Recurrent tricuspid endocarditis sustained by Streptococcus agalactiae and Enterococcus faecalis in an HIV-infected intravenous drug abuser patient.
Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. B10230)
Calza L, Manfredi R, Marinacci G, Fortunato L, Chiodo F Infectious Diseases, University of Bologna, Bologna, Italy
Introduction. Infective endocarditis associated with HIV infection occurs almost exclusively in i.v. drug users and is rarely reported in other HIV-infected patients. Case report. A 33-year-old i.v. drug abuser male patient, with advanced HIV infection was first hospitalized owing to persisting hyperpyrexia, chills, asthenia, hepatomegaly, splenomegaly, leukocytosis, severe anemia, and increased erythrocyte sedimentation rate. His CD4+ lymphocyte count was 232 cells/mm3, while plasma HIV viral load was 9200 copies/mL; ongoing antiretroviral therapy included stavudine, didanosine, and efavirenz since 13 months. Ecocardiographic study disclosed a large mobile vegetation of 21 mm in diameter involving tricuspid valve, and three consecutive blood cultures tested positive for Streptococcus agalactiae. On the basis of in vitro antimicrobial sensitivity testing, therapy with i.v. ampicillin and gentamicin was administered for 22 days, leading to a complete clinical remission and ecocardiographic anomaly disappearance. Six months later, our patient developed again hyperpyrexia and chills, associated with leukocytosis, severe anemia and increased erythrocyte sedimentation rate; ecocardiographic study revealed a recurrence of tricuspid endocarditis (showing a vegetation of 16 mm in diameter), and five consecutive blood cultures tested positive for Enterococcus faecalis. A novel 28-day attack course of teicoplanin and gentamicin was administered on the basis of in vitro antimicrobial susceptibility testing, leading to a complete clinical and ecocardiographic recovery.
CONCLUSION: Tricuspid valve is the most frequently involved site of infection in bacterial endocarditis reported in HIV-infected i.v. drug user patients, and Staphylococcus aureus is the most frequent causal agent. Our patient represents the first reported case of recurrent bacterial endocarditis sustained by Streptococcus agalactiae and Enterococcus faecalis in an i.v. drug abuser patient with HIV infection.
Keywords: AEGIS, Endocarditis, Enterococcus faecalis, HIV Infections, Streptococcus agalactiae, Endocarditis, Bacterial, Tricuspid Valve, HIV-1, HIV Seropositivity, Teicoplanin, Ampicillin, Tricuspid Valve Insufficiency, Gentamicins, Human, In Vitro, Male
