Invasive Listeriosis of Intracardiac Device

Abstract

Introduction Listeria monocytogenes is a food-borne pathogen which can cause invasive infection in immunocompromised adults. Listeria has been known to cause infections during pregnancy and in older adults. Listeria endocarditis is a rare condition. A case of listeria-related intracardiac device infection is reported below. Case Report A 74-year-old male with a past medical history of coronary artery disease, congestive cardiac failure, permanent atrial fibrillation status after nodal ablation, and placement of a biventricular pacemaker presented to the hospital with complaints of generalized fatigue. He was found to have listeria bacteremia, and transthoracic echocardiogram (TTE) showed pacemaker lead vegetation. The patient was treated with 6 weeks of vancomycin followed by oral suppression with amoxicillin. Discussion Listeria can affect native valves, prosthetic valves, or nonvalvular intracardiac devices. The mean age of prosthetic valve endocarditis has been reported to be 67 years with male-to-female ratio 1.7 : 1 and mitral-to-aortic valve ratio 1.3 : 1. There have been case reports of listeria prosthetic valve endocarditis; however, there is paucity of literature on listeria-related pacemaker lead infection. Treatment is mostly a combination of penicillin and aminoglycosides for 4–6 weeks. Surgical removal of the infected device is preferred. Invasive listeriosis is a rare but fatal entity which should be identified and treated promptly to ensure a good outcome.

Recurrent, ICD-associated L. monocytogenes bacteraemia with multiple septic pulmonary embolisms over a 2-year period

“…In the case reports mentioned above, imaging helped in the diagnostic workup; for instance, an echocardiogram showing signs of vegetation attached to the pacer lead [13], or a PET/CT showing an increased uptake in the aortic graft region [9]. However, in the case presented here, both TEE and PET/CT failed to identify the intracardiac device as the focus of infection.…”

“…for 6 weeks followed by amoxicillin p.o. [13]. Other reports detail L. monocytogenes-associated relapses stemming from infected valves or aortic grafts [6,9], with the case described by Rohde et al experiencing two L. monocytogenes episodes within 7 weeks [9].…”

Recurrent, ICD-associated L. monocytogenes bacteremia with septic pulmonary embolisms over a 3-year period

“…for six weeks followed by amoxicillin p.o. (12). Other reports detail L. monocytogenes-associated relapses stemming from infected valves or aortic grafts (5, 8), with Rohde et al's case experiencing two L. monocytogenes episodes within seven weeks (8).…”

“…In the case reports mentioned above, imaging helped in the diagnostic workup; for instance, an echocardiogram showing signs of vegetation attached to the pacer lead (12), or a PET/CT exhibiting an increased uptake in the aortic graft region (8). However, in the case presented here, both TEE and PET/CT failed to identify the intracardiac device as the focus of infection.…”

21st century medicine and emerging biotechnological syndromes: a cross-disciplinary systematic review of novel patient presentations in the age of technology

“…A high number of device-related infections involved unusual pathogens: listeria bacteraemia originating from a pacemaker [57] and life-threatening implications of necrotising pulmonary aspergillosis originating from LVAD [58]. Further, allergy to pacemaker compounds and infection can be hard to distinguish, as highlighted in Robledo-Nolasco's paper regarding the 17F treated with antibiotics for 18 months for a presumed pacemaker infection -only to later find this was a case of nickel rejection [59].…”