Rufael D W, Cohn S E
Department of Medicine, University of Rochester School of Medicine and Dentistry, New York.
Clin Infect Dis. 1994 Dec;19(6):1054-61. doi: 10.1093/clinids/19.6.1054.
We report the first known case of native valve endocarditis due to Corynebacterium striatum and review 51 previously reported cases of native valve endocarditis due to non-diphtheriae corynebacteria. Of the 52 patients with corynebacterial endocarditis, 11 (21%) had no predisposing conditions and 27 (52%) had structural heart disease; endocarditis in the remaining 14 patients (27%) was associated with noncardiac predisposing factors including injection drug use, chronic hemodialysis, vasculitis, alcoholism, liver transplantation and hemodialysis, a peritoneovenous shunt, and prior aspiration of a noninfected bursa. The mortality rate associated with corynebacterial endocarditis was 31%. The majority of corynebacteria in this series were sensitive to penicillin, erythromycin, gentamicin, and vancomycin. Non-diphtheriae corynebacteria are capable of producing acute valvular damage, even in patients without conditions that are predisposing for endocarditis. The occurrence of bacteremia due to non-diphtheriae corynebacteria in the appropriate clinical setting should alert physicians to the possible diagnosis of endocarditis. Empirical antibiotic therapy with vancomycin, with or without an aminoglycoside, should be initiated pending antibiotic susceptibility testing.
我们报告了首例已知的由纹带棒状杆菌引起的自体瓣膜心内膜炎病例，并回顾了先前报道的51例由非白喉棒状杆菌引起的自体瓣膜心内膜炎病例。在这52例棒状杆菌性心内膜炎患者中，11例（21%）无易感因素，27例（52%）有结构性心脏病；其余14例患者（27%）的心内膜炎与非心脏易感因素有关，包括注射吸毒、慢性血液透析、血管炎、酗酒、肝移植和血液透析、腹膜静脉分流术以及先前未感染滑囊的抽吸。棒状杆菌性心内膜炎的死亡率为31%。本系列中的大多数棒状杆菌对青霉素、红霉素、庆大霉素和万古霉素敏感。非白喉棒状杆菌即使在没有心内膜炎易感因素的患者中也能够造成急性瓣膜损害。在适当的临床环境中，非白喉棒状杆菌所致菌血症的发生应提醒医生注意心内膜炎的可能诊断。在进行抗生素敏感性试验之前，应开始使用万古霉素进行经验性抗生素治疗，可加用或不加用氨基糖苷类药物。
