Cardiac surgery for infective endocarditis has acceptable early postoperative results among intravenous drug users. The 2- and 5-year survival were 79 and 59%, respectively. The number of reinfections was high within 2 years, as continued drug use seems to be a major challenge for this group.

dWe present a case of infective endocarditis caused by Streptococcus dysgalactiae subsp. dysgalactiae, a major cause of bovine mastitis and previously thought to be an animal-restricted pathogen. The patient reported no direct contact with animals, and the clinical course was severe and complicated. CASE REPORTA 65-year-old male patient was admitted to Haukeland University Hospital in western Norway with radiating pain in his left shoulder, fever, and muscle ache. One month earlier, he had been admitted to a hospital in Spain with similar symptoms but was rapidly discharged with a diagnosis of shoulder tendinitis. He had a family history of sudden cardiac death, and his previous medical history included hypertrophic obstructive cardiomyopathy and a normal coronary angiography 7 years prior to the actual admission.Upon admission, he had a pulse rate of 100/min, a temperature of 39°C, and a respiratory frequency of 24/min, thus fulfilling the criteria of systemic inflammatory response syndrome (SIRS). He was pale, with a blood pressure of 118/59 mm Hg, and a holosystolic murmur was heard at the apex. No local signs of infection were observed over his left shoulder.The initial blood chemistry results were as follows, with normal range values in parentheses: hemoglobin, 8.5 g/dl (13.4 to 17.0 g/dl); C-reactive protein, 277 mg/liter (Ͻ5 mg/liter); leukocytes, 20.8 ϫ 10 9 /liter (3.5 ϫ 10 9 to 11.0 ϫ 10 9 /liter); neutrophils, 18.5 ϫ 10 9 /liter (1.7 ϫ 10 9 to 8.2 ϫ 10 9 /liter); sedimentation rate, 102 mm/h (0 to 20 mm/h); procalcitonin, 12.1 g/liter (Ͻ0.10 g/ liter); and troponin T, 896 ng/liter (Ͻ25 ng/liter). Thrombocytes were within the normal range. The electrocardiogram (ECG) demonstrated ST segment elevation in leads V 1 and V 2 and T inversion in leads V 4 to V 6 , indicative of ischemia.Antibiotic therapy was started on day 1 and included meropenem and vancomycin. A broader initial regimen than that recommended in the Norwegian National Antibiotic Guidelines was chosen since the patient had recently been admitted to a hospital in Spain. The following day, all four blood cultures grew nonhemolytic bacteria on blood agar. Species identification was performed using matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) and showed that the isolate was Streptococcus dysgalactiae. Subsequently, group C carbohydrate specificity was documented using a slide agglutination test (Oxoid, Cambridge, United Kingdom). The antimicrobial susceptibility testing showed that the group C streptococcus (GCS) isolate was fully susceptible to all tested antibiotics, with the following MICs: penicillin G, 0.008 mg/liter; ceftriaxone, Ͻ0.016 mg/liter; clindamycin, 0.25 mg/liter; vancomycin, 0.25 mg/liter; teicoplanin, 0.25 mg/liter; and linezolid, 1 mg/liter.A more thorough anamnestic interview revealed a history of weight loss of 6 kg, bloody stools, increasing pain in the left shoulder, and inaccuracy of vision. On examination, he had no peripheral vascular phenomena indicative of septic emboliz...

The incidence of IE increased significantly. Non-viridans streptococci, enterococci and S. aureus were all significantly associated with increased mortality. The increased number of enterococcal IE and the increased number of IVDUs with left-sided IE constituted new challenges. Biological implants were preferred in a majority of patients requiring surgery.

We herein describe the first novel species within the genus Eikenella since it was established in 1972 by the reclassification of ‘Bacteroides corrodens’ to Eikenella corrodens . From a polymicrobial brain abscess, we encountered an Eikenella isolate, PXXT, that could not validly be named E. corrodens . The isolate grew on blood agar with small, translucent, pitting colonies after 3 days of anaerobic incubation. By reviewing previously collected invasive isolates, we found an additional Eikenella strain, EI-02, from a blood culture exhibiting the same properties as PXXT. Phylogenetic analyses based on both whole genome and individual house-keeping genes confirmed that the two strains allocate in a phylogenetic cluster separate from E. corrodens . Using specific amplification and sequencing of the Eikenella nusG gene, we further detected the novel Eikenella species in six historic brain abscesses previously reported to contain E. corrodens based on 16S metagenomics. Out of 24 Eikenella whole-genome projects available in GenBank, eight cluster together with PXXT and EI-02. These isolates were recovered from brain abscess (n=2), blood (n=1), bone/soft tissue (n=3), parotid gland (n=1) and unknown (n=1). It remains to be investigated whether the new species can cause endocarditis. The average nucleotide identity value between strain PXXT and the E. corrodens type strain ATCC 23834T was 92.1 % and the corresponding genome-to-genome distance value was 47.1 %, both supporting the classification of PXXT as a novel species. For this species we propose the name Eikenella exigua. The type strain of E. exigua is PXXT (DSM 109756T, NCTC 14318T).

