[Does yoghurt gnaw at cardiac valves?]

Area of Science:

• Infectious Diseases
• Cardiology
• Microbiology

Background:

• Infective endocarditis (IE) is a serious infection of the heart's inner lining, often affecting heart valves.
• Aortic valve disease predisposes individuals to IE, particularly after invasive procedures.
• Antibiotic prophylaxis is recommended to prevent IE in high-risk patients undergoing certain dental procedures.

Observation:

• A 22-year-old male with pre-existing aortic valve disease developed acute Lactobacillus endocarditis six weeks post-dental procedure.
• Despite receiving adequate antibiotic prophylaxis according to guidelines effective until 2008, the patient contracted IE.
• Lactobacillus, a probiotic bacterium, was identified as the causative agent of the endocarditis.

Findings:

• The case demonstrates that standard antibiotic prophylaxis may not always be sufficient to prevent IE in all at-risk individuals.
• Updated guidelines for IE prophylaxis, implemented after 2008, aim to improve prevention strategies.
• Lactobacillus endocarditis presents a unique challenge, requiring specific treatment approaches.

Implications:

• This case underscores the evolving landscape of IE prevention and treatment, necessitating a review of current prophylactic regimens.
• The increasing consumption of Lactobacillus-containing dairy products and probiotics may pose potential health risks, especially for immunocompromised individuals.
• Further research is warranted to understand the pathogenicity of Lactobacillus in IE and to refine preventive measures, particularly in the context of widespread probiotic use.