ISSN 1941-5923 © Am J Case Rep, 2014; 15: 554-558 DOI: 10.12659/AJCR.892057
Infective Endocarditis Caused by Finegoldia magna Following Aortic Dissection Repair: A Case Report and Data Evaluation
Received: 2014.07.22 Accepted: 2014.08.26 Published: 2014.12.12
Authors’ Contribution: Study Design A Data Collection B Analysis C Statistical Data Interpretation D Manuscript Preparation E Literature Search F Collection G Funds
AB 1 ACDEF 2 ABDE 2 E 2 BEF 3 ABDEF 1,2
Corresponding Author: Conflict of interest:
Khetam Hussein Ziv Savin Liran Shani Yaakov Dickstein Yuval Geffen Ayelet Raz-Pasteur
1 Infectious Disease Unit, Rambam Health Care Campus, Haifa, Israel 2 Department of Internal Medicine A, Rambam Health Care Campus, Haifa, Israel 3 Laboratory of Microbiology, Rambam Health Care Campus, Haifa, Israel
Ayelet Raz, e-mail: [email protected] None declared
Patient: Male, 45 Final Diagnosis: Endocarditis Symptoms: — Medication: — Clinical Procedure: Antibiotic treatment and aortic repair Specialty: Surgery
Objective: Background:
Case Report:
Conclusions:
MeSH Keywords:
Full-text PDF:
Unusual clinical course Finegoldia magna (F. magna) is a rare pathogen causing infective endocarditis (IE). Only 7 cases are documented in the literature. We report a case of infective endocarditis in a 45-year-old male due to F. magna 2 months after a Bentall procedure. He presented with fever, dyspnea, and chest pain. Aerobic and anaerobic blood samples were drawn before empirical antibiotic treatment was initiated. A transesophageal echocardiogram (TEE) demonstrated several findings involving the prosthetic valve, including a vegetation. The patient underwent a second aortic repair procedure. Tissue cultures obtained from 2 sources in the infected area during the operation were positive for F. magna. The antibiotic regimen was changed in accordance with susceptibility testing to piperacillin/tazobactam. Two weeks after the operation, the patient was released with a recommendation for antibiotic treatment for 8 weeks. We report this case because F. magna in a rare pathogen causing endocarditis. This was a case of prosthetic valve F. magna IE in which the definitive diagnosis was based on tissue cultures following sterile blood cultures. Data evaluation of all F. magna IE reported cases illustrated that tissue cultures were the predominant microbiologic diagnostic tool used. Endocarditis • Heart Valve Prosthesis • Peptostreptococcus http://www.amjcaserep.com/abstract/index/idArt/892057
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This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License
Hussein K. et al.: Infective endocarditis caused by Finegoldia magna following aortic dissection repair… © Am J Case Rep, 2014; 15: 554-558
Background Finegoldia magna (formerly Peptostreptococcus magnus) is part of the normal human mucocutaneous flora and is one of the most common gram-positive anaerobic cocci isolated from clinical specimens [1]. Peptostreptococcus species have been described as pathogens of upper respiratory infections, ear, sinus and mastoid infections, osteomyelitis, and soft tissue abscesses and ulcers [1–3]. In addition, these species have been reported to cause nosocomial infections, including lung and soft tissue abscesses, sinusitis, and bone infections [4]. Over the last 3 decades, anaerobic bacteria have been identified as the causative agent in up to 16% of published infective endocarditis cases [5]. Specifically, there have been 21 published reports of IE caused by Peptostreptococcus spp. [6]. F. magna was identified as the agent in only 7 cases, mostly by tissue culture taken during surgical procedure following sterile blood cultures [7–11].
