Staphylococcus argenteus was recently defined as a species and has previously often been mistaken for Staphylococcus aureus due to the difficulties of conventional laboratory methods to distinguish the two species. The clinical presentation of infections caused by S. argenteus is largely unknown, and its virulence has since the definition of the species been debated. Here we present, to our knowledge, the first case of infective endocarditis due to S. argenteus with valve vegetations visualized on echocardiography. The 74-year-old male patient with biological aortic valve prothesis presented with a rapid onset of diffuse symptoms and his condition hastily deteriorated to septic shock followed by several complications such as intracranial septic emboli, severe heart failure, and intracardiac thrombus. After conservative treatment and management of the multiple complications, the patient recovered and was eventually discharged to his original housing situation.

Transthoracic echocardiography (TTE) is used to assess for evidence of infective endocarditis (IE). Inappropriate patient selection leads to significant burden on healthcare services. We aimed to assess effectiveness of cardiology consultant vetting of TTE requests for suspected IE in reduction of unnecessary scans. All inpatient TTE requests querying IE over a six-month period were vetted. Clinical information and pathology results were reviewed, and requests were either accepted, deferred, or rejected. A total of 103 patients had TTE requested: 39 (38%) were accepted for scan; four cases of IE were confirmed on TTE. There were 62% of patient requests rejected and not scanned, and no cases of IE subsequently diagnosed. Thus, consultant vetting of TTE requests for suspected IE is an effective way to safely reduce unnecessary scans and enables cost-effective streamlining of echocardiography services.

UNASSIGNED: Infective endocarditis (IE) predominantly involves the cardiac valves. Timely diagnosis and initiation of therapy significantly reduce morbidity and mortality. Infective endocarditis presenting as a large left ventricular outflow tract (LVOT) mass is an atypical manifestation that provides significant challenges to the treating team.
UNASSIGNED: A 19-year-young male presented with exertional shortness of breath, palpitations, and presyncope for 4 months with constitutional symptoms for the last 6 months. Two-dimensional echocardiogram showed a large LVOT mass arising from the mitral aortic intervalvular fibrosa causing dynamic severe aortic valve obstruction, moderate aortic regurgitation, and severe mitral regurgitation. He was managed on lines of IE and received intravenous antibiotics. In view of worsening heart failure and cardiogenic shock, he underwent mass excision, mechanical aortic valve replacement, and mitral valve repair. Histopathology confirmed it as vegetation. He was discharged and is doing well at 2-month follow-up.
UNASSIGNED: An atypical presentation of IE as a large LVOT mass was observed in this young male. Sound clinical judgement, judicious use of ancillary imaging, and a multidisciplinary approach ensured timely diagnosis and appropriate treatment. Management included appropriate intravenous antibiotics followed by surgery.

暂无摘要。

UNASSIGNED: Infective endocarditis (IE) is a serious and fatal condition, with prosthetic valve endocarditis representing the worst prognosis. The recommended nuclear imaging modality 2-deoxy-2-[18F]fluoro-D-glucose positron emission tomography/computed tomography ([18F]FDG PET/CT) has limitations. In this case series, we present two patients with IE scanned with a novel PET tracer [64Cu]Cu-DOTATATE ([64Cu]Cu-[1,4,7,10-tetraazacyclododecane-N,N\',N″,N‴-tetra acetic acid]-d-Phe1, Tyr3-octreotate).
UNASSIGNED: An 84-year-old female patient (Patient 1) with a biological mitral valve prosthesis (MVP) was admitted acutely from the outpatient clinic. Transoesophageal echocardiography showed vegetations on the MVP. The patient underwent [64Cu]Cu-DOTATATE PET/CT, which showed uptake at the site of infection. The patient underwent surgical valve replacement. The post-operative period was without significant complications, and the patient was discharged home. In another case, a 72-year-old male patient (Patient 2) with a medical history of mild mitral valve stenosis, aortic valve stenosis, and gastrointestinal stromal tumour was admitted to the hospital for back and abdominal pain and subfebrile episodes. Transoesophageal echocardiography showed large vegetations in the native aortic valve. The patient underwent [64Cu]Cu-DOTATATE PET/CT, which showed no uptake at the site of the suspected infection. The patient underwent surgical valve replacement. The post-operative period was characterized by Candida albicans sternitis, and after prolonged hospitalization, the patient died of respiratory failure as a complication of sepsis.
UNASSIGNED: In conclusion, this is the first case series presenting two patients with definite IE (modified Duke criteria), who were scanned with the novel [64Cu]Cu-DOTATATE PET/CT. Patient 1, with endocarditis in the MVP, showed an uptake of the tracer, while Patient 2, with native aortic valve endocarditis, did not show any uptake.

Rothia dentocariosa is a commensal organism that is typically found in the oropharyngeal and respiratory tracts, and it typically possesses a low virulence profile, especially for immunocompetent patients. The case presented here represents an extremely rare case of deep neck cellulitis, myositis, and reactive lymphadenitis secondary to R. dentocariosa in an immunocompetent female. A 35-year-old female with no significant past medical history presented to the emergency department with neck pain with reduced range of motion, fever, chills, sinus congestion, and headache for one day. After a thorough workup, blood cultures grew R. dentocariosa in the days following admission. The patient subsequently recovered without any notable sequelae after proper antibiotic treatment. Since Rothia species are currently considered a low-virulence organism that typically causes endocarditis in immunocompromised hosts, this case should serve as a reference for its possible virulence level in immunocompetent hosts. In spite of this organism\'s pathological rarity, this case highlights the importance of understanding the microbiology, historical context, and treatment for R. dentocariosa as a cause for deep neck cellulitis, myositis, and reactive lymphadenitis.

