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A case of cerebral emboli complicating infective endocarditis caused by Abiotrophia defectiva

Session Poster Session 4

Speaker Hao Thai Phan

Event : Heart Failure 2019

  • Topic : valvular, myocardial, pericardial, pulmonary, congenital heart disease
  • Sub-topic : Valvular Heart Disease – Pathophysiology and Mechanisms
  • Session type : Poster Session

Authors : TH Phan (Ho Chi Minh,VN)

Authors:
TH Phan1 , 1Pham Ngoc Thach University of Medicine - Ho Chi Minh City - Viet Nam ,

Citation:

Background: Abiotrophia defectiva is a rare cause of endocarditis. However, some studies have estimated that this organism is responsible for 5-6% of all cases of Infective endocarditis. Endocarditis caused by A.defectiva carries greater morbidity and mortality than endocarditis caused by other streptococci. It is characterized by the occurrence of certain complications such as congestive heart failure, embolization and an increased rate of surgical interventions. We report a case of cerebral emboli complicating infective endocarditis caused by Abiotrophia defectiva.

Case presentation: A 32-year-old male patient with no history of heart disease presented to the hospital with high fever over 3 weeks, fatigue and headache. On the third day of hospitalisation, left facial paralysis developed and neck stiffness. Physical examination show a holosystolic murmur 3/6 grade in apex and left side paralysis. Fundoscopic examination was normal. Laboratory investigations were as follows: WBC 10.9 x 109/L, Hemoglobin: 11.5 g/dl, Platelets: 326x109/L and CRP: 48.3mg/L. Three sets of blood cultures were obtained. Blood cultures grew a gram positive coccobacillus which was phenotypically identified as Abiotrophia defectiva.Transthoracic echocardiography revealed a 2×0.5 cm-sized vegetation on the anterior mitral valve leaflet and a 1.5x0.7cm-sized vegetation on the posterior mitral valve leaflet and severe mitral regurgitation, LV ejection fraction was 64%. Cranial computed tomography revealed an infarct in the right parietotemporal lobe. A diagnosis of cerebral emboli complicating infective endocarditis due to Abiotrophia defectiva was made. Treatment, with ceftriaxon and vancomycin, was administered for 4 weeks. Mechanical valve replacement was required after starting the antibiotic therapy. The patient had a favorable outcome on follow up.

Discussion: Abiotrophia defectiva is a rare pathogen of infective endocarditis and in some cases embolization occur. Our patient was unaware of having any cardiac disease and the diagnosis of infective endocarditis is only considered after the development of embolic episodes. Dental procedures or dental caries are thought to be associated with the onset of infective endocarditis caused by Abiotrophia defectiva. Prompt attention to correct identification of this pathogen and surgical treatment of mitral valve must be given careful attention by the attending physican.

Conclusion: A.defectiva is a recognized cause of endocarditis. Clinicians should be aware of this organism and its pathogenic potential. Proper identification of this pathogen is important to achieve a better outcome.

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