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主动脉瓣置换术后偶然诊断出人心杆菌性心内膜炎。

Cardiobacterium hominis endocarditis incidentally diagnosed following an aortic valve replacement surgery.

作者信息

Radovanovic Milan, Marthaler Brodie R, Nordstrom Charles W, Petrovic Marija, Dumic Igor, Barsoum Michel K

机构信息

Mayo Clinic Alix School of Medicine, Rochester, MN, USA.

Department of Hospital Medicine, Mayo Clinic Health System, Eau Claire, WI, USA.

出版信息

IDCases. 2022 Jun 6;29:e01529. doi: 10.1016/j.idcr.2022.e01529. eCollection 2022.

Abstract

BACKGROUND

() is the part of the HACEK group ( that accounts for the majority of the Gram-negative infective endocarditis cases. Historically, the fastidious characteristics of these microorganisms proved challenging to many clinicians. Advances in microbiological identification of culture-negative endocarditis; however, may be the reason for the rising incidence of these infections. Here, we report an incidentally diagnosed endocarditis following an aortic valve replacement.

CASE REPORT

A healthy 54-year-old gentleman presented after several months of generalized weakness and exertional intolerance. He was found to have a bicuspid aortic valve with regurgitation and underwent aortic valve replacement surgery. Intraoperatively, the patient was found to have a large perforation of the fused leaflet associated with abnormal pink tissue in the aortic valve area. The aortic valve tissue was cultured. Gram-negative rods were isolated 48 h later and were ultimately identified as . He was successfully treated with 6 weeks of intravenous ceftriaxone with sterile blood cultures throughout the hospital stay. In retrospect, the patient's valve failure was likely secondary to subacute endocarditis from complicated by leaflet perforation.

CONCLUSION

is a rare cause of infective endocarditis with an excellent prognosis when timely diagnosed and managed. By reporting this case, we wish to raise awareness of potential asymptomatic infection, particularly amongst patients with underlying native valve abnormalities, new leaflet perforation, and valve insufficiency.

摘要

背景

()是HACEK菌群的一部分(该菌群导致了大多数革兰氏阴性感染性心内膜炎病例)。从历史上看,这些微生物的苛求特性对许多临床医生来说颇具挑战性。然而,培养阴性心内膜炎微生物鉴定方面的进展可能是这些感染发病率上升的原因。在此,我们报告一例主动脉瓣置换术后偶然诊断出的心内膜炎病例。

病例报告

一名54岁健康男性在出现数月全身无力和运动耐量下降后前来就诊。他被发现患有二尖瓣主动脉瓣伴反流,并接受了主动脉瓣置换手术。术中发现患者融合瓣叶有一个大穿孔,主动脉瓣区域有异常粉红色组织。对主动脉瓣组织进行了培养。48小时后分离出革兰氏阴性杆菌,最终鉴定为()。他在住院期间接受了6周的静脉注射头孢曲松治疗,血培养一直无菌,治疗成功。回顾来看,患者的瓣膜功能衰竭可能继发于由()引起的亚急性心内膜炎并伴有瓣叶穿孔。

结论

()是感染性心内膜炎的罕见病因,及时诊断和处理时预后良好。通过报告此病例,我们希望提高对潜在无症状感染的认识,尤其是在有潜在天然瓣膜异常、新的瓣叶穿孔和瓣膜功能不全的患者中。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/969d/9184553/8412876938ec/gr1.jpg

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