Aggregatibacter aphrophilus pacemaker endocarditis: a case report

BMC Research Notes

Heath Saltzman³  Amit Borah¹  Nishi H Patel²  Sahil R Patel² 

[1] Department of Pulmonary/Critical Care, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA;Department of Internal Medicine, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA;Department of Cardiology, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA

关键词: CIED;    Haemophilus;    Aggregatibacter;    Pacemaker;    HACEK;    Endocarditis;   

Others  :  1092476
DOI  :  10.1186/1756-0500-7-885

 received in 2014-07-28, accepted in 2014-11-13,  发布年份 2014

【 摘 要 】

Background

Aggregatibacter bacteria are a rare cause of endocarditis in adults. They are part of a group of organisms known as HACEK – Haemophilus, Aggregatibacter, Cardiobacter, Eikenella, and Kingella. Among these organisms, several Haemophilus species have been reclassified under the genus Aggregatibacter. Very few cases of Aggregatibacter endocarditis in patients with pacemaker devices have been reported.

Case presentation

We present here what we believe to be the first case of Aggregatibacter aphrophilus pacemaker endocarditis. A 62-year-old African American male with a medical history significant for dual-chamber pacemaker placement in 1996 for complete heart block with subsequent lead manipulation in 2007, presented to his primary care doctor with fever, chills, night sweats, fatigue, and ten-pound weight loss over a four-month period. Physical examination revealed a new murmur and jugular venous distension which prompted initiation of antibiotics for suspicion of endocarditis. Both sets of initial blood cultures were positive for A. aphrophilus. Transesophageal echocardiogram revealed vegetations on the tricuspid valve and the right ventricular pacemaker lead (Figure 1). This case highlights the importance of identifying rare causes of endocarditis and recognizing that treatment may not differ from the standard treatment for typical presentations. The patient received intravenous ceftriaxone for his endocarditis for a total of six weeks. Upon device removal, temporary jugular venous pacing wires were placed. After two weeks of antibiotic treatment and no clinical deterioration, a new permanent pacemaker was placed and the patient was discharged home.

Conclusions

This is the first case of A. aphrophilus endocarditis in a patient with a permanent pacemaker. Our patient had no obvious risk factors other than poor dentition and a history of repeated pacemaker lead manipulation. This suggests that valvulopathies secondary to repeated lead manipulation can be clinically significant factors in morbidity and mortality in this patient population.

【 授权许可】

   
2014 Patel et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

【 参考文献 】

• [1]Chambers ST, Murdoch D, Morris A, Holland D, Pappas P, Almela M, Fernanez-Hidalgo N, Almirante B, Bouza E, Forno D, Del Rio A, Hannan MM, Harkness J, Kanafani ZA, Lalani T, Lang S, Raymond N, Read K, Vinogradova T, Woods CW, Wray D, Corey GR, Chu VH: HACEK infective endocarditis: characteristics and outcomes from a large, multinational cohort. PLoS One 2013., 8
• [2]Marks DJ, Hyams C, Koo CY, Pavlou M, Robbins J, Koo CS, Rodger G, Hugget JF, Yap J, Macrae MB, Swanton RH, Zumla AI, Miller RF: Clinical features, microbiology and surgical outcomes of infective endocarditis: a 13-year study from a UK tertiary cardiothoracic referral centre. QJMin press
• [3]Voigt A, Shalaby A, Saba S: Continued rise in rates of cardiovascular implantable electronic device infections in the United States: temporal trends and causative insights. Pacing Clin Electrophysiol 2010, 33:414-419.
• [4]Rundstrom H, Kennergren C, Andersson R, Alestig K, Hogevik H: Pacemaker endocarditis during 18 years in Goteborg. Scand J Infect Dis 2004, 36:674-679.
• [5]Edelstein S, Yahalom M: Cardiac device-related endocarditis: epidemiology, pathogenesis, diagnosis and treatment – a review. Int J Angiol 2009, 18:167-172.
• [6]Darras-Joly C, Lortholary O, Mainardi JL, Etienne J, Guillevin L, Acar J: Haemophilus endocarditis: report of 42 cases in adults and review. Haemophilus Endocarditis Study Group. Clin Infect Dis 1997, 24:1087-1094.
• [7]Zhenhong L, Madeo J, Ahmed S, Vidal A, Makaryus A, Mejia J, Yasmin T: Permanent pacemaker-associated actinomycetemcomitans endocarditis: a case report. Germs 2013, 3:96-101.
• [8]Pai RK, Pergram SA, Kedia A, Cadman CS, Osborn LA: Pacemaker lead infection secondary to Haemophilus parainfluenzae. Pacing Clin Electrophysiol 2004, 27:1008-1010.
• [9]Nwaohiri N, Urban C, Gluck J, Ahluwalia M, Wehbeh W: Tricuspid valve endocarditis caused by Haemophilus parainfluenzae: a case report and review of the literature. Diagn Microbiol Infect Dis 2009, 64:216-219.
• [10]Khairat O: Haemophilus aphrophilus endocarditis. Br Med J 1971, 1:728.
• [11]Nørskov-Lauritsen N, Kilian M: Reclassification of actinobacillus actinomycetemcomitans, haemophilus aphrophilus, haemophilus paraphrophilus and haemophilus segnis as aggregatibacter actinomycetemcomitans gen. nov., comb. nov., aggregatibacter aphrophilus comb. nov. and aggregatibacter segnis comb. nov., and emended description of aggregatibacter aphrophilus to include V factor-dependent and V factorindependent isolates. Int J Sytematic Evolutionary Micro 2006, 56:2135-2146.
• [12]Lockhart PB, Brennan MT, Thornhill M, Michalowicz BS, Noll J, Bahrani-Mougeot FK, Sasser HC: Poor oral hygiene as a risk factor for infective endocarditis-related bacteremia. J Am Dent Assoc 2009, 140:1238-1244.
• [13]Tomás I, Diz P, Tobías A, Scully C, Donos N: Periodontal health status and bacteraemia from daily oral activities: systematic review/meta-analysis. J Clin Periodontol 2012, 39:213-228.
• [14]Ayotte JS, Ronald AR, Beamish RE: Bacterial endocarditis due to hemophilus aphrophilus. Can Med Assoc J 1970, 102:1097-1098.
• [15]Al-Barwady R, Krishnaswamy A, Bhargava M, Dunn J, Wazni O, Tuzcu EM, Stewart W, Kapadia SR: Tricuspid regurgitation in patients with pacemakers and implantable cardiac defibrillators: a comprehensive review. Clin Cardiol 2013, 36:249-254.
• [16]Baddour LM, Wilson WR, Bayer AS, Fowler VG, Bolger AF, Levison ME, Ferrieri P, Gerber MA, Tani LY, Gewitz MH, Tong DC, Steckelberg JM, Baltimore RS, Shulman ST, Burns JC, Falace DA, Newburger JW, Pallash TJ, Takahashi M, Taubert K: Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the committee on rheumatic fever, endocarditis, and kawasaki disease. Circulation 2005, 111:e394-e434.