Infective endocarditis and brain abscess secondary to Aggregatibacter aphrophilus

Daoud, Hussein; Abugroun, Ashraf; Olanipekun, Olalekan; Garrison, D. H.

doi:10.1016/j.idcr.2019.e00561

Cited by 15 publications

(10 citation statements)

References 30 publications

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“…More specifically, Q fever IE has been reported in patients with transposition of the great vessels [19], truncus arteriosus and tetralogy of Fallot [20], VSD [21,22], dextrocardia [23], cactus aorta [24], and coarctation of the aorta [25]. Moreover, although several cases of brain abscess secondary to IE have been published to date [26][27][28], the present report constitutes the first case of brain abscess attributed to Coxiella burnetii BCNIE.…”

Section: Discussionmentioning

confidence: 65%

Coxiella Endocarditis as the Cause of Recurrent Fever and Brain Abscess in a Patient with Complex Congenital Heart Disease: A Case Report and Literature Review

Ziogas

Evangeliou

Tsachouridou

et al. 2020

Case Reports in Infectious Diseases

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Introduction. Blood culture-negative infective endocarditis (BCNIE) can present subtly and is associated with a diagnostic delay leading to increased morbidity and mortality. Case Report. We present the case of an 18-year-old male with a history of complex congenital heart disease and 3-year intermittent episodes of fever of unknown origin, who was referred to our hospital for upper and lower extremity focal seizures. Laboratory blood tests were normal, blood cultures were negative, and brain imaging revealed an abscess. Cardiology consultation was requested, and transthoracic echocardiography revealed an intracardiac vegetation. Empiric antibiotic treatment with sultamicillin, gentamycin, and meropenem was initiated. Serology testing was positive for Coxiella burnetii, and the diagnosis of BCNIE was established. The antibiotic course was changed to oral doxycycline for 36 months and led to resolution of IE, with no vegetation detected on TTE after 15 months. Conclusion. BCNIE is a life-threatening disease entity that can lead to severe complications, such as valve regurgitation, emboli, and death. Patients with congenital heart disease are particularly vulnerable to IE. Timely diagnosis and antibiotic management are of paramount importance in order to avoid the potentially fatal sequelae.

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Section: Discussionmentioning

confidence: 65%

Coxiella Endocarditis as the Cause of Recurrent Fever and Brain Abscess in a Patient with Complex Congenital Heart Disease: A Case Report and Literature Review

Ziogas

Evangeliou

Tsachouridou

et al. 2020

Case Reports in Infectious Diseases

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“…The recognition of cerebrovascular events (cerebral embolism and intra-cerebral haemorrhage) as the most frequent neurologic complication of IE have been widely reported by many authors; some of whom have similarly observed that brain abscess had low frequency of occurrence in their studies. 2,7,9,18 Kim et al 19 described in detail the spectrum of cranial CT or MRI findings. They observed that tiny enhancing lesions in the white mater seemed to be valuable features which could be used to differentiate the neurological complications of I.E.…”

Section: Discussionmentioning

confidence: 99%

“…They showed little mass effect and their characteristic ring enhancement swayed diagnosis in their favour. The management of brain abscess is essentially with the use of intensive antimicrobials in those with microabscesses whereas those with macroabscesses benefit from surgical drainage in addition to antimicrobial therapy 2,18 . In this case report surgical intervention was done to drain the macro abscesses in addition to antimicrobials.…”

