Please use this identifier to cite or link to this item: https://observatorio.fm.usp.br/handle/OPI/2748
Title: GRANULICATELLA SPP. ENDOCARDITIS: CASE SERIES
Authors: SICILIANO, R. F.ADAM, E. L.GUALANDRO, D. M.CALDERARO, D.ISSA, V. S.STRABELLI, T. M. VarejaoMANSUR, A. J.ROSSI, F.CARAMELLI, B.
Citation: INTERNATIONAL JOURNAL OF ANTIMICROBIAL AGENTS, v.41, suppl.1, p.S22-S22, 2013
Abstract: Introduction: Nutritionally variant streptococci (NVS) are fastidious organisms that could be responsible for up to 6% of cases of streptococcal infective endocarditis (IE). We report four cases of IE caused by Granulicatella species. Case 1: A 31-year-old male patient presented with fever in the past 15 days and weight loss in 5 months. Echocardiogram showed a bicuspid aortic valve with a 21mm vegetation, abscess and fistula formation. Patient had valve replacement surgery, he was treated with teicoplanin plus gentamycin for four weeks, and was discharged asymptomatic. Case 2: A 64-year-old male with diabetes was admitted with 30 days progressive dyspnea and loss of 25kg in 6 months. Echocardiogram revealedtwovegetationsintheaorticvalve(26mm). Patient developed cardiogenic shock, requiring emergency valve replacement surgery. Postoperatively, he was treated with multiple antibiotic regimens including teicoplanin, meropenem, polymyxin and fluconazole, being discharged fully recovered. He was readmittedtwo weeks later and died due to heart failure and nosocomial pneumonia. Case 3: A 75-year-old man was admitted with a 3-month weight loss. Echocardiogram showed vegetation (19mm) and severe aortic regurgitation. Penicillin plus gentamicin were initiated. Patient died before cardiac surgery due to central nervous system embolization. Case 4: A 59-year-old female reported a five-month fever prior to admission. At hospital admission, tomography showed spleen and kidney embolization. Echocardiogram identified a bicuspid aortic valve with severe regurgitation and vegetation (12mm). Valve replacement surgery was performed and the patient was treated with vancomycin plus gentamycin for 30 days. She was discharged home asymptomatic. Conclusion: NVS are important agents due to the difficulties in isolation and treatment response. We suggest that in IE cases with large vegetations (>10mm), early surgery and combined antibiotic therapy should be considered, probably leading to more favorable outcomes in NVS endocarditis.
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