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Native Valve Endocarditis due to Ralstonia pickettii: A Case Report and Literature Review.

Orme J, Rivera-Bonilla T, Loli A, Blattman NN - Case Rep Infect Dis (2015)

Bottom Line: Ralstonia pickettii is a rare pathogen and even more rare in healthy individuals.Here we report a case of R. pickettii bacteremia leading to aortic valve abscess and complete heart block.To our knowledge this is the first case report of Ralstonia species causing infective endocarditis with perivalvular abscess.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Banner Good Samaritan Medical Center, Phoenix, AZ 85006, USA.

ABSTRACT
Ralstonia pickettii is a rare pathogen and even more rare in healthy individuals. Here we report a case of R. pickettii bacteremia leading to aortic valve abscess and complete heart block. To our knowledge this is the first case report of Ralstonia species causing infective endocarditis with perivalvular abscess.

No MeSH data available.


Related in: MedlinePlus

Transesophageal echocardiogram at midesophageal long-axis view with Doppler revealing regurgitation into abscess surrounding the aortic valve suggestive of aortic fistula.
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fig3: Transesophageal echocardiogram at midesophageal long-axis view with Doppler revealing regurgitation into abscess surrounding the aortic valve suggestive of aortic fistula.

Mentions: Given CT evidence of septic emboli, fevers, and ECG findings of complete AV block, an initial transthoracic echocardiogram (TTE) was performed on day two of admission, followed by a transesophageal echocardiogram (TEE) on day three of admission. TEE confirmed initial TTE findings of aortic valve thickening on the left coronary cusp highly suggestive of vegetation (Figure 2) and associated severe aortic regurgitation. Furthermore, an echo density was noted at the aortic root with color flow transmission highly suggestive of an aortic root abscess with fistula (Figure 3). There was moderate mitral valve regurgitation with normal left ventricular systolic function. A bicuspid aortic valve was also noted on the TEE. Gram-positive cocci were seen on Gram stain from blood cultures drawn on admission; therefore she was continued on vancomycin and gentamicin. The patient was referred for emergent cardiothoracic surgery with replacement of the aortic valve with a 19 mm freestyle tissue valve, incision and drainage and debridement of the subannular abscess, and reconstruction of the proximal anterior leaflet of the mitral valve and aortic annulus with pericardial patch placement which was performed at an outside hospital on day six of hospitalization. No pacemaker was placed at this time of surgery as the cardiothoracic surgeons felt that it would best be placed once her blood cultures were sterile. At the time of valve replacement a transfemoral pacer was placed.


Native Valve Endocarditis due to Ralstonia pickettii: A Case Report and Literature Review.

Orme J, Rivera-Bonilla T, Loli A, Blattman NN - Case Rep Infect Dis (2015)

Transesophageal echocardiogram at midesophageal long-axis view with Doppler revealing regurgitation into abscess surrounding the aortic valve suggestive of aortic fistula.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4306225&req=5

fig3: Transesophageal echocardiogram at midesophageal long-axis view with Doppler revealing regurgitation into abscess surrounding the aortic valve suggestive of aortic fistula.
Mentions: Given CT evidence of septic emboli, fevers, and ECG findings of complete AV block, an initial transthoracic echocardiogram (TTE) was performed on day two of admission, followed by a transesophageal echocardiogram (TEE) on day three of admission. TEE confirmed initial TTE findings of aortic valve thickening on the left coronary cusp highly suggestive of vegetation (Figure 2) and associated severe aortic regurgitation. Furthermore, an echo density was noted at the aortic root with color flow transmission highly suggestive of an aortic root abscess with fistula (Figure 3). There was moderate mitral valve regurgitation with normal left ventricular systolic function. A bicuspid aortic valve was also noted on the TEE. Gram-positive cocci were seen on Gram stain from blood cultures drawn on admission; therefore she was continued on vancomycin and gentamicin. The patient was referred for emergent cardiothoracic surgery with replacement of the aortic valve with a 19 mm freestyle tissue valve, incision and drainage and debridement of the subannular abscess, and reconstruction of the proximal anterior leaflet of the mitral valve and aortic annulus with pericardial patch placement which was performed at an outside hospital on day six of hospitalization. No pacemaker was placed at this time of surgery as the cardiothoracic surgeons felt that it would best be placed once her blood cultures were sterile. At the time of valve replacement a transfemoral pacer was placed.

Bottom Line: Ralstonia pickettii is a rare pathogen and even more rare in healthy individuals.Here we report a case of R. pickettii bacteremia leading to aortic valve abscess and complete heart block.To our knowledge this is the first case report of Ralstonia species causing infective endocarditis with perivalvular abscess.

View Article: PubMed Central - PubMed

Affiliation: Department of Internal Medicine, Banner Good Samaritan Medical Center, Phoenix, AZ 85006, USA.

ABSTRACT
Ralstonia pickettii is a rare pathogen and even more rare in healthy individuals. Here we report a case of R. pickettii bacteremia leading to aortic valve abscess and complete heart block. To our knowledge this is the first case report of Ralstonia species causing infective endocarditis with perivalvular abscess.

No MeSH data available.


Related in: MedlinePlus