Prosthetic valve endocarditis due to Streptococcus pneumoniae

Abstract

IntroductionIn the pre-antibiotic era up 10% of cases of infective endocarditis were due to Streptococcus pneumoniae, but this association is currently exceedingly rare.Case descriptionSince 1997 we have diagnosed three patients, all aged >70, with endocarditis due to S. pneumoniae. One of these three cases involved a prosthetic valve, another a prosthetic ring. All three patients completely recovered with antibiotic treatment only.Discussion and evaluationDuring the same period there were 1694 cases of pneumococcal bacteremia, of whom 395 (23%) after age 70. Therefore, after age 70 the prevalence of endocarditis out of all cases of pneumococcal bacteremia was 0.7%. A literature review detected another 16 cases of pneumococcal PVE. The mean age of these 17 patients was 64±14; 10 were female and 7 male. In most instances, symptom duration was short, < 6 days. Valve surgery was performed in 5 cases (29%) and 13 patients (76%) survived.ConclusionsEndocarditis due to S. pneumoniae is rare in the antibiotic era; even in patients with prosthetic valves its course is evidently not more virulent than with other low-virulent organisms.

Infectious endocarditis due to Streptococcus pneumoniae in a cardiac surgery patient: a new form of clinical presentation

“…TEE favors early detection of the disease and its complications and guides the appropriate therapeutic action throughout the clinical course. Given what has been reported to date , and the evolution of our patient, we would emphasize the need for intensive medical treatment and early surgery in patients with complications such as abscesses, large vegetations, or valve perforation, even when the SP is penicillin sensitive.…”

“…Another review of 16 patients with PE reported that the aortic and mitral valves were simultaneously affected in 4 cases (25%); these patients evolved satisfactorily, with medical treatment in two cases and combined medical–surgical treatment in the other two. Surgery was performed in 5 cases (31%) and 13 (81%) of the whole sample survived.…”

“…Early surgery is likely to improve the patient's prognosis . The utility of medical treatment alone has only been shown in cases with adequate response to antibiotic treatment, the absence of penicillin‐resistant SP, and none of the above‐mentioned complications .…”