BACKGROUND: Aortic valve infective endocarditis (IE) is associated with significant morbidity and mortality. We aimed to describe the clinical profile, risk factors and predictors of short- and long-term mortality in patients with aortic valve IE treated with aortic valve replacement (AVR) compared with a control group undergoing AVR for non-infectious valvular heart disease.
METHODS: Between January 2008 and December 2013, a total of 170 cases with IE treated with AVR (exposed cohort) and 677 randomly selected non-infectious AVR-treated patients with degenerative aortic valve disease (controls) were recruited from three tertiary hospitals with cardiothoracic facilities across Scandinavia. Crude and adjusted hazard ratios (HR) were estimated using Cox regression models.
RESULTS: The mean age of the IE cohort was 58.5 ± 15.1 years (80.0% men). During a mean follow-up of 7.8 years (IQR 5.1-10.8 years), 373 (44.0%) deaths occurred: 81 (47.6%) in the IE group and 292 (43.1%) among controls. Independent risk factors associated with IE were male gender, previous heart surgery, underweight, positive hepatitis C serology, renal failure, previous wound infection and dental treatment (all p < 0.05). IE was associated with an increased risk of both short-term (≤ 30 days) (HR 2.86, [1.36-5.98], p = 0.005) and long-term mortality (HR 2.03, [1.43-2.88], p < 0.001). In patients with IE, chronic obstructive pulmonary disease (HR 2.13), underweight (HR 4.47), renal failure (HR 2.05), concomitant mitral valve involvement (HR 2.37) and mediastinitis (HR 3.98) were independent predictors of long-term mortality. Staphylococcus aureus was the most prevalent microbe (21.8%) and associated with a 5.2-fold increased risk of early mortality, while enterococci were associated with the risk of long-term mortality (HR 1.78).
CONCLUSIONS: In this multicenter case-control study, IE was associated with an increased risk of both short- and long-term mortality compared to controls. Efforts should be made to identify, and timely treat modifiable risk factors associated with contracting IE, and mitigate the predictors of poor survival in IE.

A 31-year-old female presented to our hospital with sudden headache and altered consciousness. Computed tomography showed left acute subdural hematoma, and digital subtraction angiography revealed a small aneurysm on the left distal posterior cerebral artery. Coil embolization was conducted, and the patient was discharged with no neurological deficits. However, two weeks later, she presented with complete left hemiplegia and with the National Institutes of Health Stroke Scale of 20. Magnetic resonance angiography showed the occlusion of right middle cerebral artery, and the Diffusion-Weighted Imaging-Alberta Stroke Program Early Computed Tomography Score was four. Mechanical thrombectomy was conducted. Complete recanalization was achieved, and the patient recovered favorably. Although she showed no symptoms of infection such as fever throughout the treatment of aneurysm and thrombectomy, her blood culture was positive for streptococcus mitis. Furthermore, the thrombus retrieved by thrombectomy showed bacterial mass, and transesophageal echocardiography (TEE) showed vegetation on the mitral valve that could not be detected by transthoracic echocardiography. Therefore, the patient was diagnosed with infective endocarditis (IE). She was administered penicillin for 6 weeks and was discharged with no neurological deficits. When treating young patients with small aneurysms in rare locations, IE should be suspected, and blood culture and TEE should be conducted, even when there are no obvious symptoms of systemic infection.

Infective endocarditis (IE) is a bloodstream infection affecting the valves of the heart. IE is highly associated with morbidity and mortality if not properly managed. Pseudomonas aeruginosa (P. aeruginosa) as a cause of IE is extremely rare. This is a case of IE involving a male patient with a history of intravenous drug use (IVDU), secondary to P. aeruginosa, with associated relapse of bacteremia and native tricuspid valve endocarditis, complicated by septic pulmonary emboli, despite undergoing recent vegetation debulking using the AngioVac system (AngioDynamics, Inc., New York, USA) along with six weeks of IV antibiotics and no IVDU since then being on treatment.

OBJECTIVE: Patients with congenital heart disease (CHD) form a high-risk subgroup for infective endocarditis (IE), necessitating tailored prevention and treatment strategies. However, comprehensive nationwide data comparing IE characteristics and outcomes in patients with and without CHD, including children, are sparse. This study aims to address this gap in knowledge.
METHODS: Using Danish nationwide registries, all patients with IE from 1977 to 2021 were identified and stratified on whether they had a diagnosis of CHD, regardless of its complexity. Characteristics prior to and during admission as well as associated outcomes (i.e. in-hospital mortality, 1-year mortality, and 10-year mortality, and IE recurrence) were compared between groups.
RESULTS: In total, 14 040 patients with IE were identified, including 895 (6.4%) with CHD. Patients with vs. without CHD were younger at the time of IE diagnosis (median age 38.8 vs. 70.7 years), less comorbid, and more frequently underwent cardiac surgery during admission (35.7% vs. 23.0%, P < .001). Notably, 76% of patients with IE < 18 years of age had CHD. The IE-related bacteraemia differed between groups: Streptococci (29.9%) were the most common in patients with CHD, and Staphylococcus aureus (29.9%) in patients without CHD. Patients with CHD had a significantly lower cumulative incidence of in-hospital mortality (5.7% vs. 17.0%, P < .001) and 1-year mortality (9.9% vs. 31.8%, P < .001) compared with those without CHD. The 10-year cumulative incidence of IE recurrence was similar between groups (13.0% and 13.9%, P = .61).
CONCLUSIONS: Patients with CHD who develop IE exhibit distinct characteristics and improved long-term outcomes compared with patients without CHD. Notably, the majority of children and adolescents with IE have underlying CHD.