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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
PubMed
Summary

Actinobacillus actinomycetemcomitans can cause late prosthetic valve endocarditis, especially with negative initial blood cultures. Most patients recover with antibiotics, often following dental procedures.

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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.

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  • 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.