A Case of Escherichia coli Endocarditis After Hemorrhoidectomy Performed by a Herbalist

Escherichia coli: A Rare Cause of Prosthetic Valve Endocarditis

Prosthetic valve endocarditis (PVE) is a complication of valve replacement associated with high morbidity and mortality. Escherichia coli (E. coli) is rarely associated with infective endocarditis (IE), accounting for less than 1% of the cases reported. The low frequency is attributed to the organism's low affinity to adhere to the endocardial endothelium. Risk factors that may play a role in developing IE by E. coli include age above 70, diabetes mellitus, a genitourinary source of infection, female sex, healthcare contact, implanted endovascular devices, and immunosuppression. We present a 70-year-old Hispanic woman who arrived with constitutional symptoms and persistent urinary complaints. She had diabetes mellitus, recurrent urinary tract infections, and native mitral valve IE treated with antibiotic therapy and tissue valve replacement. The valve was replaced with a mechanical valve a second time due to malfunctioning. The patient was found to have E. coli bacteremia and ultimately diagnosed with PVE. She was treated solely with ceftriaxone and gentamicin combination therapy resulting in complete resolution of valve vegetations. Our case represents the 11th report of this uncommon disease and illustrates its epidemiology and associated risk factors. We summarize the previous 10 cases reported and highlight the lack of prospective trial data to define optimal therapy for managing PVE caused by E. coli.

Escherichia coli prosthetic valve endocarditis from a non-genitourinary source

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E. coli is an infrequent cause of infective endocarditis due to is limited ability to adhere to heart valves.

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There is a notable increase in the share of total cases of E. coli infective endocarditis due to prosthetic valve infections.

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There is an increased recognition of non-genitourinary sources of E. coli prosthetic valve endocarditis.

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The overall mortality rate is declining for E. coli prosthetic valve endocarditis cases.

Escherichia coli (E. coli) is a rare cause of infective endocarditis due to its lack of traditional virulence factors that promote endocardial adherence. Previous case reports of E. coli infective endocarditis demonstrate specific risk factors to include advanced age over 70, female sex, diabetes, immunosuppression, and intravascular or cardiac devices. Antecedent genitourinary infection is the most common source. We present a case of a 55-year-old Honduran man with a recent bioprosthetic mitral valve replacement and tricuspid valve repair who presented with one month of subjective fevers, night sweats, anorexia, and significant weight loss. After extensive work-up, the patient was diagnosed with E. coli infective endocarditis secondary to E. coli growth in blood cultures and a transesophageal echocardiogram (TEE) revealing a vegetation on his prosthetic mitral valve. An indolent gastrointestinal source was suspected to be the source of infection with imaging only notable for mild periappendiceal stranding concerning for a possible site of antecedent inflammation. He was treated with a 6-week course of ceftriaxone and gentamicin inpatient and then discharged on trimethoprim-sulfamethoxazole suppressive therapy with serial echocardiographic follow-up given the persistent small vegetation on repeat echocardiogram. Our case report and review of ten recent cases of prosthetic valve endocarditis described in the literature illustrates several common features of the epidemiology, presentation, and management of E. coli prosthetic valve endocarditis including more commonly reported non-genitourinary sources of bacteremia, a trend towards more frequent surgical interventions, and a declining mortality rate.

Native valve endocarditis due to Escherichia coli infection: a case report and review of the literature

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.