scispace - formally typeset

Journal ArticleDOI

Mitral valve endocarditis caused by Pseudomonas aeruginosa: a case report

14 May 2014-Journal of Infection in Developing Countries (J Infect Dev Ctries)-Vol. 8, Iss: 5, pp 676-679

TL;DR: A case of a high-risk patient with coronary artery disease and left-ventricular dysfunction, successfully treated for pseudomonal mitral valve endocarditis complicated by splenic abscess formation, is presented here.

AbstractPreviously, endocarditis caused by Pseudomonas aeruginosa mostly involved right-sided valvular infection and generally carried a good prognosis. Recently, changes have been observed in the occurrence and clinical presentation of pseudomonal endocarditis, with increasing incidence of nosocomial infections and involvement of the aortic and mitral valves. Still, pseudomonal left-sided endocarditis is rare, but is frequently associated with complications and high mortality rates. A case of a high-risk patient with coronary artery disease and left-ventricular dysfunction, successfully treated for pseudomonal mitral valve endocarditis complicated by splenic abscess formation, is presented here.

Topics: Endocarditis (65%), Mitral valve (57%)

...read more

Content maybe subject to copyright    Report

Citations
More filters

Journal ArticleDOI
09 Aug 2016-Toxins
TL;DR: It has been postulated that, given its chemical properties, PCN is able to readily cross biological membranes, however studies have yet to be undertaken to evaluate this effect, and this review highlights the possible manifestations of PCN exposure.
Abstract: Pyocyanin has recently emerged as an important virulence factor produced by Pseudomonas aeruginosa. The redox-active tricyclic zwitterion has been shown to have a number of potential effects on various organ systems in vitro, including the respiratory, cardiovascular, urological, and central nervous systems. It has been shown that a large number of the effects to these systems are via the formation of reactive oxygen species. The limitations of studies are, to date, focused on the localized effect of the release of pyocyanin (PCN). It has been postulated that, given its chemical properties, PCN is able to readily cross biological membranes, however studies have yet to be undertaken to evaluate this effect. This review highlights the possible manifestations of PCN exposure; however, most studies to date are in vitro. Further high quality in vivo studies are needed to fully assess the physiological manifestations of PCN exposure on the various body systems.

163 citations


Journal ArticleDOI
TL;DR: This case illustrates the importance of identifying the causative pathogen(s), especially for outpatients with a recent history of medical procedures, and a combination therapy with anti-pseudomonal beta-lactams or carbapenems and aminoglycosides may be the preferable treatment.
Abstract: With the development of invasive medical procedures, an increasing number of healthcare-associated infective endocarditis cases have been reported. In particular, non-nosocomial healthcare-associated infective endocarditis in outpatients with recent medical intervention has been increasingly identified. A 66-year-old man with diabetes mellitus and a recent history of intermittent urethral self-catheterization was admitted due to a high fever. Repeated blood cultures identified Pseudomonas aeruginosa, and transesophageal echocardiography uncovered a new-onset severe aortic regurgitation along with a vegetative valvular structure. The patient underwent emergency aortic valve replacement surgery and was successfully treated with 6 weeks of high-dose meropenem and tobramycin. Historically, most cases of P. aeruginosa endocarditis have occurred in the right side of the heart and in outpatients with a history of intravenous drug abuse. In the case presented, the repeated manipulations of the urethra may have triggered the infection. Our literature review for left-sided P. aeruginosa endocarditis showed that non-nosocomial infection accounted for nearly half of the cases and resulted in fatal outcomes as often as nosocomial cases. A combination therapy with anti-pseudomonal beta-lactams or carbapenems and aminoglycosides may be the preferable treatment. Medical treatment alone may be effective, and surgical treatment should be carefully considered. We presented a rare case of native aortic valve endocarditis caused by P. aeruginosa. This case illustrates the importance of identifying the causative pathogen(s), especially for outpatients with a recent history of medical procedures.

12 citations


Cites background from "Mitral valve endocarditis caused by..."

  • ...21 [24] 2014 60/M No Myocardial infarction Unknown Native mitral n....

    [...]


Journal ArticleDOI
TL;DR: The combination of the novel cephalosporin, ceftolozane, with the β-lactamase inhibitor, tazobactam, is tested against planktonic and biofilm forms of 54 clinical isolates of P. aeruginosa, using cefepime as a comparator.
Abstract: Pseudomonas aeruginosa causes a variety of life-threatening infections, some of which are associated with planktonic and others with biofilm states. Herein, we tested the combination of the novel cephalosporin, ceftolozane, with the β-lactamase inhibitor, tazobactam, against planktonic and biofilm forms of 54 clinical isolates of P. aeruginosa, using cefepime as a comparator. MIC values were determined following Clinical and Laboratory Standards Institute (CLSI) guidelines. Minimum biofilm inhibitory concentration (MBIC) values were determined using biofilm-laden pegged lids incubated in antimicrobial challenge plates containing varying concentrations of ceftolozane/tazobactam. Pegged lids were then incubated in growth recovery plates containing cation-adjusted Mueller-Hinton broth to determine the minimum biofilm bactericidal concentration (MBBC). Ceftolozane/tazobactam was highly active against planktonic P. aeruginosa, with all 54 isolates studied testing susceptible (MIC ≤4/4μg/mL). On the other hand, 51/54 biofilm P. aeruginosa had MBICs ≥16/4μg/mL, and all 54 isolates had MBBCs >32μg/mL. Of the 54 isolates, 45 (83.3%) tested susceptible to cefepime, with the MIC50/MIC90 being 4/16μg/mL, respectively, and the MBIC90 and MBBC90 both being >256μg/mL. Although ceftolozane/tazobactam is a promising antimicrobial agent for the treatment of P. aeruginosa infections, it is not highly active against P. aeruginosa biofilms.

11 citations


References
More filters

Journal ArticleDOI
TL;DR: Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009).
Abstract: Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009).

1,574 citations


"Mitral valve endocarditis caused by..." refers background in this paper

  • ...As presently illustrated, large or multiple abscesses that respond poorly to antibiotics and pose a threat of splenic rupture are indications for splenectomy [1,14,15], which should be performed before valvular surgery, unless the latter is urgent [1,14]....

    [...]



Journal ArticleDOI
TL;DR: The ICE-PCS database offers a unique opportunity to evaluate the epidemiology, characteristics, and outcome of endocarditis due to non-HACEK gram-negative bacilli in a large, contemporary, and international cohort of well-characterized patients withendocarditis.
Abstract: Endocarditis caused by non-HACEK organisms (species other than Haemophilus species, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella species) has lon...

175 citations


"Mitral valve endocarditis caused by..." refers background in this paper

  • ...aeruginosa endocarditis has not been reached [2,4]....

    [...]

  • ...A long three-week period of smoldering infection culminating in sepsis in our case is consistent with observations that pseudomonal infection might have a subacute onset [2,5]....

    [...]

  • ...beta-lactam or carbapenem) have also proven successful [2,10]....

    [...]

  • ...aeruginosa endocarditis is rarely cured by antibiotics alone (12%-15% of cases), and an early valve-replacement surgery with a prolonged postoperative antibiotic course is recommended [2,4]....

    [...]

  • ...aeruginosa infections has been noted, with most cases occurring in hospital settings and affecting the left side of the heart [2,4-8]....

    [...]