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Subacute Bacterial Endocarditis

  • Gaafar Ragab
  • Hussien Rizk
Chapter

Abstract

Subacute bacterial endocarditis involves microbial infection of the endocardium, heart valves, or intravascular device. Many pathogens are incriminated. Added to the clinical picture attributed to direct infection, the disease is capable of displaying a constellation of immunological and rheumatological manifestations. The diagnostic work-up includes microbiological and imaging techniques. The main rheumatological manifestations include musculoskeletal, renal, and vasculitic presentations. ANCA positivity has been reported repeatedly. We conducted a PubMed search on ANCA positivity with SBE, the results of which are discussed in this section. Attention to the possibility of SBE diagnosis in high-risk patients will lead to early diagnosis, timely treatment, and avoidance of unnecessary or potentially harmful treatment.

Keywords

Subacute bacterial endocarditis Pathogenesis Diagnosis Autoimmune phenomena Rheumatic manifestations Nephritis Vasculitis ANCA 

Abbreviations

AAV

ANCA-associated vasculitis

ACL

Anticardiolipin antibodies

ANA

Antinuclear antibodies

ANCA

Antineutrophil cytoplasmic antibodies

ARF

Acute renal failure

CAE

Community-acquired IE

cANCA/PR3

cANCA/proteinase 3

CGN

Crescentic GN

CNS

Central nervous system

CRF

Chronic renal failure

CSGN

Chronic sclerotic GN

HACEK

Haemophilus species, Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae

HAE

Healthcare-associated IE

IE

Infective endocarditis

MGN

Mesangial GN

pANCA

Perinuclear anti-neutrophil cytoplasmic antibodies

pANCA/MPO

pANCA/myeloperoxidase

PCR

Polymerase chain reaction

PVE

Prosthetic valve endocarditis

RPGN

Rapidly progressive glomerulonephritis

SBE

Subacute bacterial endocarditis

SNGN

Segmental necrotizing GN

TRF

Terminal renal failure

References

  1. 1.
    Habib G, Lancellotti P, Antunes MJ, et al. 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). Eur Heart J. 2015;36(44):3075–128.CrossRefPubMedCentralPubMedGoogle Scholar
  2. 2.
    Mulder BJ. Endocarditis in congenital heart disease: who is at highest risk? Circulation. 2013;128(13):1396–7.CrossRefPubMedCentralPubMedGoogle Scholar
  3. 3.
    Sorour KA. Rheumatic heart disease in Egypt: gloomy past and promising future. Egypt Heart J. 2014;66(2):139–42.CrossRefGoogle Scholar
  4. 4.
    Farouk H, Shaker A, El-Faramawy A, et al. Adult congenital heart disease registry at Cairo University. World J Pediatr Congenital Heart Surg. 2015;6(1):53–8.CrossRefGoogle Scholar
  5. 5.
    Marom D, Levy I, Gutwein O, et al. Healthcare-associated versus community-associated infective endocarditis in children. Pediatr Infect Dis J. 2011;30(7):585–8.CrossRefPubMedCentralPubMedGoogle Scholar
  6. 6.
    Murdoch DR, Corey GR, Hoen B, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the international collaboration on endocarditis-prospective cohort study. Arch Intern Med. 2009;169(5):463–73.CrossRefPubMedCentralPubMedGoogle Scholar
  7. 7.
    Hill EE, Herijgers P, Claus P, et al. Infective endocarditis: changing epidemiology and predictors of 6-month mortality: a prospective cohort study. Eur Heart J. 2007;28(2):196–203.CrossRefPubMedCentralPubMedGoogle Scholar
  8. 8.
    Gunson TH, Oliver GF. Osler's nodes and Janeway lesions. Australas J Dermatol. 2007;48(4):251–5.CrossRefPubMedCentralPubMedGoogle Scholar
  9. 9.
    Castillo FJ, Anguita M, Castillo JC, et al. Changes in clinical profile, epidemiology and prognosis of left-sided native-valve infective endