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A 57-year-old man with type II mixed cryoglobulinaemia presented to the emergency department with a history of worsening lethargy, malaise and non-drenching night sweats in a relapsing-remitting pattern. He was diagnosed with type II mixed cryoglobulinaemia 7 months ago following episodes of fever, night sweats, lethargy and malaise associated with a non-blanching, purpuric, raised erythematous rash that responded partially to immunosuppressive therapy and short courses of oral antibiotics. A single blood culture then yielded Granulicatella adiacens which was reported as a possible contaminant and therefore, not pursued. Despite numerous other investigations, the underlying cause of his type II cryoglobulinaemia remained undetermined. On his current presentation, the physical examination revealed signs of infective endocarditis. Two further blood cultures grew G. adiacens. The diagnosis of infective endocarditis was established on a transoesophageal echocardiography, and the subsequent antibiotic and surgical therapy resulted in complete remission of his type II mixed cryoglobulinaemia., (2015 BMJ Publishing Group Ltd.)

A 66-year-old male presenting with low-grade fever and general fatigue was diagnosed as having infected myxoma of the left atrium. Blood cultures grew Streptococcus mitis. He underwent urgent resection and histological examination revealed tumor cells in a mucopolysaccharide matrix and bacterial colonies along with active inflammation. Infected cardiac myxoma is extremely rare; however, it contains a potential risk of arterial embolization and so early diagnosis and urgent surgery should be considered., (© 2013 Wiley Periodicals, Inc.)

Bacterial attachment to host surfaces is a pivotal event in the biological and infectious processes of both commensal and pathogenic bacteria, respectively. Serine-rich repeat proteins (SRRPs) are a family of adhesins in Gram-positive bacteria that mediate attachment to a variety of host and bacterial surfaces. As such, they contribute towards a wide-range of diseases including sub-acute bacterial endocarditis, community-acquired pneumonia, and meningitis. SRRPs are unique in that they are glycosylated, require a non-canonical Sec-translocase for transport, and are largely composed of a domain containing hundreds of alternating serine residues. These serine-rich repeats are thought to extend a unique non-repeat (NR) domain outward away from the bacterial surface to mediate adhesion. So far, NR domains have been determined to bind to sialic acid moieties, keratins, or other NR domains of a similar SRRP. This review summarizes how this important family of bacterial adhesins mediates bacterial attachment to host and bacterial cells, contributes to disease pathogenesis, and might be targeted for pharmacological intervention or used as novel protective vaccine antigens. This review also highlights recent structural findings on the NR domains of these proteins., (© 2012 John Wiley & Sons A/S.)

Subacute bacterial endocarditis (SBE) associated with antiproteinase-3 antineutrophil cytoplasmic antibodies (PR3-ANCA) has previously been reported in 10 cases of Streptococcus viridans and in 1 case of Escherichia faecalis infection. Most of these patients had hypocomplementemia and were positive for several autoantibodies. The infections in most of these patients showed good responses to antibiotic treatment. We report three patients with ANCA-positive SBE, which was induced by attenuated slow-growing intracellular pathogens; these patients had severe complications, such as acute kidney injury, cerebral embolism, and aortic valve destruction.

S. bovis is known for causing bacteremia and endocarditis as well as accompanying malignant diseases of the gastrointestinal tract. Hence, identification of this species and recognition of the clinical characteristics of infections caused are essential for both therapy and prognosis. S. bovis isolated from haemoculture requires an immediate search for gastrointestinal tract lesions.

It has been suggested that 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) might serve as a tool for the often difficult diagnosis of infective endocarditis. The case is described of a patient with a Bartonella henselae endocarditis with a negative FDG-PET. This case report demonstrates that negative FDG-PET findings do not rule out the presence of endocarditis.

We describe an elderly patient presenting with cardio-embolic stroke who was found to have infective endocarditis (IE) affecting the mitral valve. Penicillin-resistant Facklamia hominis was identified as the causative pathogen. Despite initiation of aggressive antibiotic treatment, the patient suffered a fatal myocardial infarction 2 days post-diagnosis of IE. Facklamia spp. have not been previously reported to be associated with IE. Here, we discuss the link between IE and cardio-embolic stroke along with a discussion of various causative pathogens.

