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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
28:13

Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation

Published on: February 26, 2013

[Active infective endocarditis remaining latent for six weeks after discontinuation of antibiotic therapy: a case

Ayumu Masuoka1, Kazuhito Imanaka, Masamitsu Sugie

  • 1Department of Cardiovascular Surgery, Saitama Medical School. masuoka@saitama-med.ac.jp

Journal of Cardiology
|January 5, 2006
PubMed

Insights

This case highlights a persistent Enterococcus faecalis mitral valve endocarditis infection despite prolonged penicillin treatment. Surgery is recommended for large, mobile vegetations unresponsive to antibiotics, as infection may persist.

Area of Science:

  • Cardiology
  • Infectious Diseases
  • Cardiac Surgery

Background:

  • Infective endocarditis (IE) is a serious infection of the heart valves.
  • Enterococcus faecalis is a common pathogen causing IE, particularly in older adults.
  • Mitral valve involvement presents unique challenges in treatment and management.

Observation:

  • A 75-year-old male presented with recurrent mitral valve endocarditis caused by Enterococcus faecalis.
  • Prolonged penicillin therapy (10 weeks total) did not resolve the large, mobile vegetation.
  • Despite clinical improvement and normal labs post-antibiotics, the resected tissue remained positive for Enterococcus faecalis.

Findings:

  • Antibiotic therapy alone may be insufficient for certain cases of IE, even with clinical resolution.
  • Persistent large and mobile vegetations indicate a high risk of embolic events.
  • Microbiological confirmation of infection in resected tissue underscores treatment limitations.

Implications:

  • Aggressive surgical consideration is crucial for IE cases with persistent, large vegetations unresponsive to antibiotics.
  • Early surgical intervention may be necessary to prevent embolic complications and ensure complete infection eradication.
  • This case emphasizes the importance of integrating medical and surgical management in complex IE cases.

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