First case of Legionella pneumophila native valve endocarditis

Samuel, Vinny; Bajwa, Abubakr; Cury, James

doi:10.1016/j.ijid.2011.04.007

Cited by 15 publications

(11 citation statements)

References 5 publications

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“…All but one of the endocarditis cases occurred in patients who had received aortic homografts or prosthetic valve replacements, and in most cases, the suspected route of infection was via direct inoculation with contaminated surgical equipment. The single case of native valve endocarditis reported in the literature was due to L. pneumophila (18). In contrast, 16S rRNA PCR and sequencing of the aortic value tissue and culture isolate in our case revealed that the Legionella strain, designated H63, shared the highest similarity with L. brunensis ATCC 43878 T (98.4%), an environmental strain originally isolated from a cooling tower in Czechoslovakia and never implicated in disease (23 T (96.0%).…”

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confidence: 61%

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Native Valve Endocarditis Due to a Novel Strain of Legionella

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Legionellae are Gram-negative bacteria which are capable of causing disease, most commonly in the form of pneumonia. We describe a case of native valve endocarditis caused by a Legionella strain which by genotypic (16S rRNA and mip gene sequencing) and phenotypic analyses is unlike previously described strains of Legionella.Of the 54 validly named Legionella species, 21 have been isolated from human infections (14,24). Legionella pneumophila represents 90% of the cases, with L. longbeachae and L. bozemanae being the next most common, causing 4% and 2% of cases, respectively (25). The primary site for Legionella infection is the lung, but in rare cases, Legionella is found in extrapulmonary sites, either as a consequence of dissemination from the lung or as isolated primary infections (13). Here, we describe an unusual case of Legionella endocarditis in a native heart valve. Genotypic and phenotypic analyses indicate that the bacterial isolate is unlike previously described strains of Legionella.A 68-year-old woman with Goodpasture's syndrome who underwent living related kidney transplantation in 2004 presented to the hospital in August 2009 complaining of chest pain and dyspnea on exertion. Her history was notable for cytomegalovirus viremia in 2004 and an episode of organ rejection in 2008 requiring methylprednisolone and thymoglobulin therapy. Her maintenance immune suppression was mycophenolic acid and tacrolimus. At presentation, she reported a 1-day history of chest pain associated with nausea, diaphoresis, and anxiety. She was afebrile, with a heart rate of 100 bpm, blood pressure 113/42 mm Hg, and pulse oximetry of 96% on 2 liters of oxygen. A grade II holosystolic murmur was present. Her leukocyte count was 13,500/mm 3 (normal range, 4.1 to 10.9/ mm 3 ), creatinine level was 3.5 mg/dl (normal range, 0.4 to 1.0 mg/dl), potassium level was 5.7 meq/liter (normal range, 3.4 to 5.1 meq/liter), and troponin level was 0.2 ng/ml (normal range, Յ0.1 ng/ml). A chest radiograph demonstrated an infiltrate in the right lower lobe, which was confirmed by computed tomography (CT) scan of the chest.Due to a history of penicillin allergy, vancomycin and ciprofloxacin were initiated for suspected health care-associated pneumonia (she had been hospitalized 3 weeks earlier for "gastroenteritis"). L. pneumophila urine antigen and urine pneumococcal antigen were undetectable, and blood cultures revealed no growth. Her troponin level continued to rise and peaked at 2.18 ng/ml. A transesophageal echocardiogram showed a 1.09-cm freely mobile mass on the left coronary cusp of the aortic valve, consistent with vegetation.Vancomycin and ciprofloxacin were continued, and gentamicin was added for empirical coverage of culture-negative endocarditis. Her clinical status deteriorated, and she underwent emergency aortic valve replacement with a bovine bioprosthesis on the 6th day of hospitalization. Intraoperative findings included a trileaflet aortic valve with a large vegetation on the left coronary cusp. No aortic annulus abscess was ...