We report the first successful application of nonferromagnetic embolization coils for endovascular exclusion of a mycotic right subclavian artery aneurysm. A 58-year-old woman presented with acute cervical pain and a pulsatile mass in the right supraclavicular fossa under antibiotic medication for subacute infectious endocarditis. Diagnostic work-up including duplex sonography, digital subtraction angiography, and magnetic resonance imaging demonstrated a saccular aneurysm of the extrathoracic right subclavian artery. As an alternative to open surgery or stent-graft repair, this pathology was electively treated by transcatheter coil embolization. No neurological deficit or ischemic symptoms were noted during 9 months clinical follow-up. Multislice computed tomography scan revealed complete occlusion of the mycotic aneurysm 6 months after the interventional procedure. Transcatheter closure with Inconel embolization coils is a cost-effective and safe therapeutic option in patients with mycotic aneurysm originating from the subclavian artery.

Endogenous endophthalmitis is a rare complication of infective endocarditis and has been decreasing due to the availability of effective antibiotics. We highlight a case of endogenous endophthalmitis due to levofloxacin-resistant Streptococcus mitis presenting as infective endocarditis. Endogenous endophthalmitis should be considered as a manifestation of an underlying systemic disease, especially in patients who present with non-specific signs and symptoms with no obvious source of precipitating infection.

A prospective study of all cases of Streptococcus suis blood or CSF culture positive admitted to Lamphun Provincial Hospital in northern Thailand was carried out. Fifty-three cases of S. suis were identified, which comprised 70% of all viridans streptococci cases. The majority of cases (88.6%) were contracted orally and 83.0% had an underlying disease present. Five clinical syndromes were identified: acute meningitis (37.2%), septicemia (27.9%), toxic shock syndrome (TSS) (23.3%), subacute bacterial endocarditis(SBE) (9.3%) and spondylitis (2.3%). The patients with TSS had a lower mean age than those without TSS. S. suis IgG and IgM antibody levels in the TSS group were lower than those without TSS which is important when considering the clinical syndrome and severity of the infection.

Bartonella quintana is a gram-negative microorganism, which may lead to infective endocarditis especially in compromised patients. The major concern about this pathogen is the diagnosis and detection. Furthermore, the treatment of the infection has been a challenge for physicians. In this report, we present a 71-year-old patient with Bartonella quintana aortic valve endocarditis from the view of diagnosis and treatment aspects.

The pathogenesis of Osler's nodes and Janeway lesions remains a mystery despite vigorous debate over the last 113 years. They are given great emphasis among the clinical signs of bacterial endocarditis but are seldom seen in practice. Two cases of subacute bacterial endocarditis are presented. A 66-year-old woman with Bartonella henselae endocarditis developed Osler's nodes on the hands postoperatively, and a 23-year-old man with Streptococcus oralis endocarditis developed tender macules with an appearance suggestive of Janeway lesions on one heel. The dermatopathology was similar in the two cases, consisting of a leukocytoclastic vasculitis without micro-abscess formation or visible organisms. Although the appearance is usually consistent, it is not always possible to distinguish Osler's nodes from Janeway lesions based purely on clinical presentation. Furthermore, the histology of both clinical signs can look similar. Further reports are needed before more firm conclusions can be drawn, however, it may be that the histological appearance of Osler's nodes and Janeway lesions is primarily determined by the nature of the causative organism, while the clinical appearance may be determined by anatomical site.

There are several species of coagulase-negative Staphylococci (CoNS) that are part of the normal skin flora and are relatively noninvasive/low virulence organisms. CoNS are important pathogens in patients with prosthetic devices and are the most common pathogen associated with prosthetic valve endocarditis. CoNS native valve infective endocarditis (IE) is rare. Patients with hypertrophic obstructive cardiomyopathy and an outflow pressure gradient greater than 30 mm Hg are predisposed to IE. There has been only one reported case of non-mitral valve IE due to CoNS in a patient with hypertrophic obstructive cardiomyopathy. To the best of our knowledge, we report the first case of Staphylococcal hominis mitral valve endocarditis in a patient with hypertrophic obstructive cardiomyopathy.

We report a case of a 79-y-old male with enterococcal endocarditis presenting with dysphagia and weight loss. The patient's longstanding underlying bacteremia was thought to have caused pro-inflammatory changes leading to alterations in the neuronal environment affecting peripheral nerve function. Dysphagia improved once antibiotic treatment was initiated.

