1 Salmonella enteritidis is the most common serotype, presumably as a consequence of frequent chicken and egg contamination.1,2 Most cases of salmonellosis are limited to gastroenteritis, but bacteremia occurs in 3% to 8% of infections; cardiovascular infections, including pericarditis and endocarditis, develop in 1% to 5% of patients.3,4 The pathogenesis of cardiac salmonellosis is related to the quantity of bacteria ingested, the characteristic ability of Salmonella to adhere to damaged endothelium, the strength of the host's immune response, and the host's previous exposure. The sequelae of Salmonella endocarditis, including valve perforation, valve ring abscess, atrioventricular wall perforation, and cusp rupture, result in an estimated mortality rate of up to 75%. 5,6 Identifying patients at risk of cardiovascular salmonellosis is important for early diagnosis and treatment.
Case Reports Patient 1A 73-year-old woman presented after 3 days of progressive nausea, diarrhea, fevers, and weakness. Her medical history was significant for asthma, hypertension, and replacements (4 years earlier) of both mechanical mitral and bioprosthetic aortic valves.The patient's initial temperature was 101 °F, her blood pressure was 59/31 mmHg, and her heart rate was 74 beats/min. An electrocardiogram (ECG) showed sinus rhythm. Her white blood cell count was 8,200 K/µL; blood urea-nitrogen level, 42 mg/dL; creatinine level, 2.04 mg/dL; and initial venous lactate level, 1.3 mmol/L. Urinalysis showed 26 to 100 white cells per high-power field, and a chest radiograph showed bilateral pulmonary infiltrates. She was stabilized, started on intravascular levofloxacin (0.75 mg/kg/d), and admitted to the intensive care unit, where she developed rigors and respiratory distress that necessitated endotracheal intubation and mechanical ventilation. A repeat ECG showed a new pattern of left bundle-branch block. An echocardiogram showed heavy mitral annular calcification, which produced a dense artifact around the sewing ring that suggested endocarditis.On the 2nd day of hospitalization, blood-culture results were positive for gramnegative rods. Transesophageal echocardiography revealed an aortic valve abscess and a 1.1 × 0.5-cm vegetation (with a central cavitation) on her mechanical mitral valve (Fig. 1). The presumed source of the endocarditis was the urinary tract infection,