Aggregatibacter aphrophilus infective endocarditis confirmed by broad-range PCR diagnosis: A case report

Hirano, Kōji; Tokui, Toshiya; Inagaki, Masumi; Fujii, Taro; Maze, Yasumi; Toyoshima, Hirokazu

doi:10.1016/j.ijscr.2017.01.041

Cited by 14 publications

(7 citation statements)

References 13 publications

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“…This includes universal PCR analysis with 16S rRNA gene sequencing and comparison with the DNA database. 13 , 14 This is a useful tool for bacterial identification in culture negative infection, as with our case. The BR-PCR result was the first marker that led to microbial diagnosis and appropriate antibiotic treatment.…”

Section: Discussionmentioning

confidence: 55%

A rare cause of culture negative bioprosthetic valve endocarditis: a case report of Aggregatibacter aphrophilus infection

Wassef

Sarkar

Viswanathan

et al. 2021

European Heart Journal - Case Reports

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Background The prevalence of culture negative infective endocarditis (IEC) is reported as 2–7% though this figure may be as high as 70% in developing countries.1 This higher rate will, at least in part, be due to reduced diagnostic facilities though some data suggests higher rates even when appropriate cultures were taken. The frequency is significantly elevated in patients who have already been exposed to antibiotics prior to blood cultures.1,2 A rare cause of culture negative IEC is the HACEK group of organisms that are normal habitants of the oropharyngeal flora and account for 1–3% of native valve endocarditis.3Aggregatibacter aphrophilus (A. aphrophilus) is a member of the HACEK group of organisms. Case summary A 32-year-old gentleman with a previous bioprosthetic aortic valve presented with a 1-week history of diarrhoea, vomiting, malaise, and weight loss. He was awaiting redo surgery for stenosis of the bioprosthesis, which had been inserted aged 17 for aortic stenosis secondary to a bicuspid valve. The initial blood tests revealed liver and renal impairment with anaemia. A transoesophageal echocardiogram demonstrated a complex cavitating aortic root abscess, complicated by perforation into the right ventricle. He underwent emergency redo surgery requiring debridement of the aortic abscess, insertion of a mechanical aortic prosthesis (St Jude Medical, USA), annular reconstruction and graft replacement of the ascending aorta. Despite antibiotic therapy, he remained septic with negative blood and tissue cultures. Bacterial 16S rRNA gene sequencing confirmed A. aphrophilus infection, for which intravenous ceftriaxone was initiated. This was subsequently changed to ciprofloxacin due to neutropenia. The patient self-discharged from the hospital during the third week of antibiotic therapy. One week later, he was re-admitted with fever, night sweats, and dyspnoea. Transthoracic echocardiogram revealed a large recurrent aortic abscess cavity around the aortic annulus fistulating into the right heart chambers; this was confirmed by a computed tomography scan. There was dehiscence of the patch repair. Emergency redo aortic root replacement (25 mm mechanical valve conduit, ATS Medical, USA) and annular reconstruction was performed with venoarterial extracorporeal membrane oxygenation (VA-ECMO) support. VA-ECMO was weaned after 3 days. The patient completed a full course of intravenous meropenem and ciprofloxacin and made a good recovery. Discussion IEC with oropharyngeal HACEK organisms is rare and difficult to diagnose, due to negative blood culture results. The broad-range polymerase chain reaction and gene sequencing with comparison to the DNA database is useful in these circumstances. This case demonstrates the importance of the 16S rRNA gene sequencing for HACEK infection diagnosis and appropriate antibiotic treatment.

