Two cases of cardiac device-related endocarditis due to Streptococcus dysgalactiae subsp. equisimilis (group C or G streptococci)

BMC Infectious Diseases

Suvi Tuohinen²  Sari Rantala¹ 

[1] Department of Internal Medicine, Tampere University Hospital, P.O. Box 2000, FIN-33521 Tampere, Finland;Heart Center Co., Tampere University Hospital and School of Medicine, University of Tampere, Tampere, Finland

关键词: Lead extraction;    Endocarditis;    Cardiac device;    Group G streptococci;    Streptococcus dysgalactiae subsp. equisimilis;   

Others  :  1134221
DOI  :  10.1186/1471-2334-14-174

 received in 2013-12-17, accepted in 2014-03-27,  发布年份 2014

【 摘 要 】

Background

Cardiac device-related endocarditis is a very rare clinical manifestation of S. dysgalactiae subsp. equisimilis disease. This pathogen is a common cause of cellulitis. We here report two cases of cardiac device-related endocarditis due to Streptococcus dysgalactiae subsp. equisimilis. Blood cultures yielded this pathogen and both patients had recurrent bacteremia. Transthoracic and transesophageal echocardiography revealed lead vegetations. This is a new description of this pathogen to cause cardiac device-related endocarditis.

Case presentation

The first case is a 79-year-old finnish woman who received a dual-chamber pacemaker for intermittent complete heart block in April 2011. She had three episodes of S. dysgalactiae subsp. equisimilis bacteremia. During first episode she had arthritis of glenohumeral joint. Focus was unknown in the second and third bacteremic episodes. During third bacteremic episode transesophageal echocardiography (TEE) revealed lead vegetation. Patient underwent successful complete system removal. She was treated with benzylpenicillin four million IU six times a day for four weeks intravenously. The second case is a 92-year-old finnish man. A dual-chamber pacemaker was implanted on June 2012 due to total heart block. He had recurrent S. dysgalactiae subsp. equisimilis bacteremia with cellulitis. During the second bacteremic episode transthoracic echocardiography (TTE) was performed because of persistent fever. Echocardiography revealed lead vegetation. Abdominal CT revealed also an abscess in the psoas region. This elderly patient was very fragile, and the pacemaker system was not extracted. Therapy was continued with benzylpenicillin four million IU six times a day for six weeks intravenously and thereafter suppressive treatment with amoksisillin 500 mg three times a day was initiated.

Conclusion

Streptococcus dysgalactiae subsp. equisimilis (group C and G streptococci) seldom cause cardiac device endocarditis. Both patients had recurrent bacteremia of S. dysgalactiae subsp. equisimilis and echocardiography revealed cardiac device-related endocarditis. These cases emphasize the importance of considering endocarditis in elderly persons having cardiac devices together with the presence of unexplained bacteremia, fever without focus or persistent fever.

