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Blood culture negative endocarditis

Tsutomu Mito, Yusuke Hirota, Shingo Suzuki, Kazutaka Noda, Takanori Uehara, Yoshiyuki Ohira, Masatomi Ikusaka
A 65-year-old Japanese man was admitted with a 4-month history of fatigue and exertional dyspnea. Transthoracic echocardiography revealed a vegetation on the aortic valve and severe aortic regurgitation. Accordingly, infective endocarditis and heart failure were diagnosed. Although a blood culture was negative on day 7 after admission, a prolonged blood culture with subculture was performed according to the patient's history of contact with cats. Consequently, Bartonella henselae was isolated. Bartonella species are fastidious bacteria that cause blood culture-negative infective endocarditis...
2016: Internal Medicine
Anca Meda Georgescu, Leonard Azamfirei, Krisztina Szalman, Edit Szekely
BACKGROUND: Over the last decades Staphylococcus aureus (SA) has become the dominant etiology of native valve infective endocarditis, with the community-acquired methicillin-sensible Staphylococcus aureus (CA-MSSA) strains being the prevailing type. CASE: We report here a case of extremely severe CA-MSSA aortic valve acute endocarditis associated with persistent Staphylococcus aureus bacteremia (SAB) in a previously healthy man and include a literature review.The patient developed severe and rare complications (purpura, purulent pericarditis, intracerebral hematoma, and rhabdomyolysis) through systemic embolism; they required drainage of pericardial empyema and cerebral hematoma, the latter eventually caused a fatal outcome...
October 2016: Medicine (Baltimore)
Noman Ahmed Jang Khan, Masroor A Khan, Guillermo Juan Morell Chardon
End stage renal disease has a list of consequences, cardiovascular being the most common. Inefficient dialysis can cause significant deposition of calcium all over the body, including heart valves making heart function impaired. We illustrate a case of 38-year-old female with end stage renal disease on peritoneal dialysis. The patient had been complaining of pain and swelling of the right hand for the last few months and had been seen by hand surgeon and was admitted electively for the biopsy of hand lesions...
2016: Case Reports in Cardiology
Glenn J Rapsinski, Jina Makadia, Nitin Bhanot, Zaw Min
BACKGROUND: Gram-negative microorganisms are uncommon pathogens responsible for infective endocarditis. Pseudomonas mendocina, a Gram-negative water-borne and soil-borne bacterium, was first reported to cause human infection in 1992. Since then, it has rarely been reported as a human pathogen in the literature. We describe the first case of native valve infective endocarditis due to P. mendocina in the USA. CASE PRESENTATION: A 57-year-old white man presented with bilateral large leg ulcers, fever, and marked leukocytosis...
October 4, 2016: Journal of Medical Case Reports
A Daly, J M Redmond, M M Hannan
Traditionally, the modified Duke's criteria, based primarily on positive blood cultures, is used to diagnose Infective Endocarditis (IE). However, reports demonstrate that 31% of cases are diagnosed as Culture Negative Infective Endocarditis (CNIE)1. Consequently, empiric broad-spectrum antibiotics are prescribed to cover unidentified organisms and, as a result, antibiotic therapy may be compromised. Molecular diagnostic techniques aid with identifying causative organisms in cases of CNIE and we question if the increasing use of such technologies will change the local epidemiology of CNIE...
2016: Irish Medical Journal
Estelle Menu, Frédérique Gouriet, Jean-Paul Casalta, Hervé Tissot-Dupont, Maude Vecten, Ludivine Saby, Sandrine Hubert, Erwan Salaun, Alexis Theron, Dominique Grisoli, Cécile Lavoute, Frédéric Collart, Gilbert Habib, Didier Raoult
OBJECTIVES: Much progress has been made in understanding the main causes of blood culture-negative endocarditis (BCNE). Few studies concerning BCNE treatment (due to previous antibiotics used or fastidious pathogens) are available. We performed this study to evaluate the effectiveness of our therapeutic protocol in BCNE, based on compliance with the protocol, outcome and 1 year mortality. PATIENTS AND METHODS: We collected prospectively and analysed retrospectively cases of BCNE between 2002 and 2014, using a simplified and standardized protocol developed by our multidisciplinary team...
September 27, 2016: Journal of Antimicrobial Chemotherapy
Florian Hitzenbichler, Michaela Simon, Bernd Salzberger, Frank Hanses
PURPOSE: We retrospectively evaluated blood culture (BC) isolates of coagulase-negative staphylococci other than Staphylococcus epidermidis (NonSe-CoNS) for clinical relevance at a tertiary care hospital in Germany from January 2011 to September 2015. METHODS: Clinical data were correlated to microbiological results based on medical records. Infection was considered likely if (1) no other infection and (2) two or more isolates of the same species were present and (3) symptoms ameliorated after therapy...
