sciences Center Lubbock Texas USA
| | - Amanda L Bell
- Department of Internal Medicine Texas Tech University Health Sciences Center Lubbock Texas USA
| | - Mingxiao V Yang
- School of Medicine Texas Tech University Health Sciences Center Lubbock Texas USA
| | - Barbara L Mora
- Department of Internal Medicine Texas Tech University Health Sciences Center Lubbock Texas USA
| | - Leigh Ann Jenkins
- Division of Cardiology Texas Tech University Health Sciences Center Lubbock Texas USA
| | - Pooja Sethi
- Division of Cardiology Texas Tech University Health Sciences Center Lubbock Texas USA
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Tessier S, Durgham A, Krinock M, Singh A, Longo S, Nanda S. Native valve emphysematous enterococcal endocarditis: expanding the differential diagnosis. Germs 2021; 11:608-613. [PMID: 35096679 PMCID: PMC8789363 DOI: 10.18683/germs.2021.1297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2021] [Revised: 11/09/2021] [Accepted: 11/14/2021] [Indexed: 04/06/2024]
Abstract
INTRODUCTION Emphysematous endocarditis is caused by the gas-forming organisms Citrobacter koseri, Escherichia coli, Clostridium species, and Finegoldia magna. We report the first case of emphysematous endocarditis caused by Enterococcus faecalis. CASE REPORT An 82-year-old man presented with fever and rapidly progressive shortness of breath. He was found to be in atrial fibrillation with rapid ventricular rates. Two-dimensional transthoracic echocardiography demonstrated severe mitral regurgitation. Subsequent two- and three-dimensional transesophageal echocardiogram revealed a large, highly mobile vegetation on the atrial surface of the anterior mitral leaflet with aneurysmal destruction of the lateral scallop requiring mitral valve replacement. Sequencing of the vegetation revealed Enterococcus faecalis, an anaerobic gram-positive coccus that, in rare cases, produces gas using a heme-dependent catalase. Histopathological analysis of the infected valve suggested interstitial gas accumulation, leading to the diagnosis of emphysematous endocarditis. CONCLUSIONS E. faecalis-associated emphysematous endocarditis should be included in the differential diagnosis of valvular vegetation in patients with a rapidly progressing clinical course. When possible, histopathological analysis should be used alongside other imaging techniques to confirm the diagnosis of emphysematous endocarditis. This case also highlights the importance of collecting blood cultures prior to initiating antibiotic treatment.
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Affiliation(s)
- Steven Tessier
- MS, Lewis Katz School of Medicine, Temple University, 3500 N Broad St, Philadelphia, PA, 19140, USA
| | - Anthony Durgham
- BS, Lewis Katz School of Medicine, Temple University, 3500 N Broad St, Philadelphia, PA, 19140, USA
| | - Matthew Krinock
- DO, Department of Medicine, St. Luke’s University Health Network, 801 Ostrum St, Bethlehem, PA, 18105, USA
| | - Amitoj Singh
- MD, Department of Medicine, University of Arizona, 1501 N. Campbell Ave, Tucson, AZ, 85724, USA
| | - Santo Longo
- MD, Department of Pathology, St. Luke’s University Health Network, 801 Ostrum St, Bethlehem, PA, 18105, USA
| | - Sudip Nanda
- MD, Department of Cardiology, St. Luke’s University Health Network, 801 Ostrum St, Bethlehem, PA, 18105, USA
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Andrade NL, da Cruz Campos AC, Cabral AM, Damasco PH, Lo-Ten-Foe J, Rosa ACP, Damasco PV. Infective endocarditis caused by Enterobacteriaceae: phenotypic and molecular characterization of Escherichia coli and Klebsiella pneumoniae in Rio de Janeiro, Brazil. Braz J Microbiol 2021; 52:1887-1896. [PMID: 34549374 PMCID: PMC8578509 DOI: 10.1007/s42770-021-00528-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 05/12/2021] [Indexed: 12/16/2022] Open
Abstract