No abstract

COVID-19 infection primarily causes severe pneumonia complicated by acute respiratory distress syndrome and multiorgan failure requiring a ventilator support. We present a case of a 55-year-old male, admitted with COVID-19. He was obese but had no other medical conditions. His blood pressure was measured by his general physician on several occasions in the past, all values being normal (<140/90 mmHg). He developed multiorgan failure, requiring vasopressor and ventilator support for 17 days. A prone positioning improved the arterial oxygenation, and reduced the need for supplemental oxygen. After recovery, he showed persistently elevated blood pressure and sinus tachycardia both in clinic and out-of-clinic. The activation of the renin–angiotensin–aldosterone and sympathetic systems, volume-overload, hyperreninemia and cytokine storm might have contributed to the exaggerated cardiovascular response.

Background Oral streptococci represent the causing microorganism for infective endocarditis (IE) in many patients. The impact of oral infections is questioned, and it has been suggested that bacteraemia due to daily routines may play a bigger part in the aetiology of IE. The aim of this study was to examine the association between oral health and infective endocarditis caused by oral bacteria in comparison with bacteria of other origin than the oral cavity. Methods A retrospective study was conducted at Haukeland University Hospital from 2006- 2015. All consecutive adult patients admitted to hospital for treatment of IE and subjected to an oral focus screening including orthopantomogram, were included. The clinical, radiological and laboratory characteristics of the patients, collected during oral infectious focus screening, were analysed. Patient survival was calculated using Kaplan–Meier and mortality rates were compared using Cox-regression. Results A total of 208 patients were included, 77% (n = 161) male patients and 23% (n = 47) female, mean age was 58 years. A total of 67 (32%) had IE caused by viridans streptococci. No statistically significant correlation could be found between signs of oral infection and IE caused by viridans streptococci. The overall mortality at 30 days was 4.3% (95% CI: 1.6–7.0). There was no statistical difference in mortality between IE caused by viridans streptococci or S. aureus (HRR = 1.16, 95% CI: 0.57–2.37, p = 0.680). Conclusion The study indicates that the association between origin of the IE causing bacteria and findings during oral infection screening might be uncertain and may suggest that the benefit of screening and elimination of oral infections in patients admitted with IE might be overestimated. However, the results should be interpreted with caution and further studies are needed before any definite conclusions can be drawn.

To cite this article: Kristoffersen AH, Bj anes TK, Jordal S, Leh S, Leh F, Svarstad E. Polyvinylpyrrolidone induced artefactual prolongation of activated partial thromboplastin times in intravenous drug users with renal failure. J Thromb Haemost 2016; 14: 936-9. EssentialsProlonged activated partial thromboplastin times (APTT) were found in drug users with renal failure. An oral methadone solution containing polyvinylpyrrolidone (PVP) had been injected intravenously. Spiking normal plasma with increasing concentrations of PVP resulted in artifically prolonged APTT. APTT prolongation may indicate PVP deposits as underlying cause in patients with renal failure.Summary. Unexpectedly prolonged activated partial thromboplastin times (APTTs) were noted in several patients with chronic renal insufficiency and a history of intravenous drug abuse. Deposits of polyvinylpyrrolidone (PVP), an excipient in one oral methadone solution used in opioid maintenance programs, were found in renal biopsies. One case is described in detail, and this is followed by a summary of findings in 11 other patients and the results of an in vitro experiment in which plasma was spiked with PVP at increasing concentrations. APTTs measured with STA PTT automate (Stago) were prolonged in all patients and in spiked samples, whereas supplemental coagulation parameters and APTTs measured with HemosIL SynthAsil or Actin FSL (Siemens) were within reference intervals. These results indicate that interference with APTTs by PVP is reagent-dependent.We suggest that a prolonged APTT should raise the suspicion of PVP deposit-associated kidney disease in patients with chronic renal failure and a history of intravenous drug abuse.