Subacute bacterial endocarditis caused by Cardiobacterium hominis: A case report

Cardiobacterium hominis infective endocarditis: A literature review

Background

Cardiobacterium hominis is a member of the HACEK group, which causes infective endocarditis (IE) but is rarely associated with other infections. It is difficult to biologically identify C. hominis because of its slow growth in culture. However, the clinical features of C. hominis IE remain unclear.

Method

We searched the PubMed database for all articles of C. hominis IE published between January 2000 and July 2022.

Results

The major clinical features of 44 previously reported cases of C. hominis IE were as follows: the median age was 59 years, of which 36 were men; the initial presenting symptoms were chest discomfort (30 %), followed by fever (27 %), night sweats (20 %), fatigability (18 %), weight loss (16 %), and dyspnea (16 %). Almost half of the patients were febrile upon admission. The major predisposing factors were postsurgical valve treatment (57 %), dental treatment or caries (20 %), and congenital valve abnormality (5 %). The median time to identify C. hominis in the blood culture was 4 days, but the longest time was 42 days. The most commonly infected valve was the aortic valve, and the most common complication was systemic embolism. Surgical treatment was performed in 23 (52 %) patients. The most frequent initial treatment regimen was cephem antibiotics, with a median treatment duration of 6 weeks. The overall mortality and recovery rates of C. hominis IE were 9 % and 91 %, respectively.

Conclusion

If C. hominis infection is confirmed, physicians should check for the presence of vegetations of the heart valves and understand these characteristics.

Apyretic pulmonary oedema revealing Cardiobacterium hominis endocarditis: case report and review of literature

Cardiobacterium hominis is a member of the HACEK group of bacteria, responsible for infective endocarditis, mainly in patients with damaged or prosthetic valves. The low virulence of this organism can explain the insidious presentation and subacute or chronic progression of C. hominis infective endocarditis. Here, a 41-year-old man with a past history of surgery for a Waldhausen type aortic coarctation was hospitalised with dyspnea and chest pains revealing an acute pulmonary oedema, without fever. Transesophageal echocardiography indicated a 20 mm vegetation on biscuspid aortic valve. Six sets of blood culture were positive with Cardiobacterium hominis. In case of lack of fever, the diagnosis of infectious endocarditis is difficult because other symptoms are non-specific and biological markers of inflammatory syndrome are quiet or non-existent. This is the first case of C. hominis infectious endocarditis with a clinical presentation of acute pulmonary oedema in the literature. We report here an apyretic pulmonary oedema revealing C. hominis endocarditis and a review of the literature on apyretic infective endocarditis due to C. hominis.

Infective endocarditis caused by Cardiobacterium hominis endocarditis: A case report and review of the literature

BACKGROUND

While it has been increasing cases of C. hominis endocarditis in the past decades due to advances of diagnostic methods, the epidemiology and clinical manifestations of IE caused by C. hominis is still unknown.

CASE PRESENTATION

A 62-year old man was admitted to our institute with fever, anorexia and general fatigue for the preceding one month. He had a past medical history of both aortic and mitral valves replacement due to cardiac diseases. He was diagnosed as IE caused by C. hominis according to the modified duke criteria. The patient received 2 weeks of combination therapy of intravenous ceftriaxone (CTRX) 2g and gentamycin 180mg daily followed by 4 weeks CTRX 2g daily alone. Oral moxifloxacin 400mg once daily was given for an additional 4 weeks. After the antibiotic therapy was discontinued, disease recurrence was not observed. We reviewed previously reported C. hominis IE cases in 60 publications including ours. Of 73 patients enrolled, 53 were male, the mean age was 52 years. The most common risk factor of IE was past history of cardiac diseases in 44/73 (60%). As for antibiotics initially prescribed, third-generation cephalosporins was most frequently used in 28/69 (41%). While the cure rate was 67/73 (93%), 31/73 patients (43%) received a surgical intervention. Embolic lesions to the central nervous system and vertebrae were seen in 16/72 (22%) and 5/72 (7%).

CONCLUSION

IE caused by C. hominis has a favorable prognosis, showing the cure rate of 93%. Physicians should recognize the possible occurrence of emboli among IE patients.

PHIRST Trial - pharmacist consults: prioritization of HIV-patients with a referral screening tool

The role of pharmacists in HIV outpatient clinics has greatly increased in the past decades. Given the limited resources of the health system, the prioritization of pharmacist consults is now a main concern. This study aimed to create a scoring system allowing for standardized prioritization of pharmacist consults for patients living with HIV. Data was retrospectively collected from 200 HIV patients attending the Chronic Viral Illness Service at the McGill University Health Center. An expert panel consisting of four pharmacists working in the field of HIV prioritized each patient individually, after which a consensus was established and was considered as the gold standard. In order to create a scoring system, two different methods (Delphi, statistical) were used to assign a weight to each characteristic considered to be important in patient prioritization. A third method (equal weight to each characteristic) was also evaluated. The total score per patient for each method was then compared to the expert consensus in order to establish the score cut-offs to indicate the appropriate categories of delay in which to see the patient. All three systems failed to accurately prioritize patients into urgency categories ("less than 48 h", "less than 1 month", "less than 3 months", "no consult required") according to expert pharmacist consensus. The presence of high level interactions between patient characteristics, the limited number of patients and the low prevalence of some characteristics were hypothesized as the main causes for the results. Creating a prioritization tool for pharmacy consults in HIV outpatient clinics is a complex task and developing a decision tree algorithm may be a more appropriate approach in the future to take into account the importance of combinations of patient characteristic.