Infective Endocarditis by Yersinia Species: A Systematic Review
Petros Ioannou1, Georgios Vougiouklakis1, Stella Baliou2
1Department of Internal Medicine & Infectious Diseases, University Hospital of Heraklion, Heraklion, 71110 Crete, Greece.
Abstract:
Yersinia spp. are non-spore-forming Gram-negative bacilli. They comprise only three species known to cause disease in humans, namely Y. pestis, Y. enterocolitica and Y. pseudotuberculosis. Since infective endocarditis (IE) is rarely caused by Yersinia, the management of these infections can be problematic due to the lack of experience. The purpose of this study was to systematically review all published cases of IE by Yersinia species in the literature. A systematic review of PubMed, Scopus and Cochrane Library (through 1 November 2020) for studies providing epidemiological, clinical and microbiological information as well as data on treatment and outcomes of IE caused by Yersinia species was performed. A total of 12 studies, containing data of 12 patients, were included. A prosthetic valve was present in 17% of patients. The mitral valve was the most commonly infected site, followed by the aortic valve. Fever, sepsis and embolic phenomena were common clinical signs, followed by heart failure. Aminoglycosides, cephalosporins and quinolones were the most commonly used antimicrobials. Clinical cure was noted in 83%, while overall mortality was 17%. This systematic review describes IE by Yersinia and provides information on patients' epidemiology, clinical signs and the related therapeutic strategies and outcomes.
Insights
Infective endocarditis (IE) caused by Yersinia bacteria is rare but treatable. This review of 12 cases shows common symptoms, effective antibiotic treatments, and a high clinical cure rate of 83% for Yersinia IE.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Yersinia species are Gram-negative bacilli, with three species causing human disease: Yersinia pestis, Yersinia enterocolitica, and Yersinia pseudotuberculosis.
- Infective endocarditis (IE) is infrequently caused by Yersinia, leading to challenges in diagnosis and management due to limited clinical experience.
Purpose of the Study:
- To systematically review all published cases of IE caused by Yersinia species.
- To gather epidemiological, clinical, microbiological, treatment, and outcome data for Yersinia-induced IE.
Main Methods:
- A systematic literature review was conducted using PubMed, Scopus, and Cochrane Library up to November 1, 2020.
- Data from 12 studies involving 12 patients with Yersinia IE were analyzed.
Main Results:
- The mitral valve was the most frequently affected site, followed by the aortic valve; 17% of patients had prosthetic valves.
- Common clinical signs included fever, sepsis, and embolic phenomena, progressing to heart failure.
- Aminoglycosides, cephalosporins, and quinolones were primary antimicrobial treatments.
Conclusions:
- Yersinia species can cause infective endocarditis, presenting with diverse clinical signs and requiring specific antimicrobial strategies.
- The review highlights a high clinical cure rate (83%) and a 17% mortality rate for Yersinia IE, emphasizing the importance of prompt diagnosis and treatment.
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