THE ENDOCARDITIS ENIGMA: SPOTLIGHT ON AN UNUSUAL MICROBE

Document Type

Conference Proceeding

Publication Date

4-1-2025

Publication Title

J Am Coll Cardiol

Keywords

adult, aged, aortic regurgitation, aortic valve replacement, blood culture, case report, cellulitis, clinical article, complication, conference abstract, diagnosis, drug therapy, dyspnea, echocardiography, emergency ward, endocarditis, fatigue, group B streptococcal bacteremia, group B streptococcal infection, heart ejection fraction, human, left coronary cusp, male, mortality rate, nonhuman, oral drug administration, physical examination, Streptococcus agalactiae, surgery, systolic heart murmur, tachycardia

Abstract

Background: Group B Streptococcus (GBS) infections in non-pregnant adults have been increased in recent decades. Most invasive GBS disease occurs at mean age of 60 & has high mortality. We present a case of idiopathic GBS infection in a healthy adult. Case A 55-year old male without any cardiac history presented to the emergency department with generalized fatigue. On arrival he was febrile, but not tachycardic or dyspneic. Physical examination was significant for a grade 2/6 systolic murmur in the right 2nd intercostal space. Blood cultures obtained resulted positive for Streptococcus Agalactiae, a GBS. Empiric antimicrobial treatment was initiated. On obtaining further history, he was recently treated in the hospital for lower extremity cellulitis and a Trans-Thoracic Echocardiogram (TTE) during the admission performed showed normal ejection fraction, moderate Aortic Regurgitation (AR) but no vegetations on valves. Further investigating AR, having positive Duke Criteria, a Trans-Esophageal Echocardiogram (TEE) was performed. TEE unveiled a sessile mass attached to the ventricular side of the left coronary cusp of the aortic valve, measuring 15mm with prolapse of the leaflet, severe aortic regurgitation. These findings were most consistent with a large vegetation. A diagnostic angiogram revealed healthy coronary vasculature. Eventually, the patient underwent a successful surgical aortic valve replacement with a 29mm stented porcine bioprosthetic aortic valve. Decision-making Aortic Valve Endocarditis secondary to GBS is uncommonly reported in literature. Immunocompetent patients are not at high risk for invasive GBS. Clinical acumen and vigilance for endocarditis backed by examination and echocardiographic skills is needed. Thus, timely diagnosis & prevention of complications is important. Conclusion The incidence of invasive GBS amongst adults has greatly increased and usually elderly patients are affected, converse to our case reported. GBS bacteremia & endocarditis carry a very high mortality rate. Healthy patients with invasive GBS should undergo a comprehensive workup for potential underlying illness. Combined medical-surgical therapy confers better outcomes.

Volume

85

Issue

12

First Page

4467

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