We describe a case of Streptococcus viridans endocarditis in a 17-year-old female with congenital ventricular septal defect, that followed shortly after performing naval piercing. She was eventually treated with penicillin with complete recovery. We review other cases from the literature of piercing-associated endocarditis, and suggest that individuals at particularly high risk might be considered for antibiotic prophylaxis prior to such procedures., (2007 S. Karger AG, Basel)

In this article we present the path that led to current concepts regarding antimicrobial treatment of endocarditis caused by viridans streptococci highly susceptible to penicillin. Early treatment trials indicate that some patients with subacute endocarditis can be cured with shorter treatment duration than currently advised by international guidelines. Also, high-dose antibiotics, as recommended today, have a predominantly pharmacokinetic and pharmacodynamic rationale that is based mostly on experimental animal studies. Shortening antimicrobial treatment in select patients with endocarditis would be of great benefit. As yet there are no predictors of cure that can be used to individualize treatment duration in patients with bacterial endocarditis.

Introduction: Infections by Bartonella spp. include a wide spectrum of emerging and re-emerging infectious diseases, such as culture-negative endocarditis., Methods: Description of 3 cases of endocarditis due to Bartonella spp. and review of those previously reported in Spain., Results: Including these 3 new cases of endocarditis due to Bartonella spp., a total of 6 cases have been reported in Spain. The median age of the patients was 51.6 years and 83.3% were men. There was history of contact with cats in 66.7%, and 50% were alcoholic. Only one patient had prior valvular disease. There were no clinical manifestations typical to any of the Bartonella species. The aortic valve was the one most commonly affected. In all cases, B. henselae was the agent implicated. The diagnosis was made by serology in 5 cases (83.3%). The outcome was favorable in all patients, although 4 of them (66.7%) required valve replacement., Conclusion: Endocarditis due to Bartonella spp. is present in Spain and is likely to be underestimated. We should suspect this pathogen in patients with negative blood cultures and a history of chronic alcoholism, homeless patients, and those who have had contact with cats or who have been bitten by fleas or lice, as well as patients with endocarditis and positive serology against Chlamydia spp.

Congenital cardiac disease is recognized as a major predisposing substrate for infective endocarditis. We present three cases of unanticipated intraoperative discovery of vegetations in patients with congenital cardiac malformations without preoperative clinical, laboratory or echocardiographic evidence of infective endocarditis, and their successful treatment. The relevant literature is reviewed, with emphasis of the need to maintain a high index of suspicion for the presence of endocarditis during repair of congenital cardiac lesions.

Endocarditis due to Pasteurella pneumotropica are very rarely described. We report a new case of bacterial endocarditis in a 43 years-old patient with mitral stenosis. The patient was admitted to the hospital for lethargy, malaise and hemiparesis. On physical examination, a new systolic murmur was found. Transthoracic echocardiography revealed a vegetation on the mitral valve. Three blood culture sets were drawn and after 24 hours of incubation, the last two sets yielded Pasteurella pneumotropica and cell wall deficient forms (L-forms). The patient was successfully treated with gentamicin and ceftriaxone and underwent mitral valve replacement.

We report the successful surgical intervention in two cases of aortic valve bacterial endocarditis after scorpion stings. Infective endocarditis developed in both patients several weeks after they suffered repeated scorpion stings. Both patients had similar, but uncommon features: (1) the isolated organisms were unusual causes of infective endocarditis (streptococcus group G and Streptococcus milleri), (2) annular abscesses developed that required either aortic root replacement with a homograft or annular patch repair with pericardium, and (3) complete heart block developed postoperatively, requiring permanent pacemaker implantation. Both patients completed a 6-week postoperative course of antibiotic therapy and are without recurrent infection.

We describe a case of Gemella bergeriae endocarditis in a patient with a bicuspid aortic valve. Diagnosis was confirmed by sequencing of 16S rRNA genes in heart valve tissue. This is the first report of Gemella endocarditis confirmed by molecular detection of bacterial genes in heart valve tissue.

A 6-year-old boy presented with fatigability, shortness of breath, and bulging neck veins. Echocardiography revealed large vegetations, aortic insufficiency, a dilated left ventricle, and bicuspid aortic valve. There was no history of immunocompromise, fevers, or feline exposures. Blood cultures were negative; antibodies against Bartonella henselae were positive. Gentamicin was administered intravenously. Ross procedure was performed and patient was discharged on antibiotics in 5 days. Native valve was thickened by scar and fibrinous vegetations. Warthin-Starry stain demonstrated coccobacilli. Light and ultrastructural morphology, and monoclonal staining implicated B. henselae. Bacterial membranes contain calcium apatite crystals. Antigenic material was present in bacteria and calcified nodules. This case illustrates calcified protobacteria becoming incorporated into scar tissue during endocarditis.

