Prosthetic Valve Endocarditis Caused by Legionella pneumophila

Re, McCabe; Jc, Baldwin; Ca, McGregor; Dc, Miller; Kl, Vosti

doi:10.7326/0003-4819-100-4-525

Cited by 47 publications

(15 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…has been cited in only three publications. In 1984, McCabe reported the first case of Legionella pneumophila endocarditis in a patient with porcine aortic and mitral valve prostheses (182). In 1988, Tompkins et al reported seven cases of nosocomial prosthetic-valve endocarditis at Stanford University Hospital Center.…”

Section: ͻ150 ϫ 10mentioning

confidence: 99%

Endocarditis Due to Rare and Fastidious Bacteria

2001

View full text Add to dashboard Cite

The etiologic diagnosis of infective endocarditis is easily made in the presence of continuous bacteremia with gram-positive cocci. However, the blood culture may contain a bacterium rarely associated with endocarditis, such as Lactobacillus spp., Klebsiella spp., or nontoxigenic Corynebacterium, Salmonella, Gemella, Campylobacter, Aeromonas, Yersinia, Nocardia, Pasteurella, Listeria, or Erysipelothrix spp., that requires further investigation to establish the relationship with endocarditis, or the blood culture may be uninformative despite a supportive clinical evaluation. In the latter case, the etiologic agents are either fastidious extracellular or intracellular bacteria. Fastidious extracellular bacteria such as Abiotrophia, HACEK group bacteria, Clostridium, Brucella, Legionella, Mycobacterium, and Bartonella spp. need supplemented media, prolonged incubation time, and special culture conditions. Intracellular bacteria such as Coxiella burnetii cannot be isolated routinely. The two most prevalent etiologic agents of culture-negative endocarditis are C. burnetti and Bartonella spp. Their diagnosis is usually carried out serologically. A systemic pathologic examination of excised heart valves including periodic acid-Schiff (PAS) staining and molecular methods has allowed the identification of Whipple's bacillus endocarditis. Pathologic examination of the valve using special staining, such as Warthin-Starry, Gimenez, and PAS, and broad-spectrum PCR should be performed systematically when no etiologic diagnosis is evident through routine laboratory evaluation

show abstract

Section: ͻ150 ϫ 10mentioning

confidence: 99%

Endocarditis Due to Rare and Fastidious Bacteria

2001

View full text Add to dashboard Cite

show abstract

“…Previously prosthetic valve legionella endocarditis has been reported. 3 Furthermore, in our case, the patient contracted legionella pneumonia during a regional outbreak of the disease and subsequently developed legionella endocarditis. Interestingly, this patient did develop microembolic lesions in his feet.…”

Section: Discussionmentioning

confidence: 56%

“…Interestingly very few cases of legionella endocarditis are associated with embolic phenomena causing some to conclude that emboli are not a feature of this legionella endocarditis. 3 In this case reported here, legionella endocarditis occurred in a patient with aortic homograft. Previously prosthetic valve legionella endocarditis has been reported.…”

Section: Discussionmentioning

confidence: 66%

Innocent victim of a localised outbreak: legionella endocarditis

Massey

Kumar²,

Pepper³

2003

Heart

View full text Add to dashboard Cite

Legionella pneumophila endocarditis is extremely rare. The case of a fit 26 year old man who had previously undergone homograft aortic root replacement is reported. He was admitted with legionella pneumonia during the recent localised outbreak but went on to develop endocarditis. His aortic valve was replaced with a mechanical valve and he made an uneventful recovery. Public health issues and diagnosis in susceptible patients during localised outbreaks are discussed.A 26 year old man was admitted to his local hospital with a microbiologically confirmed diagnosis of Legionella pneumophila pneumonia contracted during an outbreak in Cumbria. Significant medical history included congenital ventricular septal defect with aortic valve prolapse. Previous surgical procedures included closure of the ventricular septal defect and repair of the prolapsing aortic cusp in 1986. This was followed by aortic root replacement with a homograft for worsening aortic regurgitation in 1994. He was asymptomatic until recently and his most recent echocardiogram did not show any aortic regurgitation.Soon after his admission with legionella pneumonia, he required admission to an intensive therapy unit for respiratory failure requiring ventilation, where his stay was further complicated by the development of severe aortic regurgitation, disseminated intravascular coagulation, and microemboli affecting his digits. A diagnosis of legionella endocarditis was established and he was treated with intravenous clarithromycin and rifampicin. He made a good recovery. He was referred for urgent repeat aortic valve replacement. An echocardiogram showed severe aortic regurgitation with a dilated left ventricle (left ventricular end systolic diameter 7.0 cm) and near equilibrium of the aortic and left ventricle pressure at the end of diastole.He underwent repeat aortic valve replacement. Intraoperatively, complete destruction of both left and right cusps of the aortic valve were noted. However, there was no evidence of active infection or aortic root involvement. The valve leaflets were excised and the valve was replaced with a 23 mm St Jude Medical (St Paul, Minnesota, USA) mechanical valve. The cultures of the excised leaflets were negative, which is consistent with a prolonged course of antibiotics. He made an uneventful postoperative recovery. An echocardiogram before discharge showed no aortic regurgitation.

show abstract

“…These cases contrast with those of surgical wound infection, in which the microorganism is inoculated directly (3, 7). Legionella has already been reported to be responsible for infection of prosthetic material other than joints (4,8,9,12,13,15). Most patients were immunosuppressed, and the portal of entry remained unknown.…”

Section: Case Reportmentioning

confidence: 99%

Legionella micdadei, a New Cause of Prosthetic Joint Infection

et al. 2011

View full text Add to dashboard Cite

Extrapulmonary infections caused by Legionella spp. other than Legionella pneumophila are rare. We report what is, to our knowledge, the first description of a prosthetic joint infection due to Legionella spp. Systematic testing of samples with suspected prosthetic infection by molecular biology techniques was essential. Legionella micdadei should be added to the list of microorganisms causing prosthetic joint infection.

show abstract

Prosthetic Valve Endocarditis Caused by Legionella pneumophila

Cited by 47 publications

References 21 publications

Endocarditis Due to Rare and Fastidious Bacteria

Endocarditis Due to Rare and Fastidious Bacteria

Innocent victim of a localised outbreak: legionella endocarditis

Legionella micdadei, a New Cause of Prosthetic Joint Infection

Contact Info

Product

Resources

About