【 授权许可】

   
2014 Rantala and Tuohinen; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

【 参考文献 】

• [1]Broyles LN, Van Beneden C, Beall B, Facklam R, Shewmaker PL, Malpiedi P, Daily P, Reingold A, Farley MM: Population-based study of invasive disease Due to beta-hemolytic streptococci of groups other than A and B. Clin Infect Dis 2009, 48(6):706-712.
• [2]Ekelund K, Skinhoj P, Madsen J, Konradsen HB: Invasive group A, B, C and G streptococcal infections in Denmark 1999–2002: epidemiological and clinical aspects. Clin Microbiol Infect 2005, 11(7):569-576.
• [3]Goldberger Z, Lampert R: Implantable cardioverter-defibrillators: expanding indications and technologies. JAMA 2006, 295(7):809-818.
• [4]Osmonov D, Ozcan KS, Erdinler I, Altay S, Yildirim E, Turkkan C, Ekmekci A, Gungor B, Gurkan K: Cardiac device-related endocarditis: 31-Years’ experience. J Cardiol 2013, 61(2):175-180.
• [5]Rodriguez Y, Garisto J, Carrillo RG: Management of cardiac device-related infections: a review of protocol-driven care. Int J Cardiol 2013, 166(1):55-60.
• [6]Auckenthaler R, Hermans PE, Washington JA 2nd: Group G streptococcal bacteremia: clinical study and review of the literature. Rev Infect Dis 1983, 5(2):196-204.
• [7]Greenspon AJ, Patel JD, Lau E, Ochoa JA, Frisch DR, Ho RT, Pavri BB, Kurtz SM: 16-year trends in the infection burden for pacemakers and implantable cardioverter-defibrillators in the United States 1993 to 2008. J Am Coll Cardiol 2011, 58(10):1001-1006.
• [8]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(4):414-419.
• [9]Takahashi T, Sunaoshi K, Sunakawa K, Fujishima S, Watanabe H, Ubukata K: Clinical aspects of invasive infections with Streptococcus dysgalactiae ssp. equisimilis in Japan: differences with respect to Streptococcus pyogenes and Streptococcus agalactiae infections. Clin Microbiol Infect 2010, 16(8):1097-1103.
• [10]Rantala S, Vuopio-Varkila J, Vuento R, Huhtala H, Syrjanen J: Clinical presentations and epidemiology of beta-haemolytic streptococcal bacteraemia: a population-based study. Clin Microbiol Infect 2009, 15(3):286-288.
• [11]Cohen-Poradosu R, Jaffe J, Lavi D, Grisariu-Greenzaid S, Nir-Paz R, Valinsky L, Dan-Goor M, Block C, Beall B, Moses AE: Group G streptococcal bacteremia in Jerusalem. Emerg Infect Dis 2004, 10(8):1455-1460.
• [12]Rohde M, Talay SR, Rasmussen M: Molecular mechanisms of Streptococcus dysgalactiae subsp equisimilis enabling intravascular persistence. Microbes Infect 2012, 14(4):329-334.
• [13]Rohde M, Graham RM, Branitzki-Heinemann K, Borchers P, Preuss C, Schleicher I, Zahner D, Talay SR, Fulde M, Dinkla K, Chhatwal GS: Differences in the aromatic domain of homologous streptococcal fibronectin-binding proteins trigger different cell invasion mechanisms and survival rates. Cell Microbiol 2011, 13(3):450-468.
• [14]Sohail MR, Uslan DZ, Khan AH, Friedman PA, Hayes DL, Wilson WR, Steckelberg JM, Jenkins SM, Baddour LM: Infective endocarditis complicating permanent pacemaker and implantable cardioverter-defibrillator infection. Mayo Clin Proc 2008, 83(1):46-53.
• [15]Victor F, De Place C, Camus C, Le Breton H, Leclercq C, Pavin D, Mabo P, Daubert C: Pacemaker lead infection: echocardiographic features, management, and outcome. Heart 1999, 81(1):82-87.
• [16]Sohail MR, Uslan DZ, Khan AH, Friedman PA, Hayes DL, Wilson WR, Steckelberg JM, Stoner S, Baddour LM: Management and outcome of permanent pacemaker and implantable cardioverter-defibrillator infections. J Am Coll Cardiol 2007, 49(18):1851-1859.
• [17]Johansen JB, Jorgensen OD, Moller M, Arnsbo P, Mortensen PT, Nielsen JC: Infection after pacemaker implantation: infection rates and risk factors associated with infection in a population-based cohort study of 46299 consecutive patients. Eur Heart J 2011, 32(8):991-998.
• [18]Margey R, McCann H, Blake G, Keelan E, Galvin J, Lynch M, Mahon N, Sugrue D, O’Neill J: Contemporary management of and outcomes from cardiac device related infections. Europace 2010, 12(1):64-70.
• [19]Gould FK, Denning DW, Elliott TS, Foweraker J, Perry JD, Prendergast BD, Sandoe JA, Spry MJ, Watkin RW, Working Party of the British Society for Antimicrobial C: Guidelines for the diagnosis and antibiotic treatment of endocarditis in adults: a report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother 2012, 67(2):269-289.