Rachina Svetlana A, Mukhina Nadezhda V, Cherkasova Natalia A, Komarova Irina S, Ushakova Olga E, Nasrulloeva Suman M, Burmistrova Elena N, Ivanchik Natali V
MD, PhD, DSc, Head of the Internal Medicine Department #2, Sechenov First Moscow State Medical University, 8-2 Trubetskaya str. Moscow, 119991, Russian Federation.
MD, PhD, Associate Professor of the Internal Medicine Department #2, Sechenov First Moscow State Medical University, 8-2 Trubetskaya str. Moscow, 119991l, Russian Federation.
Germs. 2022 Mar 31;12(1):130-136. doi: 10.18683/germs.2022.1316. eCollection 2022 Mar.
Right-sided lesions caused by staphylococci are the most common clinical entity of infectious endocarditis (IE) among iv drug abusers. But some aspects of the epidemiological history are critical in terms of early detection of uncommon pathogens.
We describe a clinical observation of native aortic valve IE caused by in a 37-year-old female with a history of heroin addiction, alcohol abuse and liver cirrhosis.She presented herself at our hospital with acute fever, chills, subconjunctival petechial hemorrhages, traces of scratches on the hands, splenomegaly, peripheral edema, elevated WBC and inflammatory serum markers. Initial transthoracic echocardiography was negative, but the patient was put on oxacillin for suspected right-sided IE. The transesophageal echocardiography revealed vegetation on noncoronary leaflet of aortic valve. Blood culture was positive with the growth of in 4/4 samples.On detailed questioning, a close domestic contact with cats was revealed. Oxacillin was switched to meropenem and tigecycline with a prompt clinical response. The isolate was found to be susceptible to penicillins, so the patient was discharged after 3 weeks with recommendations to take amoxicillin for up to 4 weeks. At 3 and 6 months follow-up there were no signs of IE relapse revealed.
is a rare causative agent of IE. In our case, this pathogen was identified in a patient with injection drug use, where such etiology is not usually assumed. The close contact with cats was not taken into account, which caused late diagnosis and delayed therapy.
葡萄球菌引起的右侧病变是静脉注射药物滥用者感染性心内膜炎（IE）最常见的临床类型。但就罕见病原体的早期检测而言，流行病学史的某些方面至关重要。
我们描述了一名37岁有海洛因成瘾、酗酒和肝硬化病史的女性原发性主动脉瓣IE的临床观察情况。她因急性发热、寒战、结膜下瘀点、手部抓痕痕迹、脾肿大、外周水肿、白细胞升高和炎症血清标志物升高前来我院就诊。最初的经胸超声心动图检查结果为阴性，但因怀疑右侧IE，患者开始使用苯唑西林治疗。经食管超声心动图显示主动脉瓣无冠瓣有赘生物。血培养4份样本均生长出[未提及的病原体]，结果呈阳性。经详细询问，发现患者与猫有密切的家庭接触。将苯唑西林换为美罗培南和替加环素后，临床症状迅速缓解。发现分离出的[未提及的病原体]对青霉素敏感，因此患者在3周后出院，并建议服用阿莫西林长达4周。在3个月和6个月的随访中，未发现IE复发迹象。
[未提及的病原体]是IE的罕见病原体。在我们的病例中，该病原体在一名注射吸毒患者中被发现，而通常不会考虑这种病因。未考虑到与猫的密切接触，导致诊断延迟和治疗延误。