Section: Discussionmentioning

confidence: 99%

Multiple Brain Abscesses In A Child With Infective Endocarditis

FWACS, FMCR,

PON, BEd, PhD,

FWACS, Mni,

et al. 2023

IJHMR

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Background: Infective endocarditis is a lethal infection affecting the endocardium of the heart and the valves.The causes are varied with staphylococcus aureus and streptococcus as the major causative agents.The triad of fever exceeding 38oc,vegetation in the heart and blood culture of the causative agents are the hallmarks of the diagnosis .The disease is known to be affect all ages with the very young age group, those with congenital heart disease and those on cardiac prosthesis as the most vulnerable. Septic emboli from the septic vegetation can spread to the brain, kidney, spleen, and lungs resulting in massive metastatic infections.It therefore has multisystemic manifestations and complications. Though neurological complications are common, brain abcess is known to be rare constituting only 1.0% of neurological complications. Objective: The study aimed at reporting occurrence of both cerebral and cerebellar micro- and macro-abscesses in a 3 year boy with infective endocarditis; a rare occurrence in the literature. Methods: This case report was carried out at University College Hospital Ibadan. Results: The boy presented with fever of 38oc for five weeks, convulsions and altered state of consciousness for ten days..In course of treatment patient however developed irritability and aggressive behaviour, which attracted the use of largactil to which he reacted with extrapyramidal signs and convulsions. Within the week he developed yellowness of the eyes and increase in abdominal girth. Patient had cranial computed tomography (CT) after plain skull X-rays and was referred to University College Hospital Ibadan as a result of the radiologically diagnosed brain abscess seen on CT images. child had grunting respiration with dyspnea, and the respiratory rate was 50/mm. However, the chest was clinically clear. In the cardiovascular system (CVS); the pulse was 140/mm, with moderate volume. The blood pressure (BP) was l60/110 mmHg. The first and second heart sounds were heard with a gallop rhythm. Cranial CT scan showed multiple ring enhancing hypodense lesions with surrounding hypodensity measuring 1cm in diameter and above with only a few measuring less than 1.0cm in both cerebral hemispheres and cerebelli in keeping with multiple cerebral and cerebellar abscesses. An echocardiography showed a brightly echogenic spot attached to the papillary muscle in the left ventricle suggesting vegetation consistent with an infective endocarditis. Retroviral test was negative for both type I and II.Blood culture — was negative, however urine culture yielded klebsiella sp. Serum urea, creatinine, Ca2+ and P04 were all elevated.The abdominal ultrasound scan confirmed the hepatosplenomegaly with decreased echogenicity but both kidneys appeared normal.There was no demonstrable ascitis. The boy was placed on antimicrobials; and had craniotomy for the drainage of the macroabscesses. He improved significantly. His renal and cardiac condition equally improved; he was subsequently discharged to continue treatment in the the paediaric outpatient. The infective endorcarditis still poses enormous challenge in management and the condition calls for multi disciplinary approach. It requires high index of suspicion for early detection; as well deployment of multiple imaging modalities by the cardiologists and radiologists to arrive at a more accurate diagnosis for effective patient management. This may save financial and material resources on part of the patients, care givers, the facility managers and the society at large.

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“… History of AVR due to BAV. Diabetes Splinter hemorrhage in one finger Blood culture (+) 7/8 TEE (+) TTE (+) Veg on MV Protease valve No Anterior mitral leaflet CRO, 4 weeks + GEN, 2 weeks No No 12 14 2019 53/M Confusion, fever, night sweats, chills, and an unintentional twenty-pound weight loss over the past two months. No No Blood culture (-) TEE (+) TTE (+) Large weakly echogenic MV veg.…”

Section: Literature Reviewmentioning

confidence: 99%

Challenges and Insights in Aggregatibacter aphrophilus endocarditis: a review of literature

Zacarías Mendoza,

Gamarra Valverde,

Robles Velarde

2023

Arch Peru Cardiol Cir Cardiovasc

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Infective endocarditis is a serious disease associated with high mortality despite recent advances in diagnosis and treatment. Aggregatibacter aphrophilus is a fastidious Gram-negative member of the HACEK organisms (Haemophilus spp., Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae). A. aphrophilus is associated with dental infections but has also been implicated in cases of infective endocarditis. We highlight the importance of a high index of suspicion in symptomatic patients with an initial negative blood culture, particularly in high-risk groups such as patients with congenital valve disease and prosthetic valve. The knowledge of this rare entity may lead to early diagnosis and appropriate management. We review the main characteristics of Aggregatibacter aphrophilus endocarditis reported in the medical literature.

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Infective endocarditis and brain abscess secondary to Aggregatibacter aphrophilus

Cited by 15 publications

References 30 publications

Coxiella Endocarditis as the Cause of Recurrent Fever and Brain Abscess in a Patient with Complex Congenital Heart Disease: A Case Report and Literature Review

Coxiella Endocarditis as the Cause of Recurrent Fever and Brain Abscess in a Patient with Complex Congenital Heart Disease: A Case Report and Literature Review

Multiple Brain Abscesses In A Child With Infective Endocarditis

Challenges and Insights in Aggregatibacter aphrophilus endocarditis: a review of literature

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