We report the first documented case of Gemella haemolysans endocarditis in the United States in a patient following denture fixation. G. haemolysans was isolated form the patient's blood cultures. The patient was treated with ampicillin for 6 weeks with significant clinical improvement. This case highlights the fact that endocarditis prophylaxis should be considered in denture fixation for high risk patients.

Erysipelothrix rhusiopathiae is a rare cause of endocarditis. Most cases were observed in people working with animals. We report a case in a 45-year old man without any exposure to animals. He was admitted to our hospital because of dyspnoea. Blood cultures were drawn following fever on day 8 of hospitalisation. Erysipelothrix rhusiopathiae was cultured and echocardiography showed a vegetation on the mitral valve. Appropriate antibiotic therapy and surgical treatment led to a good outcome of the infection.

A 31-year-old woman underwent urgent aortic valve replacement due to infective endocarditis at 16 weeks' gestation. Because of rapid and severe congestive heart failure, maternal rescue was regarded as the priority in the anesthetic management. Previous literature shows that high-flow high-pressure normothermic perfusion during cardiopulmonary bypass provides the best way of reducing fetal risk. Though it was not performed, the fetus was alive for 24 hours after the operation. Perioperative administration of dopamine and furosemide could have diminished uterine blood flow. If these drugs could have been avoided, the fetus may have stayed alive. However, considering the risk of teratogenesis due to drug administration and cardiopulmonary bypass, propriety of pregnancy prolongation is controversial.

We report an illustrative case of a 60-year-old man with Streptococcus viridans subacute bacterial endocarditis (SBE) and positive antineutrophil cytoplasmic autoantibodies (c-ANCA). C-ANCA positivity has been associated with a variety of rheumatic and infectious disease areas, but has been rarely associated with SBE. The patient had mitral valve prolapse with mitral regurgitation, and S viridans SBE developed after a dental procedure. Laboratory abnormalities included anemia, elevated erythrocyte sedimentation rate, positive rheumatoid factor, positive anticardiolipin antibody, positive lupus anticoagulant, and highly elevated c-ANCA level. We believe this is only the ninth reported case of S viridans SBE with a positive c-ANCA, and the third with mitral valve prolapse and vegetations.

The paper contains the generalized many-year research conducted by staff of the chair for microbiology (including virology and immunology) aimed at describing the universal principles related with forming an inter-individual diversity of gastric-and-intestinal micro-biocenosis. The research demonstrated a high dependence of qualitative and quantitative parameters of the analyzed biotope on various-genesis factors. It was established that the nature of violations in the gastric-and-intestinal micro-biocenosis is not dependent on peculiarities of an influencing pathogenetic factor, and its difference is related only with quantitative and qualitative (specific) changes in the microbial composition. The marked feature makes it possible to regard the gastric-and-intestinal micro-biocenosis as a non-specific indicator of the condition of a macro-organism and that of the environmental quality.

Aim: It is routine practice to prolong the incubation period of blood cultures from patients with suspected subacute bacterial endocarditis (SBE) or fungal infection. The protocol in this laboratory required 28 days incubation with weekly subcultures. Following the introduction of automated continuously monitored blood culture instruments, the duration of incubation for specimens from these categories of patients was reviewed., Method: In a retrospective study of blood culture specimens submitted from 1 July 1994 to 31 July 1998, the time from collection to a positive signal from the BacT/Alert automated blood culture system, in patients suspected of SBE or fungal infection, was assessed., Results: From 355 patient episodes, 896 bottles were incubated for up to 28 days, during which time 116 bottles (40 patient episodes) signalled positive. Significant organisms from suspected endocarditis patients were isolated from 87 bottles (87%), with the time to detection ranging from 9 to 96 hours. The data collected from significant isolates obtained from clinically suspected fungaemias were extremely small, prompting a review of the total fungal isolates from all blood culture bottles incubated during the study period. Yeast isolates were obtained from 78 (0.08%) bottles with the detection time ranging from 15 to 144 hours., Conclusion: The practice in this laboratory now is to incubate blood cultures for up to 7 days when the clinical notes indicate the possibility of SBE or a fungal infection.

