Jahani Zahra, Latifian Mina, Ahmadi Pooria, Esmaeili Saber
Department of Infectious Disease and Tropical Medicine, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
Department of Epidemiology and Biostatics, Research Centre for Emerging and Reemerging Infectious Diseases, Pasteur Institute of Iran, Pasteur Institute of Iran, Tehran, Iran.
J Cardiothorac Surg. 2025 May 21;20(1):233. doi: 10.1186/s13019-025-03463-1.
Prosthetic valve Endocarditis (PVE) is an uncommon but potentially life-threatening infection involves a valve prosthesis or annuloplasty ring. Streptococci, including Streptococcus mitis and enterococci are major etiological agents, with studies indicating their significant role in late-onset PVE in some regions of world, staphylococci have surpassed streptococci as the most frequent causative organism. Despite challenges in diagnosis, molecular methods offer high sensitivity.
A 30-year-old female patient, Iranian, with a history of hypothyroidism, tetralogy of Fallot, and a bioprosthetic valve replacement and weakness after two months from exprience upper respiratory tract infection (URTI), was admitted with complaints of epistaxis, fever and worsening of shortness of breath. She exhibited symptoms of anemia, thrombocytopenia, elevated WBC, LDH, and D-dimer levels, along with splenomegaly, pleural effusions, and pulmonary congestion. Echocardiography revealed significant valve vegetation and RV failure. Despite comprehensive treatment, including cardiac surgery and antifungal therapy, her condition deteriorated, leading to cardiac arrest and death. Posthumous molecular analysis identified S. mitis as the causative agent, despite negative blood cultures.
This case highlights the challenges of diagnosing and treating complex PVE, particularly when conventional cultures are negative. The detection of S. mitis through molecular methods underscores the importance of early and accurate identification of pathogens in guiding effective treatment.
人工瓣膜心内膜炎（PVE）是一种罕见但可能危及生命的感染，累及人工瓣膜或瓣环成形术环。链球菌，包括缓症链球菌和肠球菌是主要病原体，研究表明它们在世界某些地区的迟发性PVE中起重要作用，葡萄球菌已超过链球菌成为最常见的致病微生物。尽管诊断存在挑战，但分子方法具有高灵敏度。
一名30岁伊朗女性患者，有甲状腺功能减退、法洛四联症病史，接受了生物人工瓣膜置换术，在经历上呼吸道感染（URTI）两个月后出现虚弱，因鼻出血、发热和呼吸急促加重入院。她表现出贫血、血小板减少、白细胞、乳酸脱氢酶和D-二聚体水平升高的症状，伴有脾肿大、胸腔积液和肺充血。超声心动图显示瓣膜有大量赘生物和右心室衰竭。尽管进行了包括心脏手术和抗真菌治疗在内的综合治疗，她的病情仍恶化，导致心脏骤停和死亡。死后分子分析确定缓症链球菌为病原体，尽管血培养结果为阴性。
本病例突出了诊断和治疗复杂PVE的挑战，尤其是在传统培养结果为阴性时。通过分子方法检测到缓症链球菌强调了早期准确识别病原体以指导有效治疗的重要性。
