Staphylococcus Lugdunensis Endocarditis and Cerebrovascular Accident: A Systemic Review of Risk Factors and Clinical outcome

Kyaw, Htoo; Raju, Felix; Shaikh, Atif; Lin, Aung Naing; Lin, Aye T; Abboud, Joseph A.; Reddy, Sarath

doi:10.7759/cureus.2469

Cited by 18 publications

(31 citation statements)

References 25 publications

(26 reference statements)

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“…Even though S. lugdunensis is highly susceptible to a myriad of antibiotic therapies, S. lugdunensis is more aggressive than other CNS as S. lugdunensis carries a high mortality rate in endocarditis patients [16]. Thus, if S. lugdunensis is isolated, transesophageal echocardiography should be conducted to evaluate for IE [48][49][50]. Treatment with a β-lactam and debridement of foreign material should be pursued [48][49][50].…”

Section: Treatmentmentioning

confidence: 99%

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Staphylococcus lugdunensis: Review of Epidemiology, Complications, and Treatment

Parthasarathy¹,

Shah²,

Sager³

et al. 2020

Cureus

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Staphylococcus lugdunensis is a species of coagulase-negative staphylococci (CNS) that induces a variety of infectious diseases, including skin and soft tissue infection (SSTI), infective endocarditis (IE), and bone and PJI. This review article underscores the important points in the literature about S. lugdunensis infections, including its epidemiology, diagnosis, and treatment, as well as specific types of infections it can cause. Anatomical and age-related distributions of S. lugdunensis SSTIs have been noted, though they most commonly occur as abscesses. S. lugdunensis can also manifest as an aggressive form of IE presenting with valve destruction and abscess formation, frequently requiring surgery and with a high mortality rate. Bone and joint infections caused by S. lugdunensis are also more invasive than infections by other species of CNS. The clinical presentation of S. lugdunensis infection in SSTI, IE, and bone/joint infection is frequently more similar to that of S. aureus infection than that of other CNS infections, necessitating species-level differentiation of CNS for proper diagnosis. Though historically, this depended upon biochemical tests that were neither routine nor reliable, the implementation of matrix-assisted laser desorption/ionization time of flight mass spectrometry (MALDI-TOF MS) in clinical laboratories has made identification of CNS species such as S. lugdunensis more practical. Imaging modalities, especially the fluorodeoxyglucose (FDG) with positron emission tomography (PET), are another important emerging trend in the diagnosis of infectious diseases such as S. lugdunensis infection. S. lugdunensis remains highly susceptible to a wide gamut of antibacterial therapies, which is uncharacteristic of other CNS. Infections can usually be treated by antibiotics traditionally used for CNS such as oxacillin. The breakpoints for S. lugdunensis are higher than those of other CNS and similar to S. aureus breakpoints. In the case of aggressive IE or bone/joint infection by S. lugdunensis, it is recommended to treat with a βlactam agent. Further study is needed to understand the diversity, virulence, and population structure of this species, as well as its role in other infections, such as urinary tract infections (UTIs), respiratory infections, peritonitis, and bacteremia.

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Section: Treatmentmentioning

confidence: 99%

“…Thus, if S. lugdunensis is isolated, transesophageal echocardiography should be conducted to evaluate for IE [48][49][50]. Treatment with a β-lactam and debridement of foreign material should be pursued [48][49][50].…”

Section: Treatmentmentioning

confidence: 99%

Staphylococcus lugdunensis: Review of Epidemiology, Complications, and Treatment

Parthasarathy¹,

Shah²,

Sager³

et al. 2020

Cureus

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“…In a systematic review study, 94.7% of all IE cases due to this organism were left-sided. Of those, the mitral valve was most affected accounting for 52.5% of the cases reported, and the aortic valve was documented in 37% [8]. Our patient presented in this case had aortic valve involvement requiring valve replacement and a 6-week course of intravenous nafcillin.…”

Section: Discussionmentioning

confidence: 69%

Aggressive Staphylococcus lugdunensis Endocarditis in a Young Healthy Patient: A Case Report

et al. 2020

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Staphylococcus lugdunensis (S. lugdunensis) is a β-hemolytic coagulase-negative staphylococcus causing skin and soft tissue infections with an increasing incidence. Commonly found as normal flora in the perineal region, S. lugdunensis has been found in rare cases of infective endocarditis causing increased morbidity and mortality. We present a case of a previously healthy young male diagnosed with S. lugdunensis-caused infective endocarditis. A 31-year-old male with no significant past medical history, who presented to the emergency department with acute onset crushing substernal chest pressure and dyspnea with profuse sweating following 1-week-long febrile illness and malaise. The initial electrocardiogram (ECG) showed diffuse ST depressions in all precordial leads, consistent with an acute coronary syndrome. Emergent transthoracic echocardiogram revealed an ejection fraction (EF) of 45% with severe aortic insufficiency with emanating from a torn right coronary cusp. The patient had a cardiac arrest, and recovery of spontaneous circulation (ROSC) was obtained after 13 min. He subsequently underwent mechanical aortic valve replacement surgery. The native valve specimen cultures grew S. lugdunensis. Postoperatively and after a long course of antibiotics, the patient fully recovered without complications. S. lugdunensis is a common organism with increasing incidence that can lead to significant morbidity and mortality if not properly detected and treated. We hope this case presentation would support emergency valve replacement surgery in patients with S. lugdunensis-suspected infective endocarditis.

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“…S. lugdunensis endocarditis is usually destructive in a native as well as a prosthetic valve. The incidence of S. lugdunensis endocarditis varies from 3 to 7 per 100,000 person-years annually worldwide [2]. S. lugdunensis meningitis has been reported in the previous literature as a single pathology [3–5].…”

Section: Introductionmentioning

confidence: 99%

Embolic Stroke and Meningitis Secondary to Staphylococcus lugdunensis Native Valve Endocarditis

Aldhaleei

Bhagavathula

Aldoghaither

2019

Case Reports in Infectious Diseases

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Staphylococcus lugdunensis is a coagulase-negative staphylococcus that leads to destructive infective endocarditis. The clinical course of S. lugdunensis endocarditis is usually aggressive with a high mortality rate compared to endocarditis caused by other coagulase-negative staphylococcal species. Despite that, it is usually sensitive to Penicillin G, and surgical intervention is sometimes warranted. Here, we report a case of S. lugdunensis endocarditis complicated by both embolic stroke and meningitis.

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Staphylococcus Lugdunensis Endocarditis and Cerebrovascular Accident: A Systemic Review of Risk Factors and Clinical outcome

Cited by 18 publications

References 25 publications

Staphylococcus lugdunensis: Review of Epidemiology, Complications, and Treatment

Staphylococcus lugdunensis: Review of Epidemiology, Complications, and Treatment

Aggressive Staphylococcus lugdunensis Endocarditis in a Young Healthy Patient: A Case Report

Embolic Stroke and Meningitis Secondary to Staphylococcus lugdunensis Native Valve Endocarditis

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