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Authors: SICILIANO, R. F.NASTRI, A. C. de Seixas SantosODONGO, F. C. AtienoSOUZA, L. de OliveiraAZUMA, A. O.GUALANDRO, D. M.CARAMELLI, B.STRABELLI, T. M. Varejao
Abstract: Group A β-hemolytic Streptococcus is an uncommon agent in bacterial endocarditis with few cases described in the literature. We report 2 cases of acute infective endocarditis (IE) due to Streptococcus pyogenes with systemic complications. Case 1:A 22-year-old woman was admitted with confusion and a 5-day fever history. The patient presented neck stiffness, altered mental status and mitral regurgitation murmur. Cerebrospinal fluid showed 1840 cells (82% neutrophils) and ceftriaxone was prescribed. Blood cultures yielded Streptococcus pyogenes. Echocardiography revealed 2 vegetations in the mitral valve and posterior cusp perforation with moderate reflux. She had no clinical or image signs of heart failure or embolization and was discharged after 4 weeks of ceftriaxone treatment. Case 2: A 16-year-old boy, with a past history of corrected type II truncus arteriosus, aortic prosthesis and right ventricle–pulmonary artery tube presented with fever in the last week. Blood cultures yielded Streptococcus pyogenes and penicillin plus gentamicin was started. The patient developed hypotension, dyslalia and sepsis. A cranial tomography identified a small bleeding area in the left parietal region. Transesophageal echocardiography revealed no signs of vegetations. Abdominal tomography showed spleen abscess and kidney infarction. The patient was submitted to splenectomy on hospital day 30, and to cardiac surgery for aortic valve and right ventricle–pulmonary artery tube replacement on hospital day 36. He completed 4 weeks of antibiotic treatment after surgical procedures and was discharged. Conclusion: Both cases were young people presenting with acute illness and several complications related to IE. According to current data, most cases of Streptococcus pyogenes IEoccurinchildrenor young adults, have rapid clinical progression and high rates of complications, just as our patients. This agent is associated with high virulence and high rates of complications and must be promptly recognized and treated to avoid high mortality rates.
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Comunicações em Eventos - FM/MCP
Departamento de Cardio-Pneumologia - FM/MCP

Comunicações em Eventos - HC/ICHC
Instituto Central - HC/ICHC

Comunicações em Eventos - HC/InCor
Instituto do Coração - HC/InCor

Comunicações em Eventos - LIM/47
LIM/47 - Laboratório de Hepatologia por Vírus

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