Community-acquired multidrug-resistant pneumonia,bacteraemia,and infective endocarditis:A case report

BACKGROUND The prevalence of multidrug-resistant(MDR)bacteria has increased globally,with extensive drug-resistant(XDR)bacteria posing a threat to patients.CASE SUMMARY This case report describes a young man admitted for suspected tropical fever infections who experienced rapid deterioration in health.Despite negative results for tropical fever infections,he had neutrophilic leucocytosis,acute kidney injury,and chest imaging findings suggestive of bilateral consolidations.On day two,he was diagnosed with infective endocarditis with possible rheumatic heart disease and MDR methicillin-resistant Staphylococcus aureus bacteraemia,and communityacquired pneumonia.Despite treatment with broad-spectrum antibiotics,he did not respond and succumbed to death on day five.CONCLUSION This case highlights that clinicians/public should be aware of MDR communityacquired pneumonia,bacteraemia,and endocarditis which ultimately culminate in high rates of morbidity and mortality.Early identification of pathogenic strain and prompt antibiotic treatment are a mainstay for the management and prevention of early fatalities.Simultaneously,route cause analysis of communityacquired MDR/XDR pathogens is a global need.

Valve repair after infective endocarditis secondary to perforation caused by Streptococcus gordonii:A case report

BACKGROUND We report a case of infective endocarditis(IE)in a patient with congenital heart valve lesions accompanied by IE,which was diagnosed based on blood culture analysis that revealed the presence of a gram-negative bacterium,Streptococcus gordonii.CASE SUMMARY The patient had a history of precordial valve disease diagnosed by cardiac ultrasound,as well as a 4-mo history of fever.He was subjected to comprehensive anti-infection and anti-heart failure treatment in the internal medicine department.Further examination revealed sudden dislodgement from and perforation through the aortic valve by the superfluous organisms,as well as occurrence of bacterial emboli dislodgement,which caused bacteremia and infectious shock.He recovered and was discharged from the hospital after surgical and postoperative anti-infection treatments.CONCLUSION We review the treatment process and highlight inspirations and reflections from this case;suggest possible future changes in treatment modalities.

Clinical outcomes in patients with native valve infective endocarditis and diabetes mellitus

BACKGROUND There is a lack of data on the clinical outcomes in patients with native valve infective endocarditis(NVIE)and diabetes mellitus(DM).AIM To investigate(1)trends in the prevalence of DM among patients with NVIE;and(2)the impact of DM on NVIE outcomes.METHODS We identified 76385 with NVIE from the 2004 to 2014 National Inpatient Sample,of which 22284(28%)had DM.We assessed trends in DM from 2004 to 2014 using the Cochrane Armitage test.We compared baseline comorbidities,microorganisms,and in-patients procedures between those with vs without DM.Propensity match analysis and multivariate logistic regression were used to investigate study outcomes in in-hospital mortality,stroke,acute heart failure,cardiogenic shock,septic shock,and atrioventricular block.RESULTS Crude rates of DM increased from in 22%in 2004 to 30%in 2014.There were significant differences in demographics,comorbidities and NVIE risk factors between the two groups.Staphylococcus aureus was the most common organism identified with higher rates in patients with DM(33.1%vs 35.6%;P<0.0001).After propensity matching,in-hospital mortality(11.1%vs 11.9%;P<0.0001),stroke(2.3%vs 3.0%;P<0.0001),acute heart failure(4.6%vs 6.5%;P=0.001),cardiogenic shock(1.5%vs 1.9%;P<0.0001),septic shock(7.2%vs 9.6%;P<0.0001),and atrioventricular block(1.5%vs 2.4%;P<0.0001),were significantly higher in patients with DM.Independent predictors of mortality in NVIE patients with DM include hemodialysis,congestive heart failure,atrial fibrillation,staphylococcus aureus,and older age.CONCLUSION There is an increasing prevalence of DM in NVIE and it is associated with poorer outcomes.Further studies are crucial to identify the clinical,and sociodemographic contributors to this trend and develop strategies to mitigate its attendant risk.