The etiological agent for infective endocarditis (IE), a life-threatening disease, is usually gram-positive bacteria. However, gram-negative bacteria can rarely cause IE and 4% of cases are associated with morbidity and mortality. This study aimed to characterize Escherichia coli and Klebsiella pneumoniae isolates from the blood of patients with IE. The characteristics of blood isolates were compared with those of urinary isolates from patients with urinary tract infections (UTIs). The results of this study revealed that K. pneumoniae isolates from patients with IE were phylogenetically related to those from patients with UTI. Additionally, the resistance phenotype, resistance gene, virulence gene, and plasmid profiles were similar between the blood and urinary isolates. The isolates belonging to the sequence types (STs) 76, 36, 101 (K. pneumoniae), and 69 (E. coli) are reported to be associated with drug resistance. The Enterobacteriaceae isolates from patients with IE did not produce extended-spectrum β-lactamase or carbapenemase. Additionally, this study investigated the virulence phenotype, biofilm formation ability, and the ability to adhere to the epithelial cells in vitro of the isolates. The isolates from patients with IE exhibited weaker biofilm formation ability than the urinary isolates. All isolates from patients with IE could adhere to the renal epithelial cells. However, three isolates from patients with UTIs could not adhere to the epithelial cells. The closely related K. pneumoniae isolates (648, KP1, KP2, KP3, and KP4) could not form biofilms or adhere to the epithelial cells. In summary, the molecular analysis revealed that the genetic characteristics of IE-causing K. pneumoniae and E. coli were similar to those of UTI-causing isolates. These isolates belonged to the STs that are considered treatable. Genetically similar isolates did not exhibit the same virulence phenotype. Thus, these non-hypervirulent clones must be monitored as they can cause complex infections in susceptible hosts.
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Affiliation(s)
- Nathália L Andrade
- Department of Microbiology, Immunology and Parasitology, Biomedical Center, Rio de Janeiro State University, Blv 28 de Setembro, 87, 3th floor, Vila Isabel, Rio de Janeiro, Brazil
| | - Ana Carolina da Cruz Campos
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, EB80 Hanzeplein 1, 9713, GZ, Groningen, The Netherlands.
| | - Andrea Maria Cabral
- Pedro Ernesto University Hospital, Rio de Janeiro State University, Vila Isabel, Rio de Janeiro, Brazil
| | | | - Jerome Lo-Ten-Foe
- Department of Medical Microbiology and Infection Prevention, University of Groningen, University Medical Center Groningen, EB80 Hanzeplein 1, 9713, GZ, Groningen, The Netherlands
| | - Ana Cláudia P Rosa
- Department of Microbiology, Immunology and Parasitology, Biomedical Center, Rio de Janeiro State University, Blv 28 de Setembro, 87, 3th floor, Vila Isabel, Rio de Janeiro, Brazil
| | - Paulo V Damasco
- Pedro Ernesto University Hospital, Rio de Janeiro State University, Vila Isabel, Rio de Janeiro, Brazil.,Department of Infectious and Parasitic Diseases, Graffrée e Guinle University Hospital, Federal University of the State of Rio de Janeiro, Rio de Janeiro, Brazil
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Leonard MF, Rodriguez-Villalobos H, Boisen N, Scheutz F, Laterre PF, Hantson P. The causal relationship between O2:K7:H6 extra-intestinal pathogenic Escherichia coli (ExPEC) and native valve endocarditis: a case report. BMC Infect Dis 2021; 21:370. [PMID: 33879083 PMCID: PMC8056695 DOI: 10.1186/s12879-021-06066-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2020] [Accepted: 04/12/2021] [Indexed: 11/23/2022] Open
Abstract
Background Native valves infective endocarditis due to Escherichia coli is still a rare disease and a particular virulence of some E.coli isolate may be suspected. Case presentation A 79-year-old woman presented during the post-operative period of an orthopedic surgery a urinary tract infection following obstructive ureteral lithiasis. E. coli was isolated from a pure culture of urine and blood sampled simultaneously. After evidence of sustained E.coli septicemia, further investigations revealed acute cholecystitis with the same micro-organism in biliary drainage and a native valve mitral endocarditis. E.coli was identified as O2:K7:H6, phylogenetic group B2, ST141, and presented several putative and proven virulence genes. The present isolate can be classified as both extra-intestinal pathogenic E.coli (ExPECJJ) and uropathogenic E. coli (UPECHM). Conclusions The relationship between the virulent factors present in ExPEC strains and some serotypes of E. coli that could facilitate the adherence to cardiac valves warrants further investigation.
