Infective endocarditis secondary to an infrequent agent in a patient with haemodialysis
Endocarditis infecciosa secundaria a agente poco frecuente en paciente en hemodiálisis
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His previous medical history showed chronic ischaemic heart disease, hypertension and receiving treatment of corticosteroids. Having no previous symptoms, he ran a temperature of > 39º C and felt a general discomfort. The examination revealed signs of hypotension, tachycardia, grade III/VI heart murmur (heard everywhere else in the body) and temperature. The blood test findings were as follows: leukocytes: 25,900 (N: 90%, L: 4%, M: 6%), Hb: 9mg/dl, anisopoikilocytosis with spherocytes and macrocytes, hypersegmented neutrophils, positive direct Coombs¿s test and normal liver and pancreatic profiles. The abdominal ultrasound and the thorax X-ray did not show any interesting pathological data. These, in addition to a negative urine culture, ruled out any sources of infection in those areas. S. aureus and K. oxytoca were isolated in the blood cultures of the catheter and the peripheral blood cells. This is why a transthoracic echocardiogram was carried out, leading to the discovery of a 2.5 x 1.5cm wart in the posterior medullary velum of the mitral valve and a smaller-sized one in the anterior medullary velum of the tricuspid valve. Following these findings, a treatment of vancomycin and gentamycin was administered according to an antibiogram, which later revealed a spleen embolism and a cardiogenic shock, resulting to the patient¿s death.</p><p class="elsevierStylePara">K. oxytoca represents 0.5-0.6% of all isolations in bacterias; more than a third of those are polymicrobial infections and between 37 and 52% are nosocomial. The majority are caused by the biliopancreatic or urinary pathology, and the various types of infective endocarditis are extremely rare, with a very high mortality rate (49%) despite receiving adequate antibiotic treatment.<span class="elsevierStyleSup">4,5</span></p><p class="elsevierStylePara">Given the immunosuppression of our patients following a substitute treatment, its associated comorbidity and the risk of contracting nosocomial infections, a quick detection of infective endocarditis is necessary since an early antibiotic treatment reduces the high risk of morbidity and mortality. </p>" "pdfFichero" => "P-E-S-A454-EN.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "Bibliography" "seccion" => array:1 [ 0 => array:1 [ "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib1" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Galindo P, Pérez A, Ferreira C, Zarco E, Vaquero E. Shock séptico por Streptococcus boris en paciente en hemodiálisis. Nefrología 2009;29(4):378. <a href="http://www.ncbi.nlm.nih.gov/pubmed/19668325" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 1 => array:3 [ "identificador" => "bib2" "etiqueta" => "2" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Anderson MJ, Janoff EN. Klebsiella endocarditis: report of two cases and reviews. Clin Infect Dis 1998;26:468-74. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9502472" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 2 => array:3 [ "identificador" => "bib3" "etiqueta" => "3" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Escalante B, Aibar MA, Muñoz M, Olivera S. Endocarditis nosocomial por Klebsiella oxytoca. An Med Intern 2007;24(11):563-4." "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 3 => array:3 [ "identificador" => "bib4" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Kim BN, Ryu J, Kim YS, Woo JH. Retrospective analysis of clinical and microbiological aspects of Klebsiella oxytoca bacteremia over a 10 year period. Eur J Clin Microbiol Infect Dis 2002;21:419-426. <a href="http://www.ncbi.nlm.nih.gov/pubmed/12111596" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] 4 => array:3 [ "identificador" => "bib5" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:3 [ "referenciaCompleta" => "Lin RD, Hsueh PR, Chang SC, Chen YC, Hsieh WC, Luh KT. Bacteremia due to Klebsiella oxytoca: clinical features of patients and antimicrobial susceptibilities of the isolates. Clin Infect Dis 1997;24:1217-22. <a href="http://www.ncbi.nlm.nih.gov/pubmed/9195086" target="_blank">[Pubmed]</a>" "contribucion" => array:1 [ 0 => null ] "host" => array:1 [ 0 => null ] ] ] ] ] ] ] ] ] "idiomaDefecto" => "en" "url" => "/20132514/0000002900000006/v0_201502091611/X2013251409033634/v0_201502091612/en/main.assets" "Apartado" => array:4 [ "identificador" => "35436" "tipo" => "SECCION" "en" => array:2 [ "titulo" => "Letters to the Editor" "idiomaDefecto" => true ] "idiomaDefecto" => "en" ] "PDF" => "https://static.elsevier.es/multimedia/20132514/0000002900000006/v0_201502091611/X2013251409033634/v0_201502091612/en/P-E-S-A454-EN.pdf?idApp=UINPBA000064&text.app=https://revistanefrologia.com/" "EPUB" => "https://multimedia.elsevier.es/PublicationsMultimediaV1/item/epub/X2013251409033634?idApp=UINPBA000064" ]
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