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Listerial prosthetic valve endocarditis in a patient with congenitally corrected transposition of the great vessels
International Journal of Cardiology 223 (2016) 433–435
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Correspondence
Listerial prosthetic valve endocarditis in a patient with congenitally corrected transposition of the great vessels Amudhan Jyothidasan M.B.B.S, MD ⁎, Susan Noe MD, FACC, FACP, Joe B. Calkins Jr MD, FACC, FACP, FASE Medical College of Georgia and Charlie Norwood VA Medical Center, United States
a r t i c l e
i n f o
Article history: Received 5 June 2016 Accepted 30 July 2016 Available online 4 August 2016
Keywords: Listeria Endocarditis Congenitally corrected transposition of great vessels.
A 54 year old man with congenitally corrected transposition of the great vessels presented following a stroke. Echocardiogram revealed a
systemic ventricular (RV) EF of 15–20% and large highly mobile vegetations on the mitral and tricuspid valves, measuring 22 mm and 19 × 7 mm, respectively (Fig. 1 & 2) with severe mitral and tricuspid regurgitation. Blood cultures grew beta hemolytic Streptococcus. He underwent replacement of his infected atrio-ventricular valves with bioprosthetic valves. Postoperative course was uncomplicated. Two years later he presented with low-grade fever and heart failure. Blood cultures grew Listeria monocytogenes (4/4 bottles) and transthoracic echocardiogram showed a large vegetation involving the prosthetic tricuspid valve measuring 10 × 24 mm (Fig. 3) with severe tricuspid (systemic atrio-ventricular) valve regurgitation. There was no evidence of abscess or perforation. The patient declined surgical intervention for his infective endocarditis. He was treated with a 6-week course of ampicillin and gentamicin. Following completion of antibiotics, repeat blood cultures were negative and TTE showed a decrease in the size of the
Fig. 1. Transesophageal view showing vegetations involving the tricuspid (solid arrow) and the mitral (dotted arrow) valves. ⁎ Corresponding author at: 300 Ferry Road, Apt 501, Galveston, TX 77550, United States. E-mail address: [email protected] (A. Jyothidasan).
http://dx.doi.org/10.1016/j.ijcard.2016.07.282 0167-5273/Published by Elsevier Ireland Ltd.
434
Correspondence
Fig. 2. Transesophageal view showing vegetations involving the leaflets of the tricuspid (systemic AV) valve.
vegetation to 4 × 7 mm. The patient remained euvolemic and afebrile on subsequent follow up. Congenitally corrected transposition of the great vessels (CCTGV) is a rare form of congenital heart disease characterized by atrioventricular and ventriculo-arterial discordance [1,2]. Patients with CCTGV without associated anomalies usually come to medical attention with progressive congestive heart failure in adulthood. Systemic AV valve (tricuspid) regurgitation is a very common finding and it is unclear if this represents the cause or the effect of the failing ventricle. Although few studies specifically address the issue of infective endocarditis in patients with CCTGV, available reports indicate a high incidence of IE in these patients. In one series, six of 52 (11%) patients
with CCTGV developed infective endocarditis [3]. This increased susceptibility for endocarditis is likely from the underlying abnormal valves and increased turbulence from regurgitation. Listeria endocarditis is an exceedingly rare entity with one third of the reported cases occurring in prosthetic valves. Other underlying predisposing conditions include rheumatic heart disease, hypertrophic cardiomyopathy, mitral valve prolapse and ischemic cardiomyopathy [4]. Historically Listeria endocarditis has been considered a particularly severe disease that is associated with a mortality rate of nearly 50%. Valve abscess, congestive heart failure and prosthetic valve dehiscence are more common with Listeria and contribute to a high proportion of patients treated surgically. However a recent comprehensive review of
Fig. 3. Transthoracic echocardiogram showing a large vegetation involving the prosthetic tricuspid valve (systemic AV valve) extending into the systemic ventricle.
