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Gonococcal endocarditis: a case report and review of the literature

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Abstract

A 59-year-old Caucasian male presented with progressive dyspnea, arthralgias and fever for three days. A diastolic regurgitation murmur was detected in the aortic area. A transesophageal echocardiograph showed several vegetations and severe aortic regurgitation. Blood cultures yielded Neisseria gonorrhoeae beta-lactamase negative. The patient had not noticed any urogenital discomfort or urethral discharge. The patient successfully underwent surgery for septal abscess debridement. The patient received ceftriaxone 2 g bid for eight weeks and the clinical follow-up was uneventful. The review of the literature revealed a total of the 38 additional cases reported between 1980 and the present. The majority of the patients were young, male and with native valve involvement. There has been a clear tendency for left-sided valve involvement (especially in the aortic valve). All valve cultures were reported negative despite, in most cases, the marked tissue destruction. Polymerase chain reaction was performed in two patients and positive results were shown in both. Cultures of exudates from other locations were negative in most cases. One striking fact is the high proportion of patients who underwent surgery (72 %). Information regarding antibiotic sensitivity was available in 28 cases, with penicillin resistance reported in six patients (21 %) and intermediate sensitivity in four patients (14 %). Resistance to ciprofloxacin was reported in two cases (7 %). A rapid increase and distribution of isolates resistant to third generation cephalosporins have been recently detected. The mortality is high, particularly taking into account that most were young patients who had not presented previous heart disease.

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Acknowledgments

The authors wish to thank to Dr. Julio Vazquez of the Bacteriology Department of the Instituto de Salud Carlos III for gonococcal serotyping and ST typing and to Martin Hadley-Adams for assisting with the English language and preparation of the manuscript.

Conflict of interest

The authors declare no conflict of interest.

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Authors and Affiliations

  1. Department of Internal Medicine (Infectious Diseases Unit), Hospital Universitario Puerta de Hierro, Universidad Autónoma de Madrid, Maestro Rodrigo 2, Majadahonda, 28220, Madrid, Spain

    Antonio Ramos & Elena Múñez

  2. Department of Cardiology, Hospital Universitario Puerta de Hierro, Majadahonda, 28220, Madrid, Spain

    Pablo García-Pavía & Marta Cobo

  3. Department of Microbiology, Hospital Universitario Puerta de Hierro, Majadahonda, 28220, Madrid, Spain

    Beatriz Orden & Isabel Sánchez-Romero

  4. Department of Anesthesiology, Hospital Universitario Puerta de Hierro, Majadahonda, 28220, Madrid, Spain

    Margarita Sánchez-Castilla

  5. Department of Clinical Microbiology, Hospital Universitario Gregorio Marañón, 28007, Madrid, Spain

    Mercedes Marín

  6. Department of Cardiac Surgery, Hospital Universitario Puerta de Hierro, Majadahonda, 28220, Madrid, Spain

    Carlos García-Montero

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  1. Antonio Ramos
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  2. Pablo García-Pavía
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  3. Beatriz Orden
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  6. Isabel Sánchez-Romero
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  7. Elena Múñez
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  8. Mercedes Marín
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  9. Carlos García-Montero
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Correspondence to Antonio Ramos.

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Ramos, A., García-Pavía, P., Orden, B. et al. Gonococcal endocarditis: a case report and review of the literature. Infection 42, 425–428 (2014). https://doi.org/10.1007/s15010-013-0541-9

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  • DOI: https://doi.org/10.1007/s15010-013-0541-9

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