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Actinobacillus actinomycetemcomitans prosthetic valve endocarditis.
C J Grace1, R E Levitz, H Katz-Pollak
1Division of Infectious Disease, Hartford Hospital, Connecticut.
Reviews of Infectious Diseases
|September 1, 1988
Summary
Actinobacillus actinomycetemcomitans can cause late prosthetic valve endocarditis, especially with negative initial blood cultures. Most patients recover with antibiotics, often following dental procedures.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Prosthetic valve endocarditis (PVE) is a serious complication following cardiac valve replacement surgery.
- Actinobacillus actinomycetemcomitans (Aa) is a gram-negative bacillus rarely implicated in PVE.
Observation:
- This study reports two new cases of Aa PVE and reviews 11 previously documented cases.
- All identified cases occurred more than one year after prosthetic valve implantation.
- Poor dentition or recent dental work was noted in six patients, and three had received endocarditis prophylaxis.
Findings:
- Actinobacillus actinomycetemcomitans is a potential cause of late PVE, particularly when initial blood cultures are negative.
- Ten out of 13 patients achieved cure with antibiotic therapy alone.
- Congestive heart failure and systemic emboli were infrequent complications during antimicrobial treatment.
Implications:
- Aa should be considered in the differential diagnosis of late PVE, especially in patients with dental issues.
- A 4-6 week treatment regimen combining a beta-lactam antibiotic with an aminoglycoside is recommended.
- Emerging therapeutic options include third-generation cephalosporins and rifampin due to their favorable in vitro activity.