We report the third case of endocarditis caused by the newly described micrococcal species Kytococcus schroeteri. A 49-year-old woman was admitted to the hospital with suspected prosthetic valve endocarditis. Five blood cultures and prosthetic valve cultures grew the same type of organism, initially identified as Micrococcus sp. Assignment to the genus Kytococcus was suggested by the arginine dihydrolase activity and resistance to oxacillin. After sequencing of the 16S rRNA genes, the isolate was recognized as K. schroeteri. The patient was treated first with vancomycin combined with gentamicin and later with pristinamycin and rifampin. Three cases of K. schroeteri endocarditis described within a short period of time might indicate a specific pathogenicity of this new species. The isolation of kytococci from normally sterile sites should not be overlooked. CASE REPORTA 49-year-old woman was admitted to the hospital due to persistent fever for 1 week. She had a history of rheumatic heart disease and had undergone mitral valve replacement 10 years earlier. On admission, the patient denied any recent history of dental work, intravenous drug abuse, or diagnostic procedures. Her temperature was 38.5°C, her blood pressure 110/60 mm Hg, and her pulse 88 beats/min. A systolic murmur was heard on cardiac auscultation, and the lungs were clear by auscultation and percussion. The findings of the rest of her physical examination were unremarkable. Laboratory tests revealed the following values: hemoglobin, 120 g/liter; white blood cells, 8.4 ϫ 10 9 /liter; erythrocyte sedimentation rate, 100 mm/h; and C-reactive protein, 125 mg/liter. The liver function tests, renal function tests, and serum electrolyte levels were all normal.A transesophageal echocardiogram disclosed prosthesis disinsertion, with two voluminous and mobile vegetations involving the mitral prosthesis (sizes, 12 by 13 mm and 12 by 12 mm). Mitral valve replacement was recommended. Six sets of blood cultures were drawn. Therapy with cefotaxime and amikacin was instituted, and valve replacement surgery was performed. Five blood cultures and prosthetic valve cultures yielded gram-positive cocci. According to the antimicrobial susceptibilities of the isolates, the therapy was replaced with vancomycin-gentamicin and later with pristinamycin-vancomycin, and our patient responded well to this combination therapy. Six weeks after admission, the patient was discharged from the hospital in good condition and continued to take oral rifampin and pristinamycin for 3 weeks.Microbiology. Blood cultures were processed with a BacT/ Alert system. In five of the six blood cultures drawn on admission, growth was detected after an incubation of 72 to 94 h. Subcultures on blood agar yielded circular, convex, smooth, muddy yellow, and nonhemolytic colonies of heterogeneous size after 24 h of incubation. These colonies increased in size to about 1.5 to 2.5 mm in diameter after 48 h. A Gram stain of these colonies showed spherical cells, predominantly occurring in pairs, in tetrads, a...
The aim of this retrospective study was to compare the different anticoagulation regimens used in pregnant women with prosthetic heart valves. We reviewed 86 pregnancies in 57 women from 1987 to 2011. The patients were divided into two groups: group A (39 pregnancies) had oral acenocoumarol throughout pregnancy; and in group B (47 pregnancies), acenocoumarol was replaced by subcutaneous heparin during the first trimester. Both groups received heparin at the time of delivery. The valves replaced were mitral (59.65%), aortic (12.28%), or both (28.07%). 74 pregnancies (86.04%) resulted in live births, 9 (10.46%) had stillbirths, 1 (1.16%) had spontaneous abortion and 2 (2.32%) underwent therapeutic abortions. The live birth rate was higher in women on heparin (87.23%) compared with those on acenocoumarol (84.61%). No malformations appeared in the 74 newborns, except for one case of hydrocephalus. There was one maternal death due to acute mitral valvular thrombosis while on heparin in the first trimester. Hemorrhagic complications occurred in 13 patients in the postpartum period, 4 of whom required transfusion. No anticoagulant regimen can be said to be entirely safe for use during pregnancy as there is a degree of risk with each regimen. Heparin does not offer a clear advantage over oral anticoagulation in the pregnancy outcome.
We report on the case of a 54-year-old woman diagnosed as having culture-negative endocarditis (clinical and histopathologic evidence compatible with a recent episode of endocarditis). The responsibility of Chlamydia pneumoniae in this episode of endocarditis was suggested by a serological study and was then confirmed by the positive results of PCR and in situ hybridization tests with aortic and mitral valves tissues. To our knowledge, this is the first case of endocarditis due to C. pneumoniae confirmed by molecular biology-based techniques. CASE REPORTOn 30 April 1998, a 54-year-old woman was admitted to the Department of Cardiology, Sfax Hospital, Sfax, Tunisia, because of suspicion of infectious endocarditis. Fifteen days before admission she had noted fever and progressively increasing dyspnea. She had no significant medical history, and she did not have any cats or birds.On physical examination, her blood pressure was 110/40 mm Hg, her pulse was 72 beats/min, and her axillary temperature was 39°C. Cardiac auscultation revealed systolic mitral and diastolic aortic murmurs. In addition, the liver and spleen showed hypertrophy. The rest of the physical examination was normal.An electrocardiogram showed a diastolic hypertrophy of the left ventricle. A chest radiograph was normal. An echocardiographic examination confirmed the mitral and aortic insufficiency but did not show any vegetations. Transesophageal echocardiography revealed severe aortic and mitral valve regurgitation, a vegetation (7 by 6 mm) on the right of the aortic valve, and a vegetation (5 by 6 mm) on the mitral valve.After this examination a diagnosis of endocarditis was strongly suspected. The white blood cell count was 3.6 ϫ 10 9 / liter, the hemoglobin concentration was 7 g/100 ml, and the erythrocyte sedimentation rate was 75 mm/h (normal rate, Ͻ10 mm/h). Three pairs of aerobic and anaerobic blood specimens for culture (Hemoline; bioMerieux, Marcy l'Etoile, France) drawn before administration of penicillin and gentamicin remained negative. Blood cultures were incubated at 37°C for a total of 15 days, examined daily, and subcultured on conventional media at 5, 10, and 15 days. Serum samples obtained on admission and 2 and 4 weeks later showed negative results when tested for antibodies to the following agents: Legionella pneumophila, Mycoplasma pneumoniae, and Coxiella burnetii. However, the concentration of immunoglobulin G (IgG) antibodies to C. pneumoniae, as determined by microimmunofluorescence (MIF) assay, was higher than 1:4,096 for all three serum samples. There were also cross-reactions with antigens of Chlamydia trachomatis and Chlamydia psittaci in the three serum samples. All three serum samples were positive for IgM antibodies to C. pneumoniae by the MIF test. A specific IgG antibody response for C. pneumoniae and declining C. pneumoniae IgM titers during the observation period were detected by a commercial enzyme-linked immunosorbent assay (ELISA) with C. pneumoniae (Sero CP;
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