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Case report: prosthetic valve endocarditis due to a nutritionally variant streptococcus.
The American Journal of the Medical Sciences
|June 1, 1985
Summary
This case report details the first instance of prosthetic valve endocarditis caused by nutritionally variant streptococci. Early consideration of these bacteria is crucial for patients with prosthetic valve endocarditis and negative cultures.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Prosthetic valve endocarditis (PVE) is a serious complication following cardiac valve replacement surgery.
- Routine blood cultures may fail to detect certain fastidious microorganisms, leading to diagnostic challenges.
Observation:
- A 21-year-old woman presented with fever and prosthetic valve dysfunction one week after mitral valve replacement.
- Blood and excised valve cultures were negative on standard media.
- A nutritionally variant Streptococcus mitior was identified through satellite growth around Staphylococcus aureus and enriched media.
Findings:
- This is the first reported case of PVE caused by nutritionally variant streptococci.
- The patient successfully responded to a six-week course of penicillin G and streptomycin.
- Nutritionally variant streptococci require specific growth factors, such as pyridoxine, for isolation.
Implications:
- Clinicians should consider nutritionally variant streptococci in the differential diagnosis of PVE, especially with negative routine cultures.
- Enhanced diagnostic methods and specialized media are essential for identifying fastidious bacteria in PVE.
- Prompt and appropriate antimicrobial therapy can lead to favorable outcomes in PVE caused by challenging pathogens.