Native Valve Endocarditis Caused by Escherichia Coli

Abstract

A 58-year-old male attended a tertiary care hospital with a history of fever associated with chills and rigor of six weeks duration. He also complained of dyspnoea, cough, chest pain and palpitation. He had undergone a renal transplant four years ago for treatment of congenital polycystic kidney disease. He had mild renal insufficiency and compensated metabolic acidosis.On physical examination, he was febrile (105ºF), blood pressure was 110/80 mmHg, and pulse rate 81 per min. The total leucocyte count was 4.8 x 10 3 cells/mm 3 with 81% neutrophils, 11% lymphocytes, 1% eosinophils and 7% monocytes. The haemoglobin level was 10.0 gm/dL, erythrocyte sedimentation rate 134 mm for 1 hour, C-reactive protein 268 mg/dL, urea 53 mg/dL, creatinine 2.29 mg/ dL and random blood sugar was 163 mg/dL. The peripheral blood smear showed normocytic normochromic anaemia and neutrophilia with toxic granules. Routine examination of the urine showed marked proteinuria, microscopic haematuria and many pus cells and motile bacilli. The transthoracic echocardiogram demonstrated vegetation on the aortic valve and mild annular calcification without any evidence of pericardial effusion. The electrocardiogram showed normal sinus rhythm.Blood cultures were done by collecting three consecutive blood samples at intervals of one hour. Approximately, 10 ml of venous blood was inoculated into 100 ml brain heart infusion broth supplemented with 0.01% sodium polyanethol sulphonate (HiMedia Laboratories, Mumbai). The blood culture bottles were incubated at 37ºC for 18-24 hours and observed daily for signs of growth. Turbidity was noticed in all the three bottles within 18-24 hours and Gram-stained smears showed Gram-negative, pleomorphic, coccobacilli. The broth was subcultured on to 5% sheep blood agar and MacConkey agar and incubated at 37ºC. After 18 hours of incubation, MacConkey agar medium showed lactose-fermenting colonies, about 2-3 mm in diameter. Colonies on blood agar were grey and non-haemolytic. They were found to be Gram-negative, motile, pleomorphic, coccobacilli, which were oxidase negative and catalase positive and identified by standard biochemical tests [1] as Escherichia coli. Culture of the urine also grew Escherichia coli with a colony count of >10 5 CFU/ml. AbSTRACTEscherichia coli is a rare cause of infective endocarditis. This report describes a case of native valve endocarditis caused by Escherichia coli in a 58-year-old male renal transplant patient who had a concurrent urinary tract infection caused by the same organism. The patient was successfully treated with antibiotics and recovered without surgical intervention.to amikacin, cefotaxime, ceftriaxone and resistant to netlimicin, ceftazidime, cefuroxime, ciprofloxacin, and levofloxacin.The patient was treated with intravenous infusion of ceftriaxone 2 g twice daily for two weeks and amikacin 80 mg once daily for eight weeks. He responded well to treatment and was afebrile within 72 hours after initiation of therapy. Antibiotic treatment was continued for eight weeks....

Native valve endocarditis due to Escherichia coli infection: a case report and review of the literature

“…The mean age of the patients was 59.6 ± 19.8 years (male, 52.4 ± 21.2 years; female, 64.3 ± 17.2 years). The MV was the most frequently affected structure (15 cases, including 5 cases of prosthetic valve endocarditis) [ 11 , 13 , 16 , 17 , 20 , 22 , 25 , 27 , 30 , 32 ], and the aortic valve (AV) was the second most frequently affected structure (11 cases, including 4 cases of prosthetic valve endocarditis) [ 12 , 14 – 16 , 23 , 24 , 30 , 31 ]. Both the MV and AV were affected in one patient [ 28 ].…”

“…With respect to the comorbidities of E. coli IE, seven patients were diagnosed with diabetes mellitus [ 11 , 16 , 25 , 30 , 32 ], three had a history of malignancy [ 13 , 16 ], and, notably, three had a history of excessive alcohol consumption [ 14 , 19 ]. Moreover, three patients had renal disease [ 27 , 29 , 31 ]. Two patients required renal replacement therapy [ 27 , 29 ], including one patient taking prednisolone and cyclophosphamide [ 27 ], and one patient had undergone renal transplantation [ 31 ].…”

“…Moreover, three patients had renal disease [ 27 , 29 , 31 ]. Two patients required renal replacement therapy [ 27 , 29 ], including one patient taking prednisolone and cyclophosphamide [ 27 ], and one patient had undergone renal transplantation [ 31 ]. Conditions such as diabetes, hemodialysis, and malignancy may reflect an underlying immunocompromised state.…”

“…Preceding urinary tract infection was reported in 52% (17/33) of the patients [ 12 – 15 , 20 , 21 , 25 , 28 , 30 – 32 ]. Additionally, 36% (12/33) of the patients were positive for E. coli in urine culture samples [ 12 – 15 , 20 , 21 , 25 , 31 , 32 ].…”

“…The American Heart Association recommends combination antibiotic therapy with β-lactams (penicillins, cephalosporins, or carbapenems) and either an aminoglycoside or fluoroquinolone for 6 weeks in patients with non-HACEK gram-negative endocarditis [ 5 ]. Among 31 patients in whom the antibiotics used could be identified, 6 (20%) were treated with penicillins [ 10 , 16 , 17 , 23 , 26 ], 14 (45%) were treated with cephems and/or penicillins [ 11 – 16 , 25 , 28 – 31 ], and 11 (35%) were treated with carbapenems and/or other β-lactams [ 16 – 22 , 24 , 27 , 30 – 32 ]. Although only six patients were positive for extended-spectrum β-lactamase (ESBL)-producing E.coli [ 21 , 22 , 24 , 27 , 30 , 32 ], it should be noted that one-third of the reviewed patients were treated with carbapenems.…”