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Unusual pathogens in narcotic-associated endocarditis
S Szabo1, J P Lieberman, Y A Lue
1Department of Medicine, Lincoln Hospital, Bronx, New York.
Abstract:
We report the cases of three adults with a history of intravenous drug abuse who developed endocarditis caused by Corynebacterium xerosis, Neisseria subflava, and Neisseria flavescens, respectively. No cases of endocarditis caused by C. xerosis or N. flavescens and only one case caused by N. subflava have previously been reported in association with narcotic addiction. The prominent clinical features in all patients included poor response to antibiotic therapy, persistent fever, and major embolic events. Stigmata of infection with human immunodeficiency virus, as manifested by oral candidiasis, cervical lymphadenopathy, and serologic evidence, were present in two of the three patients. At our institution, where Staphylococcus aureus remains the most frequent etiologic agent of narcotic-associated endocarditis, the occurrence of these three cases in a 9-month period is striking. We speculate that infection with human immunodeficiency virus may play a role in the pathogenesis of endocarditis caused by these unusual organisms.
Insights
Three intravenous drug users developed endocarditis from rare bacteria. Human immunodeficiency virus infection may contribute to these unusual cases, presenting with fever and embolic events unresponsive to antibiotics.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Endocarditis is a serious infection, often associated with intravenous drug abuse.
- Staphylococcus aureus is the most common cause of endocarditis in this population.
Observation:
- Three cases of endocarditis caused by Corynebacterium xerosis, Neisseria subflava, and Neisseria flavescens in intravenous drug users were observed.
- These specific bacterial causes are rarely reported in association with narcotic addiction.
- Two patients presented with clinical signs of human immunodeficiency virus infection.
Findings:
- Patients exhibited poor response to antibiotic therapy, persistent fever, and significant embolic events.
- The occurrence of these three unusual cases within a nine-month period is notable.
Implications:
- Human immunodeficiency virus infection might play a role in the development of endocarditis caused by these uncommon pathogens.
- These findings highlight the need to consider less common bacteria and potential co-infections in intravenous drug users with endocarditis.