Late-onset prosthetic valve endocarditis caused by nontoxigenic Corynebacterium diphtheriae

El‐Hazmi, Mohsen A. F.

doi:10.3855/jidc.5976

Cited by 7 publications

(5 citation statements)

References 24 publications

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“…There are few cases of C. diphtheriae -infective endocarditis reported in the literature; a review by Muttaiyah et al 1 of the literature up to 2007 found 76 cases and our further literature search found an additional 6 reported cases 5–10. Interestingly, C. diphtheriae endocarditis cases predominantly occurred in persons <30 years of age 1.…”

Section: Discussionmentioning

confidence: 74%

Corynebacterium diphtheriae-infective endocarditis in a patient with an atrial septal defect closure device

Ng¹,

Downton

Davidson

et al. 2019

BMJ Case Rep

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An 18-year-old woman presented to our institution with fever, bilateral flank pain, headache and photophobia. She had a previous atrial septal defect (ASD) closure device inserted at the age of 9 years. Blood cultures on admission were positive for Corynebacterium diphtheriae, and transoesophageal echocardiogram (TOE) revealed an echodensity associated with the ASD closure device, most consistent with a vegetation. She was treated for infective endocarditis with 6 weeks of intravenous benzylpenicillin, and follow-up TOE showed resolution of the echodensity. To our knowledge, no cases of C. diphtheriaeendocarditis of an ASD closure device have previously been reported.

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Section: Discussionmentioning

confidence: 74%

Corynebacterium diphtheriae-infective endocarditis in a patient with an atrial septal defect closure device

Ng¹,

Downton

Davidson

et al. 2019

BMJ Case Rep

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“…However, the vaccine does not prevent infections by non-toxigenic strains which can be highly aggressive. Due to its rarity, the medical literature presents non-toxigenic C. diphtheriae endocarditis mainly through case reports and reviews, with scarce descriptions of early embolic phenomena as acute ischemic strokes, vascular pseudoaneurysms and septic arthritis [3][4][5][6].…”

Section: Discussionmentioning

confidence: 99%

“…However, especially in developing countries, non-toxigenic C. diphtheriae strains are now emerging as cause of invasive disease like endocarditis, septic arthritis and osteomyelitis [1,2]. In fact, there is an increase in case reports of severe infection by nontoxigenic C. diphtheriae over the past few decades [3][4][5][6]. Non-toxigenic C. diphtheriae endocarditis has been related to the presence of valve prosthesis, use of injectable drugs and underlying cardiac disease.…”

Section: Introductionmentioning

confidence: 99%

Non-toxigenic Corynebacterium diphtheriae infective endocarditis with embolic events: a case report

et al. 2020

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Background Corynebacterium diphtheriae (C. diphtheriae) infections, usually related to upper airways involvement, could be highly invasive. Especially in developing countries, non-toxigenic C. diphtheriae strains are now emerging as cause of invasive disease like endocarditis. The present case stands out for reinforcing the high virulence of this pathogen, demonstrated by the multiple systemic embolism and severe valve deterioration. It also emphasizes the importance of a coordinated interdisciplinary work to address all these challenges related to infectious endocarditis. Case presentation A 21-year-old male cocaine drug abuser presented to the emergency department with a 1-week history of fever, asthenia and dyspnea. His physical examination revealed a mitral systolic murmur, signs of acute arterial occlusion of the left lower limb, severe arterial hypotension and acute respiratory failure, with need of vasoactive drugs, orotracheal intubation/mechanical ventilation, empiric antimicrobial therapy and emergent endovascular treatment. The clinical suspicion of acute infective endocarditis was confirmed by transesophageal echocardiography, demonstrating a large vegetation on the mitral valve associated with severe valvular regurgitation. Abdominal ultrasound was normal with no hepatic, renal, or spleen abscess. Serial blood cultures and thrombus culture, obtained in the vascular procedure, identified non-toxigenic C. diphtheriae, with antibiotic therapy adjustment to monotherapy with ampicillin. Since the patient had a severe septic shock with sustained fever, despite antimicrobial therapy, urgent cardiac surgical intervention was planned. Anatomical findings were compatible with an aggressive endocarditis, requiring mitral valve replacement for a biological prosthesis. During the postoperative period, despite an initial clinical recovery and successfully weaning from mechanical ventilation, the patient presented with a recrudescent daily fever. Computed tomography of the abdomen revealed a hypoattenuating and extensive splenic lesion suggestive of abscess. After sonographically guided bridging percutaneous catheter drainage, surgical splenectomy was performed. Despite left limb revascularization, a forefoot amputation was required due to gangrene. The patient had a good clinical recovery, fulfilling 4-weeks of antimicrobial treatment. Conclusion Despite the effectiveness of toxoid-based vaccines, recent global outbreaks of invasive C. diphtheriae infectious related to non-toxigenic strains have been described. These infectious could be highly invasive as demonstrated in this case. Interdisciplinary work with an institutional “endocarditis team” is essential to achieve favorable clinical outcomes in such defiant scenarios.

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“…Toksin üretimi olmadığında bile C.diphtheriae'nın bakteremi ve menenjit, endokardit, osteomiyelit, septik artrit, hepatit ve periferik embolik hastalık gibi ciddi komplikasyonlara yol açtığı bildirilmiştir 11,[15][16][17][18] . Toksijenik olmayan suşlarla invaziv enfeksiyonlar için immün yetmezlik, diyabet, kronik karaciğer hastalığı, konjenital ya da kalp kapak hastalıkları, intravenöz ilaç alışkanlığı, alkolizm gibi risk faktörleri söz konusudur.…”

Section: Discussionunclassified

Üst Solunum Yolu Enfeksiyonu Bulguları ile Başvuran Çocukların Boğaz Sürüntü Örneklerinde Corynebacterium diphtheriae, Corynebacterium ulcerans ve Corynebacterium pseudotuberculosis Suşlarının Araştırılması

Aydın¹,

Tanır²,

Ötgün³

et al. 2017

Mikrobiyol Bul

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Late-onset prosthetic valve endocarditis caused by nontoxigenic Corynebacterium diphtheriae

Cited by 7 publications

References 24 publications

Corynebacterium diphtheriae-infective endocarditis in a patient with an atrial septal defect closure device

Corynebacterium diphtheriae-infective endocarditis in a patient with an atrial septal defect closure device

Non-toxigenic Corynebacterium diphtheriae infective endocarditis with embolic events: a case report

Üst Solunum Yolu Enfeksiyonu Bulguları ile Başvuran Çocukların Boğaz Sürüntü Örneklerinde Corynebacterium diphtheriae, Corynebacterium ulcerans ve Corynebacterium pseudotuberculosis Suşlarının Araştırılması

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