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Recurrent Prosthetic Paravalvular Leakage in Culture-negative Endocarditis Caused by mycoplasma hominis: A Case Report

Received: 19 June 2022     Accepted: 8 October 2022     Published: 21 October 2022
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Abstract

Background: Culture-negative endocarditis in patients with previous prosthetic valve replacement is a challenging disease with high mortality and poor outcomes. Recurrent paravalvular leakage is a common complication in patients with prosthetic valve but is rarely realized to endocarditis. Objectives: To report a diagnostic strategy for culture-negative endocarditis caused by atypical pathogen in patients with previous prosthetic valve replacement. Patients and Methods: We present a case report about recurrent prosthetic valvular leakage with preoperatively unknown cause. Traditional clinical laboratory for pathogen detection and echocardiography were routinely performed. The patient received aortic and mitral valve replacement and tricuspid annuloplasty. Metagenomic next-generation sequence tests on removal tissue and blood are performed. Results: Preoperative imaging finding of vegetation and blood culture was negative. Metagenomic next-generation sequence tests on resected valve tissue and blood specimens revealed 236 and 154 unique read-pairs aligning to mycoplasma hominis, respectively. Retrospective serological immunofluorescence assay revealed cross-reaction to mycoplasma pneumonia. Haematoxylin-eosin-stained histological section of the mobile vegetation attached to the mitral mechanism prosthesis demonstrated hyalinization in intercellular substance and infiltration of neutrophils, lymphocytes, and plasmocytes, which indicated chronic infective endocarditis. Culture-negative endocarditis were diagnosed by multidisciplinary team. Azithromycin was selected for anti-mycoplasma hominis. The patient made an excellent recovery and repeat transthoracic echocardiography performed at discharge demonstrated a good prosthetic valve function. Conclusion: Culture-negative endocarditis may be a criminal in cryptogenic paravalvular leakage. A multiple-image-technique strategy combined with metagenomic next-generation sequence to patients with recurrent paravalvular leakage are recommended for early diagnosis ant timely antibiotic administration for potential endocarditis.

Published in Cardiology and Cardiovascular Research (Volume 6, Issue 4)
DOI 10.11648/j.ccr.20220604.11
Page(s) 92-96
Creative Commons

This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.

Copyright

Copyright © The Author(s), 2022. Published by Science Publishing Group

Keywords

Culture-negative Endocarditis, Recurrent Prosthetic Paravalvular Leakage, mycoplasma hominis

References
[1] Petersen J, Krogmann H, Reichenspurner H, Girdauskas E. Long-Term Outcome and Quality of Life After Biological Aortic Valve Replacement in Nonelderly Adults. The Annals of thoracic surgery 2021; 111: 142-149.
[2] Bernard J, Kalavrouziotis D, Marzouk M et al. Prosthetic choice in mitral valve replacement for severe chronic ischemic mitral regurgitation: Long-term follow-up. The Journal of thoracic and cardiovascular surgery 2021.
[3] Weber C, Petrov G, Luehr M et al. Surgical results for prosthetic versus native valve endocarditis: A multicenter analysis. The Journal of thoracic and cardiovascular surgery 2021; 161: 609-619. e10.
[4] Pyo WK, Kim HJ, Kim JB et al. Comparative Surgical Outcomes of Prosthetic and Native Valve Endocarditis. Korean circulation journal 2021; 51: 504-514.
[5] Della Corte A, Di Mauro M, Actis Dato G et al. Surgery for prosthetic valve endocarditis: a retrospective study of a national registry. European journal of cardio-thoracic surgery: official journal of the European Association for Cardio-thoracic Surgery 2017; 52: 105-111.
[6] Bayer AS, Chambers HF. Prosthetic Valve Endocarditis Diagnosis and Management- New Paradigm Shift Narratives. Clinical infectious diseases: an official publication of the Infectious Diseases Society of America 2021; 72: 1687-1692.
[7] Khalil H, Soufi S. Prosthetic Valve Endocarditis. StatPearls. Treasure Island (FL): StatPearls Publishing. Copyright © 2022, StatPearls Publishing LLC., 2022.
[8] Østergaard L, Valeur N, Ihlemann N et al. Incidence of infective endocarditis among patients considered at high risk. European heart journal 2018; 39: 623-629.
[9] Salem M, Friedrich C, Saad M et al. Active Infective Native and Prosthetic Valve Endocarditis: Short- and Long-Term Outcomes of Patients after Surgical Treatment. Journal of clinical medicine 2021; 10.
[10] Nataloni M, Pergolini M, Rescigno G, Mocchegiani R. Prosthetic valve endocarditis. Journal of cardiovascular medicine (Hagerstown, Md) 2010; 11: 869-83.
[11] Habib G, Hoen B, Tornos P et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. European heart journal 2009; 30: 2369-413.
[12] Bae M, Lee HJ, Park JH et al. Molecular diagnosis of Coxiella burnetii in culture negative endocarditis and vascular infection in South Korea. Annals of medicine 2021; 53: 2256-2265.
[13] Eder MD, Upadhyaya K, Park J et al. Multimodality Imaging in the Diagnosis of Prosthetic Valve Endocarditis: A Brief Review. Frontiers in cardiovascular medicine 2021; 8: 750573.
[14] Cremer PC. Diagnostic Uncertainty in Prosthetic Valve Endocarditis: Value of (18)F-FDG PET/CT and the Need for Standardization. JACC Cardiovascular imaging 2020; 13: 2616-2618.
[15] Habib G, Lancellotti P, Antunes MJ et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). European heart journal 2015; 36: 3075-3128.
[16] Numazaki K, Ueno H, Yokoo K, Muramatsu Y, Chiba S, Morita C. Detection of serum antibodies to Bartonella henselae and Coxiella burnetii from Japanese children and pregnant women. Microbes and infection 2000; 2: 1431-4.
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  • APA Style

