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A classic and fatal case of Streptococcus mutans subacute bacterial endocarditis; A now potentially underappreciated

S A Schmalzle1,2

  • 1University of Maryland Medical Center, Department of Medicine, Division of Infectious Disease. 22 South Greene St, Baltimore MD 21201, United States.

Idcases
|January 30, 2020
PubMed

Insights

Subacute bacterial endocarditis, though rare, presents subtly and can be fatal. Prompt evaluation of streptococcal bacteremia is crucial to prevent severe complications like stroke.

Area of Science:

  • Infectious Diseases
  • Cardiology
  • Microbiology

Background:

  • Subacute bacterial endocarditis (SBE) incidence has declined, often presenting with non-specific symptoms, complicating early diagnosis.
  • Acute bacterial endocarditis is more common and readily identified, particularly in patients with prosthetic valves, intravenous drug use, or known bacteremia.

Observation:

  • A case of Streptococcus mutans subacute bacterial endocarditis is presented.
  • The patient exhibited typical risk factors and clinical signs associated with SBE.
  • Despite classic presentation, diagnosis was delayed, leading to fatal outcomes.

Findings:

  • The patient experienced hemorrhagic conversion of an embolic stroke while on anticoagulation therapy.
  • Streptococcus mutans was identified as the causative agent of the subacute bacterial endocarditis.
  • Delayed recognition and treatment contributed to the adverse outcome.

Implications:

  • All instances of streptococcal bacteremia require thorough evaluation and appropriate treatment.
  • Streptococcus species should not be dismissed as mere blood culture contaminants.
  • Increased awareness and timely intervention are vital for managing subacute bacterial endocarditis to prevent mortality and morbidity.
Keywords:
Infective endocarditisLeukocytoclastic vasculitisStreptococcus mutansSubacute bacterial endocarditisviridans group streptococci

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