Post-mortem findings in Staphylococcus aureus acute infective endocarditis

Phogat, Deepika; Bajpai, Mukul; Ganguli, Prosenjit; Upreti, Vimal

doi:10.4322/acr.2020.212

Cited by 1 publication

(4 citation statements)

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“…The risk of complications is higher in individuals with comorbidities and lifestyle factors ( 3 , 8 , 11 ), such as the history of intravenous drug use described in the decedent above. While valvular vegetations are often described in association with IE ( 1 , 3 - 5 , 8 , 11 ), other parts of the heart can be affected such as the coronary arteries, myocardium, chordae tendineae, and pericardium ( 4 ).…”

Section: Discussionmentioning

confidence: 99%

“…In the postmortem blood culture, coagulase-negative Staphylococcus, Staphylococcus aureus, Candida tropicalis, and Viridians group Streptococci were identified ( Table 2 ). Staphylococcus aureus is a known cause of IE in the setting of intravenous drug use ( 4 ); however, Viridians group Streptococci and coagulase-negative Staphylocci are known to cause IE in the setting of prosthetic heart valves ( 19 , 20 ). While all of the organisms identified on postmortem culture are also known to be components of normal skin or mucosal flora, the results are in-keeping with a diagnosis of IE and it is difficult to determine the extent to which the results are affected by postmortem contamination.…”

Section: Discussionmentioning

confidence: 99%

“…Individuals with a history of immunosuppression, intravenous drug use, hemodialysis, and artificial heart valves are at increased risk of developing IE ( 2 , 3 ). Valvular vegetations, abscesses, and associated pericarditis can be identified grossly on postmortem examination of IE cases ( 4 ) and other adverse complications include arrhythmias, reinfection, valve insufficiency, and structural destruction of heart structures ( 5 ). Microscopically, neutrophilic and inflammatory infiltrates can be seen in the endocardium and myocardium, and bacteria can be seen on Gram or Giemsa staining.…”

Section: Introductionmentioning

confidence: 99%

“…Postmortem blood and tissue cultures can be taken to determine the causative infectious agent; however, there is an increased risk of contamination compared to perimortem blood. Staphylococcus aureus is responsible for 20% to 30% of IE cases and is the bacterium reported in most cases of intravenous drug use-associated IE ( 4 ). Other bacterial agents of IE include streptococcal organisms contributing to another 30% of cases as well as enterococcal and gram-negative species in the HACEK group such as Haemophilus, Aggregatibacter, Cardiobacterium, and Eikenella species that are known primary causes of IE ( 1 , 6 , 7 ).…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Infective Endocarditis in an Intravenous Drug User Leading to Myocardial Rupture and Hemopericardium

Cao,

Herath

2023

Academic Forensic Pathology

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Introduction: Infective endocarditis (IE) is an infectious disorder of the innermost lining of the heart that can be fatal if left untreated. Infective endocarditis can spread beyond the endocardium into the myocardium and cause arrhythmias and myocardial wall rupture. Individuals with a history of intravenous drug use are at increased risk of developing IE and are at higher risk of dying, given their limited access to health care and adherence to treatment. Methods: A medicolegal autopsy was performed on a 30-year-old woman with a history of intravenous drug use and recent assault after a hospital admission during which she did not survive resuscitation. Results: The cause of death was found to be myocardial rupture in the setting of transmural IE. Postmortem imaging showed hemopericardium which was identified grossly with valvular vegetations in the heart. A ventricular wall defect along with transmural abscess formation was identified. Perimortem toxicology was positive for fentanyl, methamphetamine, and benzoylecgonine, a metabolite of cocaine. Postmortem blood cultures were positive for coagulase-negative Staphylococci, Staphylococcus aureus, Candida tropicalis, and Viridians group Streptococci. Postmortem tissue cultures taken from the heart was positive for Candida glabrata and Streptococcus mitis. Discussion: The decedent had significant risk factors for IE, such as intravenous drug use and a prior admission to hospital for IE. The organisms identified on culture are in-keeping with the gross findings of IE and the terminal event of myocardial rupture was likely the result of tissue damage resulting from IE.

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