Lécluse E, Scanu P, Saloux E, Vergnaud M, Valette B, Agostini D, Grard Y, Braud J, Grollier G, Potier J C
Service de Soins intensifs de Cardiologie, CHRU de Caen.
Presse Med. 1994 Feb 19;23(7):325-8.
The incidence of endocarditis due to Cardiobacterium hominis is probably underestimated because clinical presentations vary greatly and culture of this Gram negative germ is difficult. A 48-year-old man with a past history of post-streptococcic aortic regurgitation was hospitalized twice within 1 week for fever (38 degrees C) and junctional tachycardia which responded to amiodarone. Subsequently, infero-apical necrosis was documented. Based on the result of the laboratory tests, coronary embolism was suspected although 12 blood cultures were negative. The patient recovered well with a standard antibiotic treatment. Fifteen days later, the blood cultures revealed Cardiobacterium hominis. Antibiotic therapy was adapted and aortic valve replacement was programmed. Two months later the patient died from uncontrollable left heart failure. A 63-year-old man who had had mitral valve replacement 10 years earlier for Streptococcus mitis endocarditis was hospitalized for fever (38 degrees C) and a painful left calf. Phlebocavography eliminated deep vein thrombosis and a complete cardiac work-up was inconclusive. Endocarditis was suspected although blood cultures were negative. The patient was given oral penicillin and discharged after one week. Three months later, the patient was again febrile (38 degrees C) and suffered a cerebral vascular event. Fourteen days after blood sampling, cultures revealed Cardiobacterium hominis. The patient's haemodynamic status worsened and valve replacement with atrioplasty was performed. Outcome after 4 years follow-up has been favourable. Endocarditis due to Cardiobacterium hominis, a saprophitic germ of the upper airway and the female genital tract, has been reported in 64 cases in the literature. The clinical picture is often limited to fever and a heart murmur and laboratory tests show an accelerated erythrocyte sedimentation rate and hyperleukocytosis. Inflammatory type anaemia is often found due to the latency of the endocarditis. Complications are frequent and can be fatal due to massive pulmonary emboli, cerebral vascular events or irreversible heart failure. C. hominis is sensitive to amoxycillin and netilmicin. Surgical treatment of the valvulopathy is indicated.
人心杆菌所致心内膜炎的发病率可能被低估了，因为临床表现差异很大，且这种革兰氏阴性菌的培养很困难。一名48岁男性，有链球菌感染后主动脉瓣关闭不全病史，1周内因发热（38摄氏度）和交界性心动过速住院两次，胺碘酮治疗有效。随后，记录到下壁心尖坏死。基于实验室检查结果，尽管12次血培养均为阴性，但仍怀疑有冠状动脉栓塞。患者经标准抗生素治疗后恢复良好。15天后，血培养发现人心杆菌。调整抗生素治疗方案并计划进行主动脉瓣置换术。两个月后，患者死于无法控制的左心衰竭。一名63岁男性，10年前因轻链球菌性心内膜炎行二尖瓣置换术，因发热（38摄氏度）和左小腿疼痛住院。静脉造影排除了深静脉血栓形成，全面的心脏检查结果不明确。尽管血培养阴性，但仍怀疑有心内膜炎。患者口服青霉素治疗，1周后出院。3个月后，患者再次发热（38摄氏度）并发生脑血管事件。采血14天后，培养发现人心杆菌。患者的血流动力学状态恶化，进行了瓣膜置换和心房成形术。4年随访结果良好。人心杆菌是上呼吸道和女性生殖道的腐生菌，文献中已报道64例人心杆菌所致的心内膜炎。临床表现通常仅限于发热和心脏杂音，实验室检查显示红细胞沉降率加快和白细胞增多。由于心内膜炎的潜伏期，常发现炎症性贫血。并发症很常见，可能因大量肺栓塞、脑血管事件或不可逆性心力衰竭而致命。人心杆菌对阿莫西林和奈替米星敏感。瓣膜病变需进行手术治疗。