Correspondence
patients with Listeria prosthetic valve endocarditis reported a mortality rate of 21%, which is similar to that of non-Listeria prosthetic valve endocarditis [5]. The antibiotic regimen of choice is either ampicillin or penicillin combined with gentamicin for 4 weeks for native valve endocarditis and 6–8 weeks for prosthetic valve endocarditis [6]. Listeria is commonly found in the soil, decaying vegetation and feces of various mammals. It is also an important food borne pathogen with increasing reports of outbreaks causing diarrheal illnesses from unprocessed meat and dairy products [7]. Our patient had hunted and processed a wild boar several days prior to presentation, which is likely to be the source of his infection. Conflict of interest None of the authors have any conflict of interest. All authors had access to the data and were involved in writing the manuscript.
435
References [1] T.P. Graham Jr., Y.D. Bernard, B.G. Mellen, et al., Long-term outcome in congenitally corrected transposition of the great arteries: a multi-institutional study, J. Am. Coll. Cardiol. 36 (1) (2000) 255–261. [2] P. Presbitero, J. Somerville, F. Rabajoli, et al., Corrected transposition of the great arteries without associated defects in adult patients: clinical profile and follow up, Br. Heart J. 74 (1) (1995) 57–59. [3] M.S. Connelly, P.P. Liu, W.G. Williams, et al., Congenitally corrected transposition of the great arteries in the adult: functional status and complications, J. Am. Coll. Cardiol. 27 (5) (1996) 1238–1243. [4] J. Antolín, A. Gutierrez, R. Segoviano, et al., Endocarditis due to Listeria: Description of two cases and review of the literature, Eur. J. Intern. Med. 19 (4) (2008) 295–296. [5] M.L. Fernandez Guerrero, P. Rivas, R. Rabago, et al., Prosthetic valve endocarditis due to Listeria monocytogenes. Report of two cases and reviews, Int. J. Infect. Dis. 8 (2) (2004) 97–102. [6] H. Hof, An update on the medical management of listeriosis, Expert. Opin. Pharmacother. 5 (8) (2004) 1727–1735. [7] V. Ferreira, M. Wiedmann, P. Teixeira, M.J. Stasiewicz, Listeria monocytogenes persistence in food-associated environments: epidemiology, strain characteristics, and implications for public health, J. Food Prot. 77 (1) (2014) 150–170.
Contents lists available at ScienceDirect
International Journal of Cardiology journal homepage: www.elsevier.com/locate/ijcard
Correspondence
Listerial prosthetic valve endocarditis in a patient with congenitally corrected transposition of the great vessels Amudhan Jyothidasan M.B.B.S, MD ⁎, Susan Noe MD, FACC, FACP, Joe B. Calkins Jr MD, FACC, FACP, FASE Medical College of Georgia and Charlie Norwood VA Medical Center, United States
a r t i c l e
i n f o
Article history: Received 5 June 2016 Accepted 30 July 2016 Available online 4 August 2016
Keywords: Listeria Endocarditis Congenitally corrected transposition of great vessels.
A 54 year old man with congenitally corrected transposition of the great vessels presented following a stroke. Echocardiogram revealed a
systemic ventricular (RV) EF of 15–20% and large highly mobile vegetations on the mitral and tricuspid valves, measuring 22 mm and 19 × 7 mm, respectively (Fig. 1 & 2) with severe mitral and tricuspid regurgitation. Blood cultures grew beta hemolytic Streptococcus. He underwent replacement of his infected atrio-ventricular valves with bioprosthetic valves. Postoperative course was uncomplicated. Two years later he presented with low-grade fever and heart failure. Blood cultures grew Listeria monocytogenes (4/4 bottles) and transthoracic echocardiogram showed a large vegetation involving the prosthetic tricuspid valve measuring 10 × 24 mm (Fig. 3) with severe tricuspid (systemic atrio-ventricular) valve regurgitation. There was no evidence of abscess or perforation. The patient declined surgical intervention for his infective endocarditis. He was treated with a 6-week course of ampicillin and gentamicin. Following completion of antibiotics, repeat blood cultures were negative and TTE showed a decrease in the size of the
Fig. 1. Transesophageal view showing vegetations involving the tricuspid (solid arrow) and the mitral (dotted arrow) valves. ⁎ Corresponding author at: 300 Ferry Road, Apt 501, Galveston, TX 77550, United States. E-mail address: [email protected] (A. Jyothidasan).
http://dx.doi.org/10.1016/j.ijcard.2016.07.282 0167-5273/Published by Elsevier Ireland Ltd.
