Aerococcus urinaeMitral Valve Endocarditis-Related Stroke: A Case Report and Literature Review

Abstract

Background. Aerococcus urinae is a rare causative pathogen of infective endocarditis that results in a high risk of embolic events. The mortality rate for A urinae endocarditis is high. Old age and underlying urologic conditions are the best-known risk factors for infection. Case Description. We report the clinical course of the disease in a 49-year-old man who presented symptoms of a urinary tract infection. A few days later, transthoracic echocardiography showed a conspicuous mitral valve with myxomatous alterations. Following the detection of a cerebral embolism with associated stroke symptoms, as well as at the beginning of cardiac failure, the emergency indication for the surgical treatment of mitral valve endocarditis was given. On the second day following the operation, circulatory collapse rapidly developed. Following an unsuccessful attempt at cardiopulmonary resuscitation, the patient died. Review of the Literature. From 1991 to 2017, 29 cases of A urinae–induced endocarditis have been described in PubMed and Medline. One or 2 new cases are published annually. We review all reported cases of A urinae endocarditis, with an emphasis on the predisposing factors, course, and outcomes of the disease. Conclusion. A urinae endocarditis is a rare disease primarily affecting elderly men with urinary tract pathologies and comorbidities. The course of the disease is severe, and the outcome is often fatal. A 16S rDNA polymerase chain reaction investigation of bacterial genome provides proof of the presence of A urinae. Because of the high risk of embolism, rapid treatment should focus on the diseased heart valve. Based on existing data and the experience gained from handling cases, treatment with β-lactam and aminoglycosides is recommended. It is also recommended that operative therapy take place as soon as possible.

Aerococcus urinae Endocarditis: Not So Severe After All?

“…3 The second conclusion concerns the risk of embolism in aerococcal IE, which in the report by Adomavicius et al is claimed to be high. 1 While cerebral embolization is a serious complication of IE, we do not agree with the authors that this is a common complication of aerococcal endocarditis. When all reported Swedish cases were investigated, embolism was found in only 1 case in 14 of A urinae IE cases.…”

“…We read with interest the report by Adomavicius et al, 1 describing a case of mitral valve infective endocarditis (IE) caused by Aerococcus urinae. There are 4 statements and conclusions in the article that make us concerned.…”

Prosthetic valve endocarditis caused by Aerococcus Urinae

“…The mortality is reported to be high due to a significant incidence of embolic events. Cardiogenic shock, septic emboli, stroke, renal failure and disseminated intravascular coagulation are other complications [ 17 ]. Aortic wall ulceration is also a complication of A. urinae IE [ 18 ].…”

Aerococcus Urinae Endocarditis Presenting with Bilateral Cerebellar Infarcts

“…4 Since the first two cases of serious A. urinae infection were described by Christensen and colleagues in 1991, A. urinae has been found to be the causative agent of infective endocarditis in 31 reported cases. 5 Isolates of A. urinae are generally susceptible to beta-lactam antibiotics. 6 A synergistic bactericidal effect between benzylpenicillin and gentamicin has been demonstrated in vitro.…”

“…Aminoglycoside-induced nephrotoxicity and ototoxicity are other potential concerns in the elderly and must be considered before initiating combination therapy. There is a suggestion of an unfavourable prognosis for A. urinae infective endocarditis, with estimated case fatality reported up to 50%, 2,5 possibly due to delays in identification of the bacterium and initiation of appropriate antibiotic therapy, in addition to patient-related factors such as age and pre-morbid cardiac status.…”