endocarditis of bioprosthetic aortic valve presenting with recurrent embolic strokes Open Access

Abstract

prosthetic valve endocarditis is a rare infection caused by bacteria. This bacterium is found in the normal flora of the human mouth, gastrointestinal tract and female genital tract. While there have been isolated cases of bacteraemia and endocarditis, the infections are associated with comorbidities, immune deficiency, dental manipulation procedures and other medical history. This case of bioprosthetic valve endocarditis caused by is unusual, as the patient was immune-competent and treated with pre-procedural antibiotics.

We present a case of a 65-year-old male who underwent a dental extraction. He presented after 3 months of fever, chills and fatigue. On initial presentation, blood cultures were positive for alpha-haemolytic streptococcus bacteraemia. He was treated with IV penicillin and underwent aortic valve replacement with a bioprosthetic valve and excision of the mitral vegetation with repair of the mitral valve. Two years later, he had a tooth extraction after being treated properly with antibiotics. Three months later he presented with difficulty speaking, left leg weakness and increased drooling. All testing was normal. Three months later he presented with left side lower extremity weakness and expressive aphasia. He was diagnosed with bioprosthetic aortic valve endocarditis and was treated with IV penicillin and gentamicin for 6 weeks and then switched to oral penicillin. He remained stable.

can potentially be a cause of complicated endocarditis in patients with prosthetic heart valves undergoing dental procedures. Timely culture-guided antibiotic therapy is critical and may obviate the need for valve surgery.

Loading

Article metrics loading...

/content/journal/acmi/10.1099/acmi.0.000038
2019-07-26
2024-03-29
Loading full text...

Full text loading...

/deliver/fulltext/acmi/1/8/acmi000038.html?itemId=/content/journal/acmi/10.1099/acmi.0.000038&mimeType=html&fmt=ahah

References

  1. Cannon JP, Lee TA, Bolanos JT, Danziger LH. Pathogenic relevance of Lactobacillus: a retrospective review of over 200 cases. Eur J Clin Microbiol Infect Dis 2005; 24:31–40 [View Article]
    [Google Scholar]
  2. Franko B, Vaillant M, Recule C, Vautrin E, Brion JP et al. Lactobacillus paracasei endocarditis in a consumer of probiotics. Med Mal Infect 2013; 43:171–173 [View Article]
    [Google Scholar]
  3. Oakey HJ, Harty DW, Knox KW. Enzyme production by lactobacilli and the potential link with infective endocarditis. J Appl Bacteriol 1995; 78:142–148 [View Article]
    [Google Scholar]
  4. Singhal N, Kumar M, Kanaujia PK, Virdi JS. MALDI-TOF mass spectrometry: an emerging technology for microbial identification and diagnosis. Front Microbiol 2015; 6:791 [View Article]
    [Google Scholar]
  5. Hoen B, Alla F, Selton-Suty C, Béguinot I, Bouvet A et al. Changing profile of infective endocarditis: results of a 1-year survey in France. JAMA 2002; 288:75–81
    [Google Scholar]
  6. Nishimura RA, Otto CM, Bonow RO, Carabello BA, ErwinIII JP et al. AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease. J Am Coll Cardiol 2017; 7:252–289
    [Google Scholar]
  7. Dupont B, Lapresle Cl. [Subacute bacterial endocarditis due to lactobacillus (author's transl)]. Nouv Presse Med 1977; 6:3627–3628
    [Google Scholar]
  8. Griffiths JK, Daly JS, Doge RA. Two cases of endocarditis due to Lactobacillus species: antimicrobial susceptibility, review and discussion of therapy. Clin Infect Dis 1992; 5:50–55
    [Google Scholar]
  9. Salminen MK, Rautelin H, Tynkkynen S, Poussa T, Saxelin M et al. Lactobacillus bacteremia, clinical significance, and patient outcome, with special focus on probiotic L. rhamnosus GG. Clin Infect Dis 2004; 38:62–69 [View Article]
    [Google Scholar]
  10. Salvana EM, Frank M. Lactobacillus endocarditis: case report and review of cases reported since 1992. J Infect 2006; 53:e5–e10 [View Article]
    [Google Scholar]
  11. Vankerckhoven V, Moreillon P, Piu S, Giddey M, Huys G et al. Infectivity of Lactobacillus rhamnosus and Lactobacillus paracasei isolates in a rat model of experimental endocarditis. J Med Microbiol 2007; 56:1017–1024 [View Article]
    [Google Scholar]
  12. Harty DW, Patrikakis M, Hume EB, Oakey HJ, Knox KW. The aggregation of human platelets by Lactobacillus species. J Gen Microbiol 1993; 139:2945–2951 [View Article]
    [Google Scholar]
  13. Soltan Dallal MM, Mojarrad M, Baghbani F, Raoofian R, Mardaneh J et al. Effects of probiotic Lactobacillus acidophilus and Lactobacillus casei on colorectal tumor cells activity (CaCo-2). Arch Iran Med 2015; 18:167–172
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journal/acmi/10.1099/acmi.0.000038
Loading
/content/journal/acmi/10.1099/acmi.0.000038
Loading

Data & Media loading...

Most cited Most Cited RSS feed