Henoch-Schönlein purpura (HSP), a systemic, small-vessel vasculitic syndrome, is characterized by a nonthrombocytopenic purpuric rash, arthralgia, abdominal pain, and nephritis. These signs and symptoms may occur in any order, and not all are necessary for the diagnosis. Although most common in 4- to 7-year-olds, HSP is well documented in adults and is often preceded by a history of mucosal-based infections, especially of the upper respiratory tract. We report a case of HSP that occurred coincident with the onset of subacute bacterial endocarditis (SBE) in an otherwise healtny 41-year-old white woman. The patient presented with a purpuric rash and arthralgia and was found to have left-sided streptococcal SBE. She subsequently developed abdominal pain and immune complex glomerulonephritis. The bacterial endocarditis was treated with antibiotics and mitral valve replacement, followed by a spontaneous resolution of the associated signs and symptoms of HSP.

Streptococcus sanguis is the major causative organism of infective (bacterial) endocarditis but, surprisingly, almost nothing is known about how it induces endocardial inflammation. In earlier studies we have shown that many bacteria secrete potent cytokine-inducing or -inhibiting proteins. We have therefore isolated the material secreted by S. sanguis grown on blood agar or in broth culture and have tested its ability to induce human peripheral blood monocytes to synthesize pro-inflammatory cytokines. The activation of monocytes by the secreted components of S. sanguis was almost totally blocked by heat and trypsin treatment but not by the lipopolysaccharide-inactivating antibiotic, polymyxin B, suggesting that activity is due to secreted proteins. The activity of the secreted material was significantly reduced by anti-CD14 monoclonal antibodies suggesting that the active protein (or proteins) was binding to the CD14/Toll-like receptor (TLR)4 complex. Fractionation of the secreted proteins by high performance liquid chromatography (HPLC) identified two proteins as being responsible for the majority of the cytokine induction: a manganese-dependent superoxide dismutase and a 190 kDa protein, which could not be sequenced, but which was neither CshA nor the PI/II proteins. These proteins, or the receptors to which they bind, may be therapeutic targets and may allow the development of adjunctive therapies to prevent endocardial damage during the often prolonged treatment of infective endocarditis with antibiotics. In addition, blocking of CD14 may have some therapeutic benefit., (Copyright 2002 Academic Press.)

Mycotic aneurysms are rare complications in patients with infective endocarditis, particularly in the pediatric population. We report a case of mycotic aneurysm of the middle cerebral artery complicating bacterial endocarditis in a child with Down's syndrome. The patient was successfully treated medically without the need for surgical intervention.

Background: Streptococcal subacute endocarditis is characterized by low-grade systemic inflammation. Although structural cardiac defects are pivotal, phagocytic cells, i.e. monocytes and neutrophils, are involved in the induction and the course of bacterial endocarditis. Decreased production of reactive oxygen metabolites was described in long-lasting infections. We hypothesized that the oxidative burst of phagocytes induced by the infecting organism is defective in patients with streptococcal endocarditis., Patients and Methods: The monocytes and neutrophils of 11 patients with streptococcal native valve endocarditis were challenged with the respective pathogens and two control streptococcal strains, and the oxidative burst was determined by fluorescence-activated cell sorter analysis. These experiments were done before any antibiotic therapy was administered, and repeated at least 12 months after recovery. Eight volunteers served as healthy controls., Results: The monocyte response to the respective pathogens was decreased in the patient groups compared to the response to the control streptococci. After cure the monocyte response to the pathogens was not different to the response to the control strains. The monocyte response of the healthy volunteers did not show any differences between the patients' pathogens and the control strains. The neutrophil oxidative burst to the pathogens was similar to that to the control streptococci in both patient and the volunteer group., Conclusion: The decreased response of patient monocytes to the pathogens may contribute to the low-grade inflammatory response and to the course of streptococcal endocarditis.

Renal involvement is common in patients with bacterial endocarditis. The most common bacteria are staphylococci and streptococci, and the commonest renal histopathological lesion is a diffuse proliferative and exudative type of glomerulonephritis. Very rarely, patients may present with an extensive glomerular epithelial crescent formation with a rapid deterioration in the renal function. This study reviews the published literature on diffuse crescentic glomerulonephritis in bacterial endocarditis and reports a 24-year-old male patient with endocarditis due to Capnocytophagia species, a gramnegative facultative anaerobic bacillus, which normally inhabits the oral cavity. Appropriate antibiotic therapy is essential to eradicate the infection. A brief course of corticosteroid therapy may be helpful in those with deteriorating renal function. Plasmapheresis may be useful in those with persistent hypocomplementemia, increased circulating immune complexes, and a progressive deterioration in the renal function. Removal of vegetation or valve replacement may be necessary. Prognosis is generally good.