Streptococcus agalactiaeInfective Endocarditis: Analysis of 30 Cases and Review of the Literature, 1962–1998

Abstract

We describe 30 cases (1.7%) of community-acquired penicillin-susceptible Streptococcus agalactiae endocarditis among 1771 episodes of endocarditis diagnosed in 4 Spanish hospitals from 1975 through 1998. Endocarditis affected a native valve (most often the mitral valve) in 25 cases (83%). Surgical valve replacement was performed for 12 patients (40%). Fourteen patients (47%) died. Mortality rates for patients with native and prosthetic valve endocarditis were 36% and 100%, respectively (P=.01). The mortality rate for native valve endocarditis decreased during the last 6 years of the study (from 61% in 1975-1992 to 8% in 1993-1998; P<.05). Additionally, 115 cases in the literature from 1962-1998 were reviewed. During 1980-1998, the percentage of patients who underwent cardiac surgery increased from 24% (in the previous period, 1962-1979) to 43% (P=.05) and the mortality rate decreased from 45% to 34% (P=NS). S. agalactiae is an uncommon cause of endocarditis with a high mortality rate, although the prognosis of native valve endocarditis has improved in recent years, probably because of an increased use of cardiac surgery.

Streptococcus agalactiae Native Valve Endocarditis: Uncommon Presentation of Multiple Myeloma

“…6 However, its demographic characteristics and outcome have changed over time. 5 The typical patient with Streptococcus agalactiae endocarditis in the pre-antibiotic era was a young woman with mitral disease who was pregnant or in labor (it colonizes the female genital tract, the throat and the rectum). Currently, Streptococcus agalactiae IE presents in older patients with underlying severe chronic diseases and affects left-sided valves as was the case of our patient.…”

“…10,11 Central nervous system involvement is frequent and similar to Enterococcus IE, but presents in a shorter period of time, which has been related with the lack of Streptococcus agalactiae fibrinolysin production in the vegetations. 5 This fact complicates the evolution of these patients and worsens the vital prognosis. 5,11 In general strains of Streptococcus agalactiae are slightly more resistant to penicillin than strains of other streptococcus; thus, an aminoglycoside must be added during the first two weeks of treatment, which should last four to six weeks.…”

“…Occasionally, the first manifestation of an underlying MM may be an episode of acute bacterial infection. 4 Adults with chronic immunosuppressive conditions are at an increased risk for Streptococcus agalactiae endocarditis, 5 which is characterized by acute onset, large vegetations, rapid valvular destruction and frequent complications. 6 Its clinical course is more aggressive than IE caused by other Streptococcus species 6 and the mortality rate exceeds 40%.…”

Interactions of the streptococcal C5a peptidase with human fibronectin

“…Common to both infants and adults is the occurrence of sight or hearing loss, cerebral palsy, and death [2,3,[5][6][7]. Interactions of GBS with biomaterials include infections of ventriculoperitoneal shunts [8], prosthetic heart valves [9], IV catheters [6], and artificial bone joints [7].…”

An “aubergine” in the heart: huge native mitral valve endocarditis caused by Streptococcus agalactiae

“…Streptococcus agalactiae is a very aggressive disease as demonstrated in the literature review, the overall mortality rate for SA infective endocarditis remains high, even despite the advent of cardiac surgery [5]. …”