Streptococcus agalactiae (group B) endocarditis — A description of twelve cases and review of the literature

Abstract

The group B streptococcus has been shown to be a major cause of meningitis in the newborn and an occasional cause of endocarditis and sepsis in postpartum women. Little attention has been devoted to this organism as a cause of bacterial endocarditis. Twelve patients with group B streptococcal endocarditis were seen at The Presbyterian Hospital, New York, NY, between 1974 and 1985. There were seven women, five men. Ages ranged from 32 to 81 years. Serious underlying disease was present in all - diabetes mellitus in seven, carcinoma in three (bladder in two, and breast in one), alcoholism in three, malnutrition in two, heroin addiction in one, tuberculosis in one, serious prior valvular heart disease in two. The aortic valve was affected in four patients - mitral in two, mitral and aortic in one, tricuspid in four, unknown in one. The presentation was acute in seven patients. Metastatic infection occurred in seven, heart failure in six, major emboli in four, septic pericarditis in one, myocardial abscess in one. The group B streptococcus should be considered as a pathogen capable of causing acute endocarditis in certain patients with defects of host defense, particularly patients with diabetes mellitus, carcinoma or alcoholism. Cardiac surgery may be necessary in these patients due to the rapid destruction of the valves which occurs, in spite of the fact that the organisms are usually highly susceptible to penicillin.

FbsA, a fibrinogen-binding protein from Streptococcus agalactiae, mediates platelet aggregation

“…19 Cases of S agalactiae-induced endocarditis in adults have been reported more frequently in recent years and are usually associated with predisposing conditions such as alcoholism and diabetes mellitus although endocarditis caused by S agalactiae in healthy adults has also been described. [20][21][22][23] S agalactiae strains, possessing Fbg-binding activity, were previously shown to induce platelet aggregation and to be involved in disseminated intravascular coagulation in mice. 24 Because crude extracts of S agalactiae strains, exhibiting significant Fbg-binding activity, were able to inhibit platelet aggregation, it was suggested that the Fbg-binding activity of S agalactiae participates in platelet aggregation.…”

Endocarditis and myocardial abscess caused by group B Streptococcus

“…Whilst he had no pre-existing cardiac pathology, the history of frequent UTIs secondary to a urethral stricture probably accounts for the offending organism. To date, to the best of our knowledge, only two other cases of GBS endocarditis complicated by myocardial abscess formation and perivalvular abscess have been reported in the literature (Scully et al, 1987;Chang & Cunha, 2004). …”

“…Systemic heparinization has the potential to exacerbate neurological injury due to intracranial haemorrhage. Conversely, waiting for effective antibiotic therapy may be preferred in the absence of heart failure or rhythm disturbances (Scully et al, 1987;Sambola et al, 2002;Prendergast & Tornos, 2010;Takahashi et al, 2013). These issues influenced the interventional timing for our patient, whose risk of haemorrhagic conversion was weighed against the risk of further pre-operative complications.…”

“…These are aggressive infections with high levels of systemic complications and mortality rates, which may be explained by the pathogen's lack of fibrinolysin (Sambola et al, 2002;Chang & Cunha, 2004). Myocardial abscess is a rare complication, with only two current reports (Scully et al, 1987;Chang & Cunha, 2004). Whilst medical management may appear beneficial in the absence of indications for emergent surgery, urgent and radical surgical debridement may improve prognosis (Scully et al, 1987;Sambola et al, 2002;Prendergast & Tornos, 2010;Kang et al, 2012) We report a case of GBS infectious endocarditis complicated by left ventricular-aortic valve discontinuity and myocardial abscess in a young, previously healthy male.…”

An “aubergine” in the heart: huge native mitral valve endocarditis caused by Streptococcus agalactiae

“…The large size of the vegetations and their friability may explain the high rate of systemic emboli [2]. Moreover, it is believed that the presence of large vegetations and frequent embolic complications do not depend on the duration of the disease, but are attributed to a lack of fibrinolysin in SA vegetations [3].…”