Lactobacillus-paracasei-Endokarditis bei einer 18-jährigen Patientin mit Trisomie 21, atrioventrikulärem Septumdefekt und Eisenmengerreaktion - therapeutische Probleme

Abstract

Endocarditis caused by lactobacilli is very rare and so far has been rarely published in adults with cardiac valve diseases especially after dental manipulations. Because of diagnostic and therapeutical problems we hereby report on one case of a female adolescent with Down's syndrome who did not undergo surgical correction of atrioventricular septal defect because of early development of Eisenmenger's syndrome. The onset was subacut and the diagnostic procedures were considerably delayed. Risk factors for the development of endocarditis in this case were preceding antibiotic treatments which increased the risk of selective growth of the causative germs as well as the tricuspidal valve incompetence with simultaneous pulmonary hypertension. The antimicrobial treatment was difficult due to resistance to antibiotic drugs generally applied in such cases and the restricted bacteriological diagnostic methods. Finally we had successfully administered chloramphenicol. The course was complicated by cerebral embolic events. FACIT: Lactobacillus species are facultative pathogenic which should be consideration in cases of subacute endocarditis in children and adolescents with ventricular septal defects and valve diseases. The determination of minimal bactericidal concentration of antibiotic agents and time-kill studies of combined antibiotics are recommended. For initial therapy we recommend high dose penicillin combined with an aminoglycoside. In cases of resistance chloramphenicol should be taken into account as second choice antibiotic drug. The duration of antibiotic therapy should at least over six weeks. In cases of risk systemic embolization is suspected therapy with low dose acetylsalicyclic acid or cardiosurgery should be assumed as therapeutic options.

Assessment of Aging Individuals with Down Syndrome in Clinical Trials: Results of Baseline Measures

“…We found that BPT appears to be reliable and useful across a wide range of intellectual disability levels in this population. Much like the Severe Impairment Battery (Schmidt, Wolter, Lenschow, & Kienast, 2001; Tariot et al., 2004), BPT has proven useful in adults with moderate AD. This nonverbal instrument appears to be sensitive to change over time and to have minimal floor and ceiling effects in the selected cohort of aging individuals with DS.…”

Splenic abscess caused by Lactobacillus paracasei

“…In this particular bacterium, few cases have been reported as the cause of human infections. These include splenic abscess after rupture of mycotic aneurysm due to intravascular infection [20], endocarditis and purpura fulminans associated with liver abscess [21], and endocarditis with cardiac valve disease [22]. As far as we are aware, this is the second case report and the first in Japan of splenic abscess caused by L. paracasei.…”