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Actinobacillus actinomycetemcomitans endocarditis.

L Paturel1, J P Casalta, G Habib

  • 1Unité des Rickettsies, Centre National de la Recherche Scientifique, CNRS UMR 6020, WHO Collaborative Center, Faculté de Médecine de la Timone, 27 Bd Jean Moulin, 13385 Marseille Cedex 5, France.

Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases
|February 5, 2004
PubMed
Summary
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Actinobacillus actinomycetemcomitans is a common cause of infective endocarditis, particularly in patients with prior heart conditions. Early diagnosis and a minimum of four weeks of antibiotic treatment are crucial for successful outcomes.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Microbiology

Background:

  • Actinobacillus actinomycetemcomitans, a HACEK group bacterium, is frequently implicated in infective endocarditis.
  • Epidemiological and clinical characteristics of A. actinomycetemcomitans endocarditis require further evaluation.

Observation:

  • A review of 102 cases (3 from the study, 99 from literature) revealed common risk factors including pre-existing heart disease (75%) and oral cavity as the portal of entry.
  • Prosthetic valves were present in 27 patients. Common symptoms included intermittent fever, weight loss, peripheral signs, anemia, and microscopic hematuria.
  • The disease presented insidiously, with a mean symptom duration of 13 weeks prior to diagnosis via blood cultures incubated for over 5 days.

Findings:

  • The aortic valve was most commonly affected. Echocardiographic findings were non-specific.

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  • Complications occurred in 63% of patients, with emboli being most frequent. The surgery rate was 23.5% and overall mortality was 18%.
  • Antibiotic therapy alone achieved a cure rate of 76.5%, with a recommended duration of at least 4 weeks. Surgical intervention was typically indicated for hemodynamic instability.

    • Implications:

    • Infective endocarditis caused by A. actinomycetemcomitans should be suspected in patients with cardiac disease and prolonged, evolving symptoms.
    • Antibiotic prophylaxis before dental procedures is crucial for at-risk cardiac patients but is often underprescribed.
    • Optimal management involves prolonged antibiotic therapy, with surgery reserved for specific complications.