Cardiobacterium hominis endocarditis associated with very severe thrombocytopenia and platelet autoantibodies

Abstract

Severe thrombocytopenia is a life-threatening condition. It is often associated with immune-mediated platelet destruction or myeloablative chemotherapy. Infective endocarditis has been associated with thrombocytopenia, which, as in sepsis, tends to be mild and is often the result of several pathological mechanisms. We report a case of Cardiobacterium hominis endocarditis associated with very severe thrombocytopenia and bleeding in a patient who refused platelet transfusion. Platelet autoantibodies directed against glycoprotein (Gp) IIb/IIIa and Gp Ib/IX were detected during active infection using a glycoprotein-specific assay. Successful treatment of C. hominis endocarditis was associated with loss of platelet autoantibodies and recovery of the platelet count. This report illustrates that the development of platelet autoantibodies can contribute to very severe thrombocytopenia in occasional patients with infective endocarditis. Am.

Clinicopathologic findings and outcome in dogs with infective endocarditis: 71 cases (1992–2005)

“…In a study 29 in humans, an immunocompromised state was associated with a 2.9-times greater risk of adverse outcome in intensive care unit patients with IE, and in another study, 25 concurrent diabetes mellitus was an independent predictor of death. 39 In the present study, only 1 dog had a normal CBC; that dog had a diagnosis of possible IE, no microbial growth on culture of blood, and underlying congenital cardiac disease. 10 Leukocytosis and hypoalbuminemia were more common laboratory abnormalities in dogs with IE than in humans with IE 1 and were findings observed in nearly all dogs.…”

Aortic homograft endocarditis caused by Cardiobacterium hominis and complicated by agranulocytosis due to ceftriaxone

“…In a recent review, the mean duration of symptoms before diagnosis was found to be 145 days (range 1 week to 11 months) 7. Laboratory findings do not differ from endocarditis caused by other organisms 7 9 18. The most common physical findings are a cardiac murmur (94%), peripheral embolic lesions (51%) and splenomegaly (40%) 9.…”

“…Surgical treatment, mostly valve replacement, was needed in 45% of published cases 7. The main complications of C hominis endocarditis include congestive heart failure, peripheral embolic events, arrhythmia, mycotic aneurysm, glomerulonephritis, vertebral osteomyelitis and severe thrombocytopoenia 9 18. The clinical outcome of C hominis endocarditis is favourable, in almost 95% of reported cases the patients were cured 6–7 9.…”

Identification ofDietziaspp. from Cardiac Tissue by 16S rRNA PCR in a Patient with Culture-Negative Device-Associated Endocarditis: A Case Report and Review of the Literature

“…Since infective endocarditis is known to be associated with continuous, low grade bacteremia, one would have expected to diagnose endocarditis due to most agents known to cause subacute bacterial endocarditis (e.g., Streptococci or Enterococcus spp.). The HACEK group of organisms were previously difficult to isolate by routine blood culture methods, but with modern culture techniques these organisms are usually isolated within three to five days [20, 21]. …”