September 22, 2016: Infection
Thomas L Holland, Larry M Baddour, Arnold S Bayer, Bruno Hoen, Jose M Miro, Vance G Fowler
Infective endocarditis (IE) is a rare, life-threatening disease that has long-lasting effects even among patients who survive and are cured. IE disproportionately affects those with underlying structural heart disease and is increasingly associated with health care contact, particularly in patients who have intravascular prosthetic material. In the setting of bacteraemia with a pathogenic organism, an infected vegetation may form as the end result of complex interactions between invading microorganisms and the host immune system...
2016: Nature Reviews. Disease Primers
Philip Simon Webb, Abdallah Al-Mohammad
A man aged 73 years with infective endocarditis presented with septic shock and was started on immediate antimicrobial therapy. His blood culture yielded no organism. Subsequently, he developed a severe allergic reaction to prolonged empirical vancomycin therapy. This manifested as fever, widespread maculopapular rash and severe progressive acute kidney injury ultimately requiring dialysis. In the context of eosinophilia, this was determined to be drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome...
August 29, 2016: BMJ Case Reports
Gaurav Chand, Leonid Shamban, Adam Forman, Prabhat Sinha
Streptococcus gallolyticus subspecies (subsp.) gallolyticus (formerly bovis biotype I) bacteremia has been associated with colonic adenocarcinoma. The bovis species underwent reclassification in 2003. Subtypes of gallolyticus are associated with colonic malignancy but are less frequent, resulting in less awareness. A 71-year-old male admitted with worsening lower back pain and fevers. Initial vital signs and laboratory data were within normal limits. MRI revealed lumbosacral osteomyelitis and antibiotics were initiated...
2016: Case Reports in Gastrointestinal Medicine
Ziqing Yu, Bing Fan, Hongyi Wu, Xiangfei Wang, Chenguang Li, Rende Xu, Yangang Su, Junbo Ge
BACKGROUND: Systemic embolism, especially septic embolism, is a severe complication of infective endocarditis (IE). However, concurrent embolism to the brain, coronary arteries, and spleen is very rare. Because of the risk of hemorrhage or visceral rupture, anticoagulants are recommended only if an indication is present, e.g. prosthetic valve. Antiplatelet therapy in IE is controversial, but theoretically, this therapy has the potential to prevent and treat thrombosis and embolism in IE...
August 11, 2016: BMC Infectious Diseases
Hiroshi Nakajima, Kaoru Dohi, Masaki Tanabe, Akiko Nakamura, Shinji Kanemitsu, Hideo Wada, Norikazu Yamada, Tsutomu Nobori, Hideto Shinpo, Masaaki Ito
A 76-year-old man was admitted to a community hospital due to a persistent high fever. He became afebrile after the administration of broad-spectrum antibiotics, but developed heart failure due to progressive aortic and mitral valve insufficiency and was transferred to our hospital. Although sequential blood cultures were negative, a broad-range polymerase chain reaction targeting the bacterial 16S-rRNA gene followed by the direct sequencing of whole blood revealed spa(+), mecA(-) and Panton-Valentine leukocidin (PVL)(+)...
2016: Internal Medicine
Lara García-Álvarez, María Mercedes Sanz, Mercedes Marín, MCarmen Fariñas, Miguel Montejo, Josune Goikoetxea, Raquel Rodríguez García, Arístides de Alarcón, Manuel Almela, Núria Fernández-Hidalgo, María Del Mar Alonso Socas, Miguel Ángel Goenaga, Enrique Navas, Luis Vicioso, José Antonio Oteo
Tropheryma whipplei endocarditis is an uncommon condition with very few series and <90 cases reported in the literature. The aim of the study was to analyze the epidemiological, clinical, and outcome characteristics of 17 cases of T. whipplei endocarditis recruited in our country from a multicentric cohort from 25 Spanish hospitals from the Spanish Collaboration on Endocarditis-Grupo de Apoyo al Manejo de la Endocarditis infecciosa en España.From a total of 3165 cases included in the cohort, 14.2% were diagnosed of blood culture negative endocarditis (BCNE) and 3...
June 2016: Medicine (Baltimore)
Toshio Doi, Takayuki Gyoten, Kimimasa Sakata, Saori Nagura, Akio Yamashita, Kazuaki Fukahara, Keiju Kotoh, Naoki Yoshimura
Isolated pulmonary valve endocarditis is an extremely rare clinical condition. Here, we report a case of pulmonary valve endocarditis caused by methicillin-resistant Staphylococcus aureus (MRSA). An 84-year-old man with a history of aortic regurgitation and patent foramen ovale was admitted to our hospital due to fever of unknown origin for 4 weeks' duration. MRSA was detected in his blood cultures. Transthoracic echocardiography demonstrated a mobile vegetation attached to the pulmonary valve, moderate to severe aortic regurgitation, and patent foramen ovale with left-to-right shunt...