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Affiliation(s)
| | - Hector Rodriguez-Villalobos
- Department of Microbiology, Cliniques universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Nadia Boisen
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, The International Centre for Reference and Research on Escherichia and Klebsiella, Copenhagen, Denmark
| | - Flemming Scheutz
- Department of Bacteria, Parasites and Fungi, Statens Serum Institut, The International Centre for Reference and Research on Escherichia and Klebsiella, Copenhagen, Denmark
| | - Pierre-François Laterre
- Department of Intensive Care, Cliniques universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium
| | - Philippe Hantson
- Department of Intensive Care, Cliniques universitaires St-Luc, Université catholique de Louvain, Brussels, Belgium.
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Extended spectrum beta lactamase producing Escherichia coli tricuspid valve endocarditis. IDCases 2020; 19:e00729. [PMID: 32140412 PMCID: PMC7049631 DOI: 10.1016/j.idcr.2020.e00729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 02/21/2020] [Accepted: 02/21/2020] [Indexed: 11/20/2022] Open
Abstract
Escherichia coli is a rare cause of endocarditis. This article reports an 82-year-old male with a mechanical aortic valve replacement who was admitted for fever and fatigue. He was diagnosed with a tricuspid valve endocarditis caused by an extended spectrum beta lactamase producing Escherichia coli following positive blood cultures and echocardiography. He received six weeks of imipenem / cilastatin and subsequently improved and was discharged with ambulatory follow ups with his infectious disease specialist.
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Akuzawa N, Kurabayashi M. Native valve endocarditis due to Escherichia coli infection: a case report and review of the literature. BMC Cardiovasc Disord 2018; 18:195. [PMID: 30340526 PMCID: PMC6194693 DOI: 10.1186/s12872-018-0929-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2018] [Accepted: 10/03/2018] [Indexed: 12/29/2022] Open
Abstract
Background Infective endocarditis due to Escherichia coli is a rare disease but is increasing in frequency, especially among older women. In addition, its mortality rate is higher than that of endocarditis due to the HACEK-group gram-negative bacteria (Haemophilus spp., Aggregatibacter spp., Cardiobacterium hominis, Eikenella corrodens, and Kingela spp.). Case presentation A 58-year-old Japanese woman with a history of alcohol abuse was admitted to our hospital because of a fever. She was diagnosed with infective endocarditis due to E. coli based on repeated blood cultures and transthoracic echocardiography, which revealed vegetations attached to the anterior leaflet and chordae tendineae of the mitral valve. Despite administration of sulbactam/ampicillin and gentamycin, she developed purulent spondylitis during hospitalization and required treatment with meropenem administration for 6 weeks, leading to resolution of the endocarditis. She took oral levofloxacin for 2 months, and the spondylitis was completely cured 7 months after discharge. Conclusion Escherichia coli affects native valves without degenerative valvulopathy rather than prosthetic valves, especially in patients with risk factors such as an immunosuppressive status, excessive alcohol consumption, or treatment with hemodialysis. Peripheral embolization, congestive heart failure, and valve-ring abscesses are major complications of E. coli endocarditis; notably, infective myocarditis can also occur. The mortality and surgical intervention rates are 21% and 42%, respectively. Physicians should be cognizant of the necessity of surgical intervention when E. coli endocarditis is resistant to antibiotic therapy.
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Affiliation(s)
- Nobuhiro Akuzawa
- Department of General Medicine, National Hospital Organization Shibukawa Medical Center, 383 Shiroi, Shibukawa, Gunma, 377-0280, Japan.
| | - Masahiko Kurabayashi
- Department of Medicine and Biological Science, Gunma University Graduate School of Medicine, 3-39-22 Showa-machi, Maebashi, Gunma, 371-8511, Japan
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