434
Correspondence
Fig. 2. Transesophageal view showing vegetations involving the leaflets of the tricuspid (systemic AV) valve.
vegetation to 4 × 7 mm. The patient remained euvolemic and afebrile on subsequent follow up. Congenitally corrected transposition of the great vessels (CCTGV) is a rare form of congenital heart disease characterized by atrioventricular and ventriculo-arterial discordance [1,2]. Patients with CCTGV without associated anomalies usually come to medical attention with progressive congestive heart failure in adulthood. Systemic AV valve (tricuspid) regurgitation is a very common finding and it is unclear if this represents the cause or the effect of the failing ventricle. Although few studies specifically address the issue of infective endocarditis in patients with CCTGV, available reports indicate a high incidence of IE in these patients. In one series, six of 52 (11%) patients
with CCTGV developed infective endocarditis [3]. This increased susceptibility for endocarditis is likely from the underlying abnormal valves and increased turbulence from regurgitation. Listeria endocarditis is an exceedingly rare entity with one third of the reported cases occurring in prosthetic valves. Other underlying predisposing conditions include rheumatic heart disease, hypertrophic cardiomyopathy, mitral valve prolapse and ischemic cardiomyopathy [4]. Historically Listeria endocarditis has been considered a particularly severe disease that is associated with a mortality rate of nearly 50%. Valve abscess, congestive heart failure and prosthetic valve dehiscence are more common with Listeria and contribute to a high proportion of patients treated surgically. However a recent comprehensive review of
Fig. 3. Transthoracic echocardiogram showing a large vegetation involving the prosthetic tricuspid valve (systemic AV valve) extending into the systemic ventricle.
Correspondence
patients with Listeria prosthetic valve endocarditis reported a mortality rate of 21%, which is similar to that of non-Listeria prosthetic valve endocarditis [5]. The antibiotic regimen of choice is either ampicillin or penicillin combined with gentamicin for 4 weeks for native valve endocarditis and 6–8 weeks for prosthetic valve endocarditis [6]. Listeria is commonly found in the soil, decaying vegetation and feces of various mammals. It is also an important food borne pathogen with increasing reports of outbreaks causing diarrheal illnesses from unprocessed meat and dairy products [7]. Our patient had hunted and processed a wild boar several days prior to presentation, which is likely to be the source of his infection. Conflict of interest None of the authors have any conflict of interest. All authors had access to the data and were involved in writing the manuscript.
435
References [1] T.P. Graham Jr., Y.D. Bernard, B.G. Mellen, et al., Long-term outcome in congenitally corrected transposition of the great arteries: a multi-institutional study, J. Am. Coll. Cardiol. 36 (1) (2000) 255–261. [2] P. Presbitero, J. Somerville, F. Rabajoli, et al., Corrected transposition of the great arteries without associated defects in adult patients: clinical profile and follow up, Br. Heart J. 74 (1) (1995) 57–59. [3] M.S. Connelly, P.P. Liu, W.G. Williams, et al., Congenitally corrected transposition of the great arteries in the adult: functional status and complications, J. Am. Coll. Cardiol. 27 (5) (1996) 1238–1243. [4] J. Antolín, A. Gutierrez, R. Segoviano, et al., Endocarditis due to Listeria: Description of two cases and review of the literature, Eur. J. Intern. Med. 19 (4) (2008) 295–296. [5] M.L. Fernandez Guerrero, P. Rivas, R. Rabago, et al., Prosthetic valve endocarditis due to Listeria monocytogenes. Report of two cases and reviews, Int. J. Infect. Dis. 8 (2) (2004) 97–102. [6] H. Hof, An update on the medical management of listeriosis, Expert. Opin. Pharmacother. 5 (8) (2004) 1727–1735. [7] V. Ferreira, M. Wiedmann, P. Teixeira, M.J. Stasiewicz, Listeria monocytogenes persistence in food-associated environments: epidemiology, strain characteristics, and implications for public health, J. Food Prot. 77 (1) (2014) 150–170.