Drainage of Cerebral Abscesses Prior to Valve Replacement in Stable Patients with Acute Left-Sided Infective Endocarditis

Molnar, Adrian; Beyer, Ruxandra; Florian, Ioan Ştefan; Mureșanu, Dafin F.; Trifan, Catalin; Muresan, Ioan-Paul; Săcui, Diana; Scridon, Traian; Bălănescu, R

doi:10.2174/1871527314666150317224921

Cited by 4 publications

(3 citation statements)

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“…Identification of cerebral involvement during an infection is important prior to valve replacement, since both C. burnetii and A. defectiva have been described as causes of brain abscesses [ 21 , 51 , 52 ]. As in other types of cardiovascular surgery, the selective screening and elective repair, as opposed to emergency surgery, improve the prognosis [ 53 ].…”

Section: Discussionmentioning

confidence: 99%

Frenemies within: An Endocarditis Case in Behçet’s Disease

Moroșan

Șerban

Trifan³

et al. 2021

JPM

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A 57-year female patient diagnosed with Behçet’s disease, on azathioprine, was noticed to have at a routine examination antinuclear and antiphospholipid antibodies. An overlapping lupus-like syndrome was diagnosed; hydroxychloroquine and aspirin were added. Three years later, the patient presented with dyspnea and sweating, with no fever. A cardiac bruit was noted; a giant vegetation was detected by echocardiography. Laboratory revealed severe thrombocytopenia, antiphospholipid antibodies and low complement. Blood cultures were positive for Abiotrophia defectiva serology and also revealed a chronic Coxiella burnetii infection. Antibiotic therapy, low-dose anticoagulation and control of the underlying disease mildly improved the platelet count, which fully recovered only after cardiac valve replacement. However, the Behçet’s disease, initially quiescent, flared after the therapy of infections. We discuss potential links between Behçet’s disease and the occurrence of antinuclear and antiphospholipid antibodies and Coxiella endocarditis in this setting. We also highlight the differences between the endocarditis in Behçet’s disease, antiphospholipid syndrome, Coxiella burnetii and Abiotrophia defectiva infection, respectively. Intracellular infections may modify the presentation of autoimmune diseases. Confounding clinical features of Coxiella persistent infection and non-bacterial thrombotic endocarditis in Behçet’s disease warrant further insight.

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Section: Discussionmentioning

confidence: 99%

Frenemies within: An Endocarditis Case in Behçet’s Disease

Moroșan

Șerban

Trifan³

et al. 2021

JPM

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“…Serial imaging is often necessary to document improvement and resolution of abscesses. 8,24,45 Antimicrobial therapy should be selected with attention to CNS penetrating effectiveness.…”

Section: Brain Abscessmentioning

confidence: 99%

“…12 When considering surgical intervention in the presence of a cerebral abscess, limited data suggest that the brain abscess should be addressed prior to cardiac surgery. 45 Antibiotic therapy should be carefully selected as CNS penetration can differ between agents, and some antibiotics (β-lactams and cefepime) can induce neurotoxicity, especially in the elderly. 55…”

Section: Treatment Antibiotic Choice and Abscess Managementmentioning

confidence: 99%

Neurological Complications of Endocarditis: A Multidisciplinary Review with Focus on Surgical Decision Making

et al. 2019

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Infective endocarditis (IE) is a systemic disease with many potential neurologic manifestations including ischemic and hemorrhagic strokes, cerebral microbleeding, infectious intracranial aneurysms, meningitis, brain abscesses, and encephalopathy. The majority of left-sided (heart) IE patients have brain lesions that may alter management decisions, warranting the systematic use of magnetic resonance imaging. Many patients require surgical treatment of valvular disease, and central nervous system lesions weigh into decision making. Data regarding the timing of surgery are conflicting, but earlier surgery appears to be safe in most ischemic strokes, while ideally surgery should be delayed for 3 to 4 weeks in patients with hemorrhagic strokes. IE requires a multidisciplinary team to collaboratively care for the patient. In this article, we review the current understanding and management of the neurological complications of IE and their impact on the performance and timing of cardiac surgery.

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The role of cardiac rehabilitation after Streptococcus agalactiae Infective Endocarditis with Septic Embolic Complication in an Elderly Patient: Case Report

Oprea

Scurtu

Encică³

et al. 2021

Balneo and PRM Research Journal

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Introduction. In the past, Streptococcus agalactiae was known to be associated with invasive infections in pregnant women and newborns. More recently, given a more appropriate antibiotic prophylaxis and treatment, the incidence among pregnant women and infants diminished. However, an increasing number of cases with infective endocarditis with Streptococcus agalactiae has been reported in the recent years in older patients with underlying comorbidities. Case report. An 80-year-old female patient presented with dyspnea, weight loss, fever, fatigue, chills, dry cough and bilateral lower limb edema. The work-up revealed complicated infective endocarditis with Streptococcus agalactiae on the native aortic valve with severe aortic regurgitation as a result of the valvular destruction and a metastatic spleen abscess. Antibiotic treatment was started with resolution of the fever and chills. The patient however developed congestive heart failure due to the valvular regurgitation. A decision was made to proceed urgently with aortic valve replacement and splenectomy, which were performed at the same time, followed by a good recovery. Results and discussion. An increasing number of cases with IE with GBS in elderly patients has been reported in the recent years, with high rate of complications and mortality. The underlying comorbidities are important risk factors for S. agalactiae IE. Considering our case, a patient in her eighties with significant abdominal surgical history and multiple medical conditions could be a typical host. Recovery after cardiac surgery is one of the most important indications of physical training. This includes patients post-coronary artery bypass grafting, after valve prosthetic replacement, after surgery for congenital diseases and after heart transplantation. Early mobilization is particularly important in avoiding immobility and cardiac deconditioning. Conclusions. Despite the fact that mortality in Group B Streptococcus endocarditis is 40%, a combined medical and surgical strategy individualized to the specific situation of each patient have led to a positive outcome in a number of cases. We present such a combined treatment approach in a case of complicated infective endocarditis with metastatic spleen abscess in an elderly patient. The aortic valve replacement and splenectomy were performed at the same time. Keywords: endocarditis, septic emboli, valve replacement, splenectomy

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Drainage of Cerebral Abscesses Prior to Valve Replacement in Stable Patients with Acute Left-Sided Infective Endocarditis

Cited by 4 publications

References 0 publications

Frenemies within: An Endocarditis Case in Behçet’s Disease

Frenemies within: An Endocarditis Case in Behçet’s Disease

Neurological Complications of Endocarditis: A Multidisciplinary Review with Focus on Surgical Decision Making

The role of cardiac rehabilitation after Streptococcus agalactiae Infective Endocarditis with Septic Embolic Complication in an Elderly Patient: Case Report

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