Case Report A 45-year-old man was admitted to the department of internal medicine for evaluation in March of 2012 following complaints of fever, dyspnea, and chest pain. Two months prior to his admission, the patient had undergone resection and replacement of the ascending aorta due to a dissecting aneurysm. The procedure included a composite aortic graft incorporated with a 25-mm aortic mechanical valve. The patient was discharged 8 days after the operation in good general condition. On readmission the patient reported 2 days of chest pain and dyspnea. He had a documented fever of 39°C at home with a single episode of night sweats. Vital signs on admission included an oral temperature of 37°C, blood pressure 95/60, respiratory rate 30 breaths per minute and blood oxygen saturation level of 96% while breathing room air. Physical examination demonstrated no remarkable findings. Laboratory tests revealed a slight leukocytosis of 12,400 cells/µl (normal range 4,500–10,000 cells/µl), hemoglobin level of 11.8 g/dL (13.5–16.5 g/dL), cardiac t-Troponin peak value of 0.12 ng/mL (
Infective Endocarditis Caused by Finegoldia magna Following Aortic Dissection Repair: A Case Report and Data Evaluation
Received: 2014.07.22 Accepted: 2014.08.26 Published: 2014.12.12
Authors’ Contribution: Study Design A Data Collection B Analysis C Statistical Data Interpretation D Manuscript Preparation E Literature Search F Collection G Funds
AB 1 ACDEF 2 ABDE 2 E 2 BEF 3 ABDEF 1,2
Corresponding Author: Conflict of interest:
Khetam Hussein Ziv Savin Liran Shani Yaakov Dickstein Yuval Geffen Ayelet Raz-Pasteur
1 Infectious Disease Unit, Rambam Health Care Campus, Haifa, Israel 2 Department of Internal Medicine A, Rambam Health Care Campus, Haifa, Israel 3 Laboratory of Microbiology, Rambam Health Care Campus, Haifa, Israel
Ayelet Raz, e-mail: [email protected] None declared
Patient: Male, 45 Final Diagnosis: Endocarditis Symptoms: — Medication: — Clinical Procedure: Antibiotic treatment and aortic repair Specialty: Surgery
Objective: Background:
Case Report:
Conclusions:
MeSH Keywords:
Full-text PDF:
Unusual clinical course Finegoldia magna (F. magna) is a rare pathogen causing infective endocarditis (IE). Only 7 cases are documented in the literature. We report a case of infective endocarditis in a 45-year-old male due to F. magna 2 months after a Bentall procedure. He presented with fever, dyspnea, and chest pain. Aerobic and anaerobic blood samples were drawn before empirical antibiotic treatment was initiated. A transesophageal echocardiogram (TEE) demonstrated several findings involving the prosthetic valve, including a vegetation. The patient underwent a second aortic repair procedure. Tissue cultures obtained from 2 sources in the infected area during the operation were positive for F. magna. The antibiotic regimen was changed in accordance with susceptibility testing to piperacillin/tazobactam. Two weeks after the operation, the patient was released with a recommendation for antibiotic treatment for 8 weeks. We report this case because F. magna in a rare pathogen causing endocarditis. This was a case of prosthetic valve F. magna IE in which the definitive diagnosis was based on tissue cultures following sterile blood cultures. Data evaluation of all F. magna IE reported cases illustrated that tissue cultures were the predominant microbiologic diagnostic tool used. Endocarditis • Heart Valve Prosthesis • Peptostreptococcus http://www.amjcaserep.com/abstract/index/idArt/892057
1469
554
2
1
16
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivs 3.0 Unported License
Hussein K. et al.: Infective endocarditis caused by Finegoldia magna following aortic dissection repair… © Am J Case Rep, 2014; 15: 554-558
Background Finegoldia magna (formerly Peptostreptococcus magnus) is part of the normal human mucocutaneous flora and is one of the most common gram-positive anaerobic cocci isolated from clinical specimens [1]. Peptostreptococcus species have been described as pathogens of upper respiratory infections, ear, sinus and mastoid infections, osteomyelitis, and soft tissue abscesses and ulcers [1–3]. In addition, these species have been reported to cause nosocomial infections, including lung and soft tissue abscesses, sinusitis, and bone infections [4]. Over the last 3 decades, anaerobic bacteria have been identified as the causative agent in up to 16% of published infective endocarditis cases [5]. Specifically, there have been 21 published reports of IE caused by Peptostreptococcus spp. [6]. F. magna was identified as the agent in only 7 cases, mostly by tissue culture taken during surgical procedure following sterile blood cultures [7–11].
Case Report A 45-year-old man was admitted to the department of internal medicine for evaluation in March of 2012 following complaints of fever, dyspnea, and chest pain. Two months prior to his admission, the patient had undergone resection and replacement of the ascending aorta due to a dissecting aneurysm. The procedure included a composite aortic graft incorporated with a 25-mm aortic mechanical valve. The patient was discharged 8 days after the operation in good general condition. On readmission the patient reported 2 days of chest pain and dyspnea. He had a documented fever of 39°C at home with a single episode of night sweats. Vital signs on admission included an oral temperature of 37°C, blood pressure 95/60, respiratory rate 30 breaths per minute and blood oxygen saturation level of 96% while breathing room air. Physical examination demonstrated no remarkable findings. Laboratory tests revealed a slight leukocytosis of 12,400 cells/µl (normal range 4,500–10,000 cells/µl), hemoglobin level of 11.8 g/dL (13.5–16.5 g/dL), cardiac t-Troponin peak value of 0.12 ng/mL (
