Endocarditis Due to Rare and Fastidious Bacteria

Abstract

The etiologic diagnosis of infective endocarditis is easily made in the presence of continuous bacteremia with gram-positive cocci. However, the blood culture may contain a bacterium rarely associated with endocarditis, such as Lactobacillus spp., Klebsiella spp., or nontoxigenic Corynebacterium, Salmonella, Gemella, Campylobacter, Aeromonas, Yersinia, Nocardia, Pasteurella, Listeria, or Erysipelothrix spp., that requires further investigation to establish the relationship with endocarditis, or the blood culture may be uninformative despite a supportive clinical evaluation. In the latter case, the etiologic agents are either fastidious extracellular or intracellular bacteria. Fastidious extracellular bacteria such as Abiotrophia, HACEK group bacteria, Clostridium, Brucella, Legionella, Mycobacterium, and Bartonella spp. need supplemented media, prolonged incubation time, and special culture conditions. Intracellular bacteria such as Coxiella burnetii cannot be isolated routinely. The two most prevalent etiologic agents of culture-negative endocarditis are C. burnetti and Bartonella spp. Their diagnosis is usually carried out serologically. A systemic pathologic examination of excised heart valves including periodic acid-Schiff (PAS) staining and molecular methods has allowed the identification of Whipple's bacillus endocarditis. Pathologic examination of the valve using special staining, such as Warthin-Starry, Gimenez, and PAS, and broad-spectrum PCR should be performed systematically when no etiologic diagnosis is evident through routine laboratory evaluation

Native valve endocarditis and femoral embolism due to Granulicatella adiacens: a rare case report

“…In spite of in vitro susceptibility, treatment failure is observed in about 41% of cases, and nearly 27% require surgical intervention due to congestive cardiac failure and major systemic emboli. 4 Life-threatening complications like recurrent infectious intracranial aneurysm with intracerebral hemorrhage as a sole presentation in silent IE in a young patient with no risk factors was also noted. This patient recovered completely only after mitral valvuloplasty.…”

“…Granulicatella spp along with Abiotrophia comprise up to 6% of all streptococcal endocarditis. 4,6 Several reports of NVS endocarditis have appeared in literature, but the recent nomenclature of Granulicatella new genus in 2000 has made this new emerging fastidious bacteria of interest in terms of pathogenesis and management.…”

“…are commonly found in the oral cavity, genitourinary and intestinal tract accounting for up to 6% of all streptococcal endocarditis along with Abiotrophia. 4 We report the first Indian case of native valve endocarditis with femoral embolism in an elderly patient without any underlying cardiac abnormalities along with brief a review of prevalence, risk factors, management and outcome of IE due to Granulicatella spp.…”

Infective Endocarditis, Heart and Beyond

“…The most commonly found bacteria are Streptococcus species including sanguis, gordonii, agalactiae, pneumoniae, oralis, mitis, beta-hemolytic group G, Staphylococcus aureus/epidermidis and diptheroids [3]. Hemophilus, Actinobacillus, Cardiobacterium, Eikenella, Kingella (HACEK) [4], Coxiella burnetii, Chlamydia, Propionibacterium acnes, Mycobacteria, Bartonella henselae, Ehrlichia chaffeensis, Tropheryma whippelii [5] along with fungi Candida, Aspergillus and Histoplasma are the rarely isolated organisms.…”

Native and Prosthetic Aortic Valve Endocarditis

“…Streptomycin may remain active in such cases and is a useful alternative. An additional recently described (Gavalda et al, 2007) Brouqui & Raoult, 2001) www.intechopen.com interpret. Some HACEK group bacilli produce b-lactamases, and ampicillin is therefore no longer the first-line option.…”