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confidence: 61%

“…A request for an autopsy was declined. (2,5,6,10,11,13,15,18,20). All but one of the endocarditis cases occurred in patients who had received aortic homografts or prosthetic valve replacements, and in most cases, the suspected route of infection was via direct inoculation with contaminated surgical equipment.…”

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confidence: 99%

Native Valve Endocarditis Due to a Novel Strain of Legionella

et al. 2011

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“…Only 16 cases have been reported from which the first is dated to 1984 [7]. In almost all cases patients had experienced valve surgery, only two other cases besides ours had native valves [8,9]. In our case the urinary und serum analyses for Legionella antigen was positive, but specific PCR for Legionella as well as was broad spectrum PCR showed repeatedly negative results.…”

Section: Discussionmentioning

confidence: 58%

“…In our case the urinary und serum analyses for Legionella antigen was positive, but specific PCR for Legionella as well as was broad spectrum PCR showed repeatedly negative results. In literature only in one patient the diagnosis was confirmed with PCR and sequencing from aortic tissue [9], in the other, Legionella pneumophila serotype 1 was detected in the urine sample and cultures on buffered charcoal-yeast extract (BCYE)-Agar using blood and bronchial fluid [8].…”

Section: Discussionmentioning

confidence: 99%

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Legionella native valve endocarditis case report and review of literature

Baumgartner¹,

Eich²,

Christen³

et al. 2016

Int Arch Med

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Legionella Pneumonia: When to Suspect, Diagnostic Considerations, and Treatment Strategies for Hospital-Based Clinicians

Eison

2014

Curr Emerg Hosp Med Rep

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Legionella species are fastidious gram-negative bacteria, ubiquitous in nature and associated with two distinct clinical syndromes: Legionnaire's disease and Pontiac fever. Legionnaires' disease is a severe multisystem disease comprised of fevers, rigors, headache, myalgias, dyspnea, delirium, and diarrhea, whereas Pontiac fever is a self-limited influenza-like illness. Either syndrome can occur during outbreaks, but typically only Legionnaires' disease and pneumonia come to the attention of the emergency room physician or hospitalist. Here we describe an illustrative case of a 70-year-old female with COPD who presented to our hospital with severe Legionnaires' disease. This article reviews the epidemiology and clinical manifestations of Legionnaires' disease and updates the latest information on diagnostic approaches and treatment strategies for hospital-based clinicians and emergency department physicians alike. Keywords Legionella Á Legionellosis Á Legionnaire's disease Á Pontiac fever Á Atypical pneumonia Á Communityacquired pneumonia Case A 70-year-old Caucasian female with a history of COPD presented with 5 days of progressive shortness of breath, fevers, and cough. She was found to have significant hypoxemia, fever to 38.9°C, leukocytosis of 22,000 [cells 9 10 9 /L] and was treated with ceftriaxone and azithromycin. Unfortunately, she deteriorated with worsening hypoxemia, hypotension, and tachycardia. She required intubation as well as norepinephrine for blood pressure support. Azithromycin was continued but ceftriaxone was discontinued in favor of vancomycin and piperacillin/tazobactam. Imaging revealed a dense right lower lobe consolidation (Figs. 1-4). Bronchoalveolar lavage cultures were unrevealing but Legionella urinary antigen returned positive. Levofloxacin was started at 750 mg once daily and the other antibiotics were discontinued. She improved steadily thereafter and made a full recovery, returning home one week later and completing 14 days of levofloxacin. She resides in the mountains on a large parcel of land and reported that she has diverted water from a nearby creek and maintains a water heater for her shower using this creek water. She also reported spending time recently in a friend's hot tub. The State health department did not find evidence of Legionella in the patient's water heater or the nearby creek. However, the hot tub in question was not included in the investigation. Legionella Legionella species are fastidious gram-negative bacteria, ubiquitous in nature as intracellular parasites within freshwater protozoa. Although isolated originally in 1943 where it was discovered residing within free-living amoebae in the soils of Poland [1], it only achieved notoriety as a pathogen in 1976 during the pneumonia epidemic at the American Legion convention in Philadelphia, PA when this gram-negative organism was isolated from the lung tissue of an autopsied victim [2]. CDC investigators later traced this organism back to another outbreak in Pontiac, Michigan in 1968 demonstrating increased L...

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First case of Legionella pneumophila native valve endocarditis

Cited by 15 publications

References 5 publications

Native Valve Endocarditis Due to a Novel Strain of Legionella

Native Valve Endocarditis Due to a Novel Strain of Legionella

Legionella native valve endocarditis case report and review of literature

Legionella Pneumonia: When to Suspect, Diagnostic Considerations, and Treatment Strategies for Hospital-Based Clinicians

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