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Section: Discussionmentioning

confidence: 55%

A rare cause of culture negative bioprosthetic valve endocarditis: a case report of Aggregatibacter aphrophilus infection

Wassef

Sarkar

Viswanathan

et al. 2021

European Heart Journal - Case Reports

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“…We used the title and abstract entries “endocarditis” and “ANCA or antineutrophil cytoplasmic antibody” and “renal biopsy,” which yielded 26 well documented cases (English language only). 4 – 28 We added our case to this review and compared clinical features, pathology findings, treatment, and prognosis ( Tables 1, 2 ).…”

Section: Discussionmentioning

confidence: 99%

“…ANCA-positive IE complicated by kidney injury is rare, and only 26 cases have been reported. 4–28 Little is known about the associated renal pathology, the use of immunosuppressants, and prognosis of this condition. We report here a case of IE complicated by kidney injury accompanied by the presence of PR3-ANCA.…”

Section: Introductionmentioning

confidence: 99%

Antineutrophil cytoplasmic antibody-positive infective endocarditis complicated by acute kidney injury: a case report and literature review

Zhang

et al. 2020

J Int Med Res

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Patients with infective endocarditis (IE) may present with multisystem disturbances resembling autoimmune diseases, such as antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (AAV). The kidneys are susceptible to damage in IE and AAV, which is a source of diagnostic ambiguity. Therefore, distinguishing infection from an inflammatory process is pivotal for guiding appropriate therapy. We report a 22-year-old man with IE characterized by ANCA positivity and complicated by acute kidney injury. A renal biopsy showed crescentic nephritis with tubulointerstitial lesions. However, transthoracic echocardiography and blood culture provided evidence of IE, and AAV was ruled out. Surgical intervention and antibiotic treatments were successful. We summarized previously reported cases of ANCA-positive IE that had renal biopsy data. We found that ANCA-positive IE can involve multiple organs. The representative renal pathology was crescentic nephritis, focal segmental glomerulonephritis, mesangial cell proliferation, tubular injury, and interstitial oedema. Immunofluorescence showed predominate C3 deposits. Electron microscopy showed electron-dense deposits in the subendothelial or mesangial areas. Eight patients received immunosuppressive therapy with excellent results. Repeated testing for bacterial pathogens and multiple renal biopsies may be useful for diagnosing ANCA-positive IE. With ANCA-positive IE, immunosuppressive therapy along with antibiotic treatments may be beneficial for recovery of renal function.

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“… Mycotic cerebral embolism and hemorrhage without neurological symptoms and acute renal failure with hematuria. [ 27 ] Jung et al 42 F None. Brain: Pyogenic ventriculitis (PV) (i.e.…”

Section: Discussionmentioning

confidence: 99%

Infective endocarditis and brain abscess secondary to Aggregatibacter aphrophilus

Daoud

Abugroun

Olanipekun

et al. 2019

IDCases

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Aggregatibacter aphrophilus is a rare cause of infective endocarditis that was first described in 1940 by Khairat et al. and is now classified under the HACEK group of bacteria ( Haemophilus spp. , Aggregatibacter spp. , Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae) . There is limited literature describing the extracardiac complications of infective endocarditis caused by this organism. We report a case of a 53-year-old male with no significant past medical history who developed acute infective endocarditis complicated by a brain abscess caused by A. aphrophilus . The patient underwent aspiration of the abscess and treated with a long course of intravenous antimicrobials. This case represents a rare complication of infective endocarditis caused by A. aphrophilus and to the best of our knowledge, is the second reported case in the literature describing such a complication in a previously healthy patient. Although neurological sequela is associated with higher mortality and may be the presenting symptom of infective endocarditis, it may also be clinically silent – only detected upon imaging.

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Aggregatibacter aphrophilus infective endocarditis confirmed by broad-range PCR diagnosis: A case report

Cited by 14 publications

References 13 publications

A rare cause of culture negative bioprosthetic valve endocarditis: a case report of Aggregatibacter aphrophilus infection

A rare cause of culture negative bioprosthetic valve endocarditis: a case report of Aggregatibacter aphrophilus infection

Antineutrophil cytoplasmic antibody-positive infective endocarditis complicated by acute kidney injury: a case report and literature review

Infective endocarditis and brain abscess secondary to Aggregatibacter aphrophilus

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