July 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Kunal D Kotkar, Sameh M Said
Antiphospholipid syndrome is a systemic autoimmune syndrome with cardiac manifestations such as nonbacterial thrombotic endocarditis, also known as Libman-Sacks endocarditis. A 61-year-old female with history of antiphospholipid syndrome presented in acute pulmonary edema. Echocardiography demonstrated mobile vegetations on the free margins of both the anterior and the posterior mitral valve leaflets. Blood cultures and fungal serologies were negative. During mitral valve replacement both the anterior and posterior mitral leaflets were covered with multiple small vegetations with features of nonbacterial thrombotic endocarditis...
July 2016: Annals of Thoracic Surgery
Anders Dahl, Trine K Lauridsen, Magnus Arpi, Lars L Sørensen, Christian Østergaard, Peter Sogaard, Niels E Bruun
BACKGROUND: The NOVA score is a recently developed diagnostic tool used to identify patients with increased risk of infective endocarditis (IE) among patients with Enterococcus faecalis bacteremia. We aimed to validate the NOVA score and to identify risk factors for IE. METHODS: From 1 January 2010 to 31 December 2013, we included 647 consecutive patients with E. faecalis bacteremia. The NOVA score was used in a slightly adapted form; 2/2 positive blood cultures resulted in 5 points, unknown origin of infection in 4 points, prior valve disease in 2 points, and heart murmur in 1 point...
September 15, 2016: Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
J Hitzeroth, N Beckett, P Ntuli
Although infective endocarditis (IE) is relatively uncommon, it remains an important clinical entity with a high in-hospital and 1-year mortality. It is most commonly caused by viridans streptococci. Staphylococcus aureus is responsible for a malignant course of IE and often requires early surgery to eradicate. Other rarer causes are various bacilli, including the HACEK (Haemophilus, Actinobacillus,Cardiobacterium, Eikenella and Kingella spp.) group of organisms and fungi. The clinical presentation varies. Patients may present with a nonspecific illness, valve dysfunction, heart failure (HF) and symptoms due to peripheral embolisation...
February 2016: South African Medical Journal, Suid-Afrikaanse Tydskrif Vir Geneeskunde
Ahmed Khurshid Pasha, Justin Z Lee, See-Wei Low, Hem Desai, Kwan S Lee, Mayar Al Mohajer
Fungal endocarditis is an extremely debilitating disease associated with high morbidity and mortality. Candida spp. are the most common isolated organisms in fungal endocarditis. It is most prevalent in patients who are immunosuppressed and intravenous drug users. Most patients present with constitutional symptoms, which are indistinguishable from bacterial endocarditis, hence a high index of suspicion is required for pursuing diagnosis. Diagnosis of fungal endocarditis can be very challenging: most of the time, blood cultures are negative or take a long time to yield growth...
October 2016: American Journal of Medicine
Ulises Granados, David Fuster, Juan M Pericas, Jaime Llopis, Salvador Ninot, Eduard Quintana, Manel Almela, Carlos Pare, Jose M Tolosana, Carlos Falces, Asuncion Moreno, Francesca Pons, Francisco Lomeña, Jose M Miro
: Early diagnosis of infective endocarditis (IE) is based on the yielding of blood cultures and echocardiographic findings. However, they have limitations and sometimes the diagnosis is inconclusive, particularly in patients with prosthetic valves (PV) and implantable cardiac electronic devices (ICED). The primary aim of this study was to evaluate the diagnostic accuracy of (18)F-fluorodeoxyglucose positron emission tomography/computed tomography ((18)F-FDG PET/CT) in patients with suspected IE an ICED infection...
June 3, 2016: Journal of Nuclear Medicine: Official Publication, Society of Nuclear Medicine
Bilal A Zahoor
Rhizobium radiobacter, a soil-based organism, is not, usually, pathogenic unless in the immunecompromised. Endocarditis, in the immunocompromised, is a typical presentation generally as a result of catheter-based infections. We describe the presentation of R. radiobacter prosthetic valve endocarditis and the inherent challenges in its presentation and diagnosis. A patient presented with acute limb ischemia secondary to R. radiobacter-mediated endocarditis and subsequent thromboembolization of the distal superior femoral and proximal popliteal arteries in the left lower limb...
August 2016: Annals of Vascular Surgery
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