    Weiteng Wang, Oudi Chen, Lixi Gan, Xin Li, Hongkun Qing, et al. (2022). Recurrent Prosthetic Paravalvular Leakage in Culture-negative Endocarditis Caused by mycoplasma hominis: A Case Report. Cardiology and Cardiovascular Research, 6(4), 92-96. https://doi.org/10.11648/j.ccr.20220604.11

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    ACS Style

    Weiteng Wang; Oudi Chen; Lixi Gan; Xin Li; Hongkun Qing, et al. Recurrent Prosthetic Paravalvular Leakage in Culture-negative Endocarditis Caused by mycoplasma hominis: A Case Report. Cardiol. Cardiovasc. Res. 2022, 6(4), 92-96. doi: 10.11648/j.ccr.20220604.11

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    AMA Style

    Weiteng Wang, Oudi Chen, Lixi Gan, Xin Li, Hongkun Qing, et al. Recurrent Prosthetic Paravalvular Leakage in Culture-negative Endocarditis Caused by mycoplasma hominis: A Case Report. Cardiol Cardiovasc Res. 2022;6(4):92-96. doi: 10.11648/j.ccr.20220604.11

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  • @article{10.11648/j.ccr.20220604.11,
      author = {Weiteng Wang and Oudi Chen and Lixi Gan and Xin Li and Hongkun Qing and Fanyu Chen and Zuoren Xiao and Xuhua Jian},
      title = {Recurrent Prosthetic Paravalvular Leakage in Culture-negative Endocarditis Caused by mycoplasma hominis: A Case Report},
      journal = {Cardiology and Cardiovascular Research},
      volume = {6},
      number = {4},
      pages = {92-96},
      doi = {10.11648/j.ccr.20220604.11},
      url = {https://doi.org/10.11648/j.ccr.20220604.11},
      eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ccr.20220604.11},
      abstract = {Background: Culture-negative endocarditis in patients with previous prosthetic valve replacement is a challenging disease with high mortality and poor outcomes. Recurrent paravalvular leakage is a common complication in patients with prosthetic valve but is rarely realized to endocarditis. Objectives: To report a diagnostic strategy for culture-negative endocarditis caused by atypical pathogen in patients with previous prosthetic valve replacement. Patients and Methods: We present a case report about recurrent prosthetic valvular leakage with preoperatively unknown cause. Traditional clinical laboratory for pathogen detection and echocardiography were routinely performed. The patient received aortic and mitral valve replacement and tricuspid annuloplasty. Metagenomic next-generation sequence tests on removal tissue and blood are performed. Results: Preoperative imaging finding of vegetation and blood culture was negative. Metagenomic next-generation sequence tests on resected valve tissue and blood specimens revealed 236 and 154 unique read-pairs aligning to mycoplasma hominis, respectively. Retrospective serological immunofluorescence assay revealed cross-reaction to mycoplasma pneumonia. Haematoxylin-eosin-stained histological section of the mobile vegetation attached to the mitral mechanism prosthesis demonstrated hyalinization in intercellular substance and infiltration of neutrophils, lymphocytes, and plasmocytes, which indicated chronic infective endocarditis. Culture-negative endocarditis were diagnosed by multidisciplinary team. Azithromycin was selected for anti-mycoplasma hominis. The patient made an excellent recovery and repeat transthoracic echocardiography performed at discharge demonstrated a good prosthetic valve function. Conclusion: Culture-negative endocarditis may be a criminal in cryptogenic paravalvular leakage. A multiple-image-technique strategy combined with metagenomic next-generation sequence to patients with recurrent paravalvular leakage are recommended for early diagnosis ant timely antibiotic administration for potential endocarditis.},
     year = {2022}
    }
    

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  • TY  - JOUR
    T1  - Recurrent Prosthetic Paravalvular Leakage in Culture-negative Endocarditis Caused by mycoplasma hominis: A Case Report
    AU  - Weiteng Wang
    AU  - Oudi Chen
    AU  - Lixi Gan
    AU  - Xin Li
    AU  - Hongkun Qing
    AU  - Fanyu Chen
    AU  - Zuoren Xiao
    AU  - Xuhua Jian
    Y1  - 2022/10/21
    PY  - 2022
    N1  - https://doi.org/10.11648/j.ccr.20220604.11
    DO  - 10.11648/j.ccr.20220604.11
    T2  - Cardiology and Cardiovascular Research
    JF  - Cardiology and Cardiovascular Research
    JO  - Cardiology and Cardiovascular Research
    SP  - 92
    EP  - 96
    PB  - Science Publishing Group
    SN  - 2578-8914
    UR  - https://doi.org/10.11648/j.ccr.20220604.11
    AB  - Background: Culture-negative endocarditis in patients with previous prosthetic valve replacement is a challenging disease with high mortality and poor outcomes. Recurrent paravalvular leakage is a common complication in patients with prosthetic valve but is rarely realized to endocarditis. Objectives: To report a diagnostic strategy for culture-negative endocarditis caused by atypical pathogen in patients with previous prosthetic valve replacement. Patients and Methods: We present a case report about recurrent prosthetic valvular leakage with preoperatively unknown cause. Traditional clinical laboratory for pathogen detection and echocardiography were routinely performed. The patient received aortic and mitral valve replacement and tricuspid annuloplasty. Metagenomic next-generation sequence tests on removal tissue and blood are performed. Results: Preoperative imaging finding of vegetation and blood culture was negative. Metagenomic next-generation sequence tests on resected valve tissue and blood specimens revealed 236 and 154 unique read-pairs aligning to mycoplasma hominis, respectively. Retrospective serological immunofluorescence assay revealed cross-reaction to mycoplasma pneumonia. Haematoxylin-eosin-stained histological section of the mobile vegetation attached to the mitral mechanism prosthesis demonstrated hyalinization in intercellular substance and infiltration of neutrophils, lymphocytes, and plasmocytes, which indicated chronic infective endocarditis. Culture-negative endocarditis were diagnosed by multidisciplinary team. Azithromycin was selected for anti-mycoplasma hominis. The patient made an excellent recovery and repeat transthoracic echocardiography performed at discharge demonstrated a good prosthetic valve function. Conclusion: Culture-negative endocarditis may be a criminal in cryptogenic paravalvular leakage. A multiple-image-technique strategy combined with metagenomic next-generation sequence to patients with recurrent paravalvular leakage are recommended for early diagnosis ant timely antibiotic administration for potential endocarditis.
    VL  - 6
    IS  - 4
    ER  - 

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Author Information
  • Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, P. R. China

  • Adult Echocardiography, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, P. R. China

  • Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, P. R. China

  • Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, P. R. China

  • Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, P. R. China

  • Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, P. R. China

  • Second Clinical Medical College, Southern Medical University, Guangzhou, P. R. China

  • Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, P. R. China

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