Sussman J I, Baron E J, Goldberg S M, Kaplan M H, Pizzarello R A
Rev Infect Dis. 1986 Sep-Oct;8(5):771-6. doi: 10.1093/clinids/8.5.771.
A case of Lactobacillus casei endocarditis that occurred on a Carpentier-Edwards porcine valve is reported. A review of the literature, which yielded 23 other reports of endocarditis due to this organism, suggests that Lactobacillus is a rare cause of endocarditis. Typically, it occurs in a patient with preexisting structural heart disease (20 of 24 [83%]) and often with some form of recent dental infection or manipulation (18 of 24 [75%]). Six (25%) of 24 patients died of this infection; however, only one (5%) of 19 who were treated with adequate antimicrobial therapy died. The response to antimicrobial therapy was better in the more recent cases. Of those 18 patients who completed a full course of therapy, seven (39%) experienced a relapse; five of these were cured of their infection with a second course of antimicrobial therapy, which usually included higher doses of intravenous penicillin. Our case represents the second reported case that required surgical intervention for cure. Embolic phenomena occurred in 10 (42%) of 24 cases. Various combinations of antibiotics have been successful in achieving cure; however, at present, high-dose penicillin (greater than 25 million units/day) in combination with an aminoglycoside for a period of six weeks appears to be the optimum therapy.
本文报告了一例发生在Carpentier-Edwards猪瓣膜上的干酪乳杆菌心内膜炎病例。对文献的回顾发现了另外23例由该微生物引起的心内膜炎报告，这表明乳杆菌是心内膜炎的罕见病因。通常，它发生在已有结构性心脏病的患者中（24例中有20例[83%]），并且常常伴有某种形式的近期牙科感染或操作（24例中有18例[75%]）。24例患者中有6例（25%）死于这种感染；然而，在接受充分抗菌治疗的19例患者中，只有1例（5%）死亡。在最近的病例中，对抗菌治疗的反应更好。在完成整个疗程的18例患者中，有7例（39%）复发；其中5例通过第二个疗程的抗菌治疗治愈了感染，第二个疗程通常包括更高剂量的静脉注射青霉素。我们的病例是第二例报告的需要手术干预才能治愈的病例。24例中有10例（42%）出现栓塞现象。各种抗生素组合已成功实现治愈；然而，目前，高剂量青霉素（大于2500万单位/天）联合一种氨基糖苷类药物使用六周似乎是最佳治疗方法。