Infective endocarditis and thoracic aortic disease: A review on forgotten psychological aspects

AIM To summarize the current evidence on psychological issues in thoracic aortic disease(TAD) and infective endocarditis(IE) setting. METHODS We performed a narrative review about psychological issues in adults with IE and TAD. Through the electronic databases, Pub Med and Psyc INFO, we searched full manuscripts in English and published until September 1, 2014. RESULTS We found sixteen studies exploring psychological issues in patients with IE(six studies) and in TAD(ten papers). Psychological issues assessed were quality of life, depression, anxiety and posttraumatic stress disorder. Quality of life was explored in IE(four papers) and in TAD(eight papers). Depression and anxiety were analyzed in TAD only(five papers). Post-traumatic stress disorder was assessed in IE(one study). Quality of life was found impaired in three of four studies about IE and in three of eight studies about TAD. Posttraumatic stress disorder was present in 11% and was associated with lower levels of quality of life in IE patients. In TAD patients, anxiety and depression levels after different invasive interventions did not differ. CONCLUSION Sixteen studies report about psychological issues in IE and TAD. Most of them explore quality of life and to a less extent anxiety and depression.

Acquired aortocameral fistula occurring late after infective endocarditis: An emblematic case and review of 38 reported cases

AIM To delineate the features and current therapeutic option of congenital and acquired aortocameral fistulas(ACF) secondary to iatrogenic or infectious disorders.METHODS From a Pub Med search using the term "aortocameral fistula", 30 suitable papers for the current review were retrieved. Reviews, case series and case reports published in English were considered. Abstracts and reports from scientific meetings were not included. A total of 38 reviewed subjects were collected and analyzed. In addition, another case- an adult male who presented with ACF between commissures of the right and noncoronary sinuses and right atrium as a late complication of Staphylococcus aureus infective endocarditis of the AV- is added, the world literature is briefly reviewed.RESULTS A total of thirty-eight subjects producing 39 fistulas were reviewed, analyzed and stratified into either congenital(47%) or acquired(53%) according to their etiology. Of all subjects, 11% were asymptomatic and 89% were symptomatic with dyspnea(21 ×) as the most common presentation. Diagnosis was established by a multidiagnostic approach in 23(60%), single method in 14(37%)(echocardiography in 12 and catheterization in 2), and at autopsy in 2(3%) of the subjects. Treatment options included percutaneous transcatheter closure in 12(30%) with the deployment of the Amplatzer duct or septal occluder and Gianturco coil and surgical correction in 24(63%). CONCLUSION Acquired ACF is an infrequent entity which may occur late after an episode of endocarditis of the native AV. The management of ACF is generally by surgical correction but non-surgical device intervention has recently been introduced as a safe alternative.

Analysis of sleep characteristics and clinical outcomes of 139 adult patients with infective endocarditis after surgery

BACKGROUND Little is known about the postoperative sleep quality of infective endocarditis patients during hospitalization and after discharge.AIM To investigate the sleep characteristics of infective endocarditis patients and to identify potential risk factors for disturbed sleep quality after surgery.METHODS The Pittsburgh Sleep Quality Index(PSQI)and the Epworth Sleepiness Scale were used to assess patient sleep quality.Logistic regression was used to explore the potential risk factors.RESULTS The study population(n=139)had an average age of 43.40±14.56 years,and 67.6%were men(n=94).Disturbed sleep quality was observed in 86 patients(61.9%)during hospitalization and remained in 46 patients(33.1%)at 6 mo after surgery.However,both PSQI and Epworth Sleepiness Scale scores showed significant improvements at 6 mo(P<0.001 and P=0.001,respectively).Multivariable logistic regression analysis showed that the potential risk factors were age(odds ratio=1.125,95%confidence interval:1.068-1.186)and PSQI assessed during hospitalization(odds ratio=1.759,95%confidence interval:1.436-2.155).The same analysis in patients with PSQI≥8 during hospitalization suggested that not using sleep medication(odds ratio=15.893,95%confidence interval:2.385-105.889)may be another risk factor.CONCLUSION The incidence of disturbed sleep after infective endocarditis surgery is high.However,the situation improves significantly over time.Age and early postoperative high PSQI score are risk factors for disturbed sleep quality at 6 mo after surgery.

Effect of Ilizarov external fixation combined with negative pressure sealing drainage and antibiotics in the treatment of infective tibial nonunion

Objective:Observation on the effect of Ilizarov external fixation combined with vacuum pressure sealing drainage and antibiotics in the treatment of infective tibial nonunion.Methods:79 patients with tibial infective nonunion who were treated in our hospital from August 2016 to August 2018 were divided into two groups according to random number table,with 39 patients in the control group treated with Ilizarov external fixation technology and 40 patients in the study group treated with vacuum pressure sealing drainage and antibiotics on the basis of the control group.Bone healing time and daily walking were recorded.Rasmussen score,serum intercellular adhesion molecule-1(ICAM-1)and IL-6 levels,lower limb Fugl-Meyer motor function score and lower limb BI index score were compared at different time.Results:The daily walking condition of the study group was significantly better than that of the control group(P<0.05),and the healing time of bone was significantly shorter than that of the control group(P<0.05);the Rasmussen score of the study group was higher than that of the control group at 1 month,6 months and 12 months after treatment(P<0.05);the levels of serum ICAM-1 and IL-6 in the two groups after treatment were lower than those before treatment(P<0.05),and the levels of serum ICAM-1 and IL-6 in the study group were lower than those in the control group after treatment(P<0.05).The lower limb Fugl-Meyer motor function score and lower limb BI index score of the two groups after treatment were higher than those before treatment(P<0.05),and the lower limb Fugl-Meyer motor function score and lower limb BI index score of the study group after treatment were higher than those of the control group(P<0.05).Conclusions:Ilizarov external fixation combined with vacuum pressure sealing drainage and antibiotics can promote the bone healing of patients with infective tibial nonunion,significantly improving their daily walking condition,alleviating inflammation,and recovering the knee joint function and lower limb function well.

Aorto-right atrial fistula: Late complication of tricuspid valve infective endocarditis

Abnormal connections between the ascending aortaand the cardiac chambers are rare, especially in thecontext of right-sided infective endocarditis(IE). Trans-thoracic echocardiography(TTE) with color-flow Dop-pler, transesophageal echocardiography(TEE), or bothmay be required for diagnosis. We present the case ofa woman admitted with right-sided heart failure(HF)symptoms. She had a previous history of tricuspid valveIE 30 years ago. TTE and TEE revealed an aorto-rightatrium fistula located just under the non-coronary cuspinto the right atrium at the level of the previously af-fected tricuspid valve. The Patient refused surgery andwas discharged home on HF medications. She has beenstable for the last 3 years. The peculiarity of this caseis the late symptomatic presentation of the aorto-atrialfistula and the unusual association to tricuspid valve IE.

Gram-negative bacteria causing infective endocarditis: Rare cardiac complication after liver transplantation

Bacterial endocarditis is a rare complication amongst solid organ transplant recipients and is often linked to bacteremia. Majority of these recipients do not have underlying valvular heart disease or congenital valvular abnormalities. Staphylococoocusaureus and Enterococcus species are the most commonly isolated organisms. There are very few reports of gram-negative bacteria causing endocarditis in liver transplant recipients. We report a 51-yearold male, a liver transplant recipient, who developed bacterial endocarditis of the mitral valve due to extended spectrum of betalactamase producing strain of Escherichia coli and was managed successfully with antibiotics.

A Rare Case of Infective Mediastinitis after Melody Valve Implantation

Pulmonary valve implant is frequently necessary in children and adults with congenital heart disease.Infective endocarditis represents a rare but life-threatening complication after transcatheter pulmonary valve implantation.There are various treatments for native or prosthetic valve endocarditis.Surgical intervention,combined with intravenous antibiotic treatment,is of paramount importance,in case of concomitant mediastinal infection,in order to ensure the radical debridement of all infected tissue,avoiding any recurrent endocarditis.In this report,we describe a rare case of mediastinitis,associated with an infected endocarditis,occurring 8 months after Melody(Medtronic
,Minneapolis,USA)valve implant,successfully treated with the implantation of a homograft to reconstruct the right ventricular outflow tract.

Leclercia adecarboxylata infective endocarditis in a man with mitral stenosis:A case report and review of the literature

BACKGROUND Infective endocarditis(IE) is a rare disease with a high mortality rate.Leclercia adecarboxylata(L.adecarboxylata) is a movable Gram-negative bacillus of enterobacteriaceae,and it can rarely be a pathogen which often affects immunodeficient patients.There are about three cases of immunocompetent patients with monomicrobial L.adecarboxylata infection.There are only three reported cases of IE caused by L.adecarboxylata in the world.The mitral valve is often affected in IE,and the prognosis for IE with mitral valve lesions is often poor.CASE SUMMARY A 51-year-old man was found to have moderate to severe mitral stenosis on echocardiography.He came to our Cardiothoracic Surgery Department for surgical management.A diastolic murmur was heard on auscultation of the heart in the mitral region.On the second day of hospitalisation,he presented with slurred speech,reduced muscle strength in the left limb,and acute cerebral infarction on cranial computed tomography.Surgical treatment was decided to postpone.On the ninth day of admission,the patient developed a sudden high fever and shock and was transferred to the Cardiac Intensive Care Unit,where echocardiogram revealed an anterior mitral valve leaflet vegetation.After empirical anti-infective treatment with vancomycin(1g q12h),an emergency valve replacement was performed.Bacterial culture identified L.adecarboxylata.Antiinfective treatment with piperacillin-tazobactam(4.5g q8h) was added for 4 wk.Follow-up echocardiography showed normal bioprosthetic valve function after mitral valve replacement.CONCLUSION We report the first case of L.adecarboxylata IE in China,and clinicians should pay attention to this pathogen.

Immediate and Long-Term Results of Transcatheter Closure of Patent Ductus Arteriosus—Comparison of Two Decades before and after Change in Antibiotic Infective Endocarditis Prophylaxis Guidelines

Objectives:To determine immediate and long-term follow-up of transcatheter closure of patent ductus arteriosus(PDA)in children.Background:National antibiotic prophylaxis(AP)guideline for infective endocarditis changed after 2009,the effect on practice of PDA closure is unknown.Methods:Observational single center study analyzing follow-up of PDA closure comparing two time periods before(2002–2009)and after(2010–2019)changes in AP guideline.Results:332 patients(68.1%female),median(interquartile range)age 3.0 years(1.5–5.7)and body weight 14.0 kg(10.0–19.3),were enrolled.PDA morphology was conical type A(50.3%),window type B(1.2%),tubular type C(40.1%),complex type D(2.1%),elongated type E(0.9%)and other(5.4%).Minimal PDA diameter and length were 1.9 mm(1.3–2.5)and 8.0 mm(6.2–10.2).PDA was closed using coils(56.3%),Amplatzer Duct Occluders(41.9%)and others(1.8%).Complete closure rate was 61.1%at catheter intervention,72.3%on day 1,87.7%after 6 months and 98.4%at last follow-up on echocardiography.Moderate complication rate(severity level 3)was 4.2%and major complication rate(severity level 4)0.3%,with no catastrophic complications(severity level 5).Annual PDA closure rate declined in the second time period(22.6/year vs.15.5/year,p=0.018),PDA size increased(1.6 mm vs.2.0 mm,p=0.002)and proportion of coils decreased(72.4%vs.37.1%,p<0.001).Conclusions:Interventional closure of PDA is associated with excellent closure rates during follow-up(>98%)and only a small number of complications leading to reintervention or surgery.Change in AP guidelines changed indication for and practice of PDA closure.

Neocuspidization of the Pulmonary Valve with Autologous Pericardium in the Adult Patient with Ventricular Septal Defect and Infective Endocarditis: A Case Report and Review of the Literature

Congenital heart disease (CHD) is one of the risk factors for developing infective endocarditis (IE). Right-sided IEoccurs in 5%–10% of endocarditis cases, and pulmonary valve (PV) is involved in less than 2% of such patients.Literature data are few, and optimal treatment methods, indications for surgery, and types of operative techniquesare still under debate. We present an adult patient with a rare combination of the ventricular septal defect (VSD)and PV IE who underwent surgical treatment. Neocuspidization with autologous pericardium was utilized for thereconstruction of his PV. We discuss details of this novel surgical technique.

Infective bicuspid aortic valve endocarditis causing acute severe regurgitation and heart failure:A case report

BACKGROUND Infective endocarditis(IE)is an uncommon but potentially life-threatening infection,which occasionally develops into acute severe valve insufficiency leading to the onset of heart failure,and necessitates timely intervention.However,the variable and atypical clinical manifestations always make the early detection of IE difficult and challenging.CASE SUMMARY A 45-year-old female who was previously healthy presented with exertional shortness of breath and paroxysmal nocturnal dyspnea.She also suffered from a significant decrease in exercise capacity,whereas her body temperature was normal.She had severe hypoxemia and hypotension along with a marked aortic valve murmur.Diffuse pulmonary edema and bilateral pleural effusion were observed on both chest X-ray and computed tomography scan.Transthoracic echocardiography was performed immediately and revealed severe regurgitation of the bicuspid aortic valve.Transesophageal echocardiography was further performed and vegetations were detected.In addition to adequate medical therapy and ventilation support,the patient underwent urgent and successful aortic valve replacement.Her symptoms were significantly relieved and the postoperative chest X-ray showed that pulmonary edema was significantly reduced.Histopathology of the resected valve and positive microorganism culture of the surgical specimen provided evidence of definite IE.CONCLUSION IE should be considered in critical patients with refractory heart failure caused by severe bicuspid aortic valve regurgitation.

Optimal Control of an HIV/AIDS Epidemic Model with Infective Immigration and Behavioral Change

In order to find out the effect of human (sexual) behavior change and immigration in spreading the HIV/AIDS, a deterministic model of HIV/AIDS with infective immigration is formulated. First, basic properties of the model, including non-negativity and boundedness of the solutions, existence of the endemic equilibrium and the basic reproduction number, R0 are analyzed. The geometrical approach is used to obtain the global asymptotic stability of endemic equilibrium. Then the basic model is extended to include several control efforts aimed at reducing infection and changing behavior. Pontryagin’s maximum principle is used to derive the optimality system and solve the system numerically. Our numerical findings are illustrated through simulations using MATLAB, which shows reliability of our model from the practical point of view.

Staphylococcus aureus bacteremia and infective endocarditis in a patient with epidermolytic hyperkeratosis:A case report

BACKGROUND Staphylococcus aureus bacteraemia(SAB)is among the leading causes of bacteraemia and infectious endocarditis.The frequency of infectious endocarditis(IE)among SAB patients ranges from 5%to 10%-12%.In adults,the characteristics of epidermolytic hyperkeratosis(EHK)include hyperkeratosis,erosions,and blisters.Patients with inflammatory skin diseases and some diseases involving the epidermis tend to exhibit a disturbed skin barrier and tend to have poor cellmediated immunity.CASE SUMMARY We describe a case of SAB and infective endocarditis in a 43-year-old male who presented with fever of unknown origin and skin diseases.After genetic tests,the skin disease was diagnosed as EHK.CONCLUSION A breached skin barrier secondary to EHK,coupled with inadequate sanitation,likely provided the opportunity for bacterial seeding,leading to IE and deepseated abscess or organ abscess.EHK may be associated with skin infection and multiple risk factors for extracutaneous infections.Patients with EHK should be treated early to minimize their consequences.If patients with EHK present with prolonged fever of unknown origin,IE and organ abscesses should be ruled out,including metastatic spreads.

Expanding utility of cardiac computed tomography in infective endocarditis: A contemporary review

There is increasing evidence on the utility of cardiac computed tomography(CCT)in infective endocarditis(IE)to investigate the valvular pathology,the extracardiac manifestations of IE and pre-operative planning.CCT can assist in the diagnosis of perivalvular complications,such as pseudoaneurysms and abscesses,and can help identify embolic events to the lungs or systemic vasculature.CCT has also been shown to be beneficial in the pre-operative planning of patients by delineating the coronary artery anatomy and the major cardiovascular structures in relation to the sternum.Finally,hybrid nuclear/computed tomography techniques have been shown to increase the diagnostic accuracy in prosthetic valve endocarditis.This manuscript aims to provide a contemporary update of the existing evidence base for the use of CCT in IE.

Do Cytokines Play a Role in Predicting Some Features and Outcome in Infective Endocarditis?

Objective: This study aimed to measure the serum concentrations of several cytokines in patients with infective endocarditis (IE), and correlate them with the C-reactive protein serum levels, echocardiographic findings and infecting microorganisms. Methods: Forty-five patients with definite IE according to the Duke’s criteria were included in the study. Ten healthy blood donors formed the control group. Serum levels of interleukin (IL) 1β, IL-6, IL-8, IL-10, IL-12 and tumor necrosis factor-α (TNF-α) were measured and compared between the groups, and also with some clinical and laboratory parameters of IE. Results: Patients with IE had significantly higher serum concentrations of the inflammatory mediators than the control patients. Median IL-12 and IL-1β levels were higher in staphylococcal than streptococcal IE. Except for TNF-α, the levels of all the other cytokines correlated with the C-reactive protein concentrations. In multivariate analysis, IL-10 and IL-12 serum levels remained as independent factors associated with the C-reactive protein concentrations. There was a significant correlation between IL-10 concentration and vegetation length. Conclusion: The inflammatory serum cytokines levels were elevated in IE in comparison to healthy controls. C-reactive protein concentrations correlated with cytokines levels. IL-1β and IL-12 serum concentrations were higher in staphylococcal when compared to streptococcal IE. IL-10 levels were associated with vegetation size.

Clinical Spectrum of Infective Endocarditis in a Tertiary Care Centre in Western India: A Prospective Study

OBJECTIVES: We examined the microbiological spectrum, clinical profile, echocardiographic features and in-hospital outcomes of patients with definitive IE. METHODS: A total of 75 consecutive cases of definitive infective endocarditis (IE), admitted between January 2011 and January 2013, were included in the study. This was a prospective study enrolling all the consecutive definitive cases of IE admitted at U. N. Mehta Institute of Cardiology and Research Centre (UNMICRC), Ahmedabad, India. Only the patients who met the modified Duke’s definitive criteria for IE were included in the study. We compared enrolled patients clinicoepidemiologic features and outcomes to subjects in the west. RESULTS: The mean age was 27.46 ± 17.11 years with a male preponderance (2.26:1). The rheumatic heart disease (41.3%) was the commonest underlying disease followed by coronary heart disease (34.7%). The blood culture was positive in 40% of episodes with commonest organisms being staphylococci (16%) and streptococci (12%). Complications were cardiovascular in 40 (53.3%) cases (congestive heart failure in 42.7%, atrioventricular block in 6.7%), septic shock in 20 (26.7%), neurological in 23 (30.7%) (cerebrovascular stroke in 20%, central nervous system hemorrhage in 5.3%, encephalopathy in 5.3%) and renal failure in 20 (26.7%) of cases respectively. Only 12 (16%) patients underwent surgery for IE. The total in hospital mortality rate was 22 (29.3%). On multivariate analysis, congestive heart failure, renal failure, neurological abnormalities, age 20 years and septic shock were independent predictors of mortality. CONCLUSIONS: The spectrum of infective endocarditis is different in Indian population compared to the west and carries a substantial morbidity and mortality. The rheumatic heart disease is still the commonest underlying heart disease in our population. The culture positivity rates and surgery for infective endocarditis are unacceptably low. Early cardiac surgery may help to improve the outcomes of these patients.

Effects of cefixime on the systemic inflammatory stress response and intestinal mucosal barrier injury in children with infective enteritis

Objective:To investigate the effects of cefixime on the systemic inflammatory stress response and intestinal mucosal barrier injury in children with infective enteritis.Methods:A total of 80 children with infective enteritis who were treated in the hospital between March 2016 and August 2017 were divided into group A (n=40) and group B (n=40) according to the random number table method. Group A received cefaclor anti-infective therapy, group B received cefixime therapy, and both therapies lasted for 1 week. The differences in serum levels of inflammatory mediators, oxidative stress indexes and intestinal mucosal injury markers were compared between the two groups before and after treatment.Results: Before treatment, the differences in serum levels of inflammatory mediators, oxidative stress indexes and intestinal mucosal injury markers were not statistically significant. After 1 week of treatment, serum inflammatory mediators IL-8 and TNF-α levels of group B were lower than those of group A whereas IL-10 level was higher than that of group A;serum oxidative stress indexes ROS and MDA levels were lower than those of group A whereas GSH-Px and CAT levels were higher than those of group A;serum intestinal mucosal injury markers DAO, D-Lactate, FABP and GST levels were lower than those of group A.Conclusion: Cefixime anti-infective therapy can effectively inhibit the inflammatory stress response and reduce the intestinal mucosal barrier injury in children with infective enteritis.