Native valve endocarditis and pacemaker infection with Mycobacterium fortuitum

Abstract

Endocarditis and cardiac device infection due to Mycobacterium fortuitum is a rare entity in the hospital settings. We report a case of pacemaker infection and native valve endocarditis due to Mycobacterium fortuitum , which was associated with tricuspid valve vegetation. two days after admission with fever, chills, body aches and swelling around her pacemaker, the patient’s pacing system was surgically removed. The patient was then discharged at day 16 after surgery and treated with a multidrug regimen of azithromycin, levofloxacin, imipenem/cilastatin, and amikacin for six weeks followed by trimethoprim/sulfamethoxazole plus doxycycline for a further three months.

Cardiovascular device infections due to rapidly growing Mycobacteria: A review of cases at a tertiary care hospital

“…The duration of antimicrobial therapy for CIED infections depends on the extent of infection, the presence of bloodstream infection, and type of causative organism [33] . M. fortuitum is the most common RGM that has been implicated in CIED infections in previous case reports [11] , [12] , [28] , [30] . Cure of the infection and successful reimplantation have been described in previous cases with complete device removal and appropriate antimicrobial therapy; duration of antimicrobial treatment was quite varied, from four weeks to six months in cases without valvular involvement or bacteremia [12] , [28] , [30] .…”

“…M. fortuitum is the most common RGM that has been implicated in CIED infections in previous case reports [11] , [12] , [28] , [30] . Cure of the infection and successful reimplantation have been described in previous cases with complete device removal and appropriate antimicrobial therapy; duration of antimicrobial treatment was quite varied, from four weeks to six months in cases without valvular involvement or bacteremia [12] , [28] , [30] . Interestingly, none of the patients in our series demonstrated cardiac valvular infection with RGM.…”

“…CV device infections due to RGM remain a rare entity [9] , [10] . Current data is limited to case reports although number of cases diagnosed during the past two decades is rising [9] , [10] , [11] , [12] , [13] , [14] , [15] , [16] , [20] , [21] , [22] , [23] , [24] , [25] , [26] , [27] , [28] , [29] , [30] , [31] . This could be due to both an increase in the number of CIED implanted in an aging population [32] , [33] , as well as, an increased clinical awareness of extrapulmonary RGM infections.…”

Mycobacterial Endocarditis, A Rare Form of Infective Endocarditis

“…For instance, a patient with a history of mitral valve replacement eight years prior was diagnosed with M.fortuitum pulmonic valve endocarditis [44]. Another patient with a surgical history of cardioverter-defibrillator implantation was diagnosed with native valve endocarditis and M.fortuitum pacemaker infection [45]. A Serbian study found that three children received combination treatment for M. fortuitum-related endocarditis shortly after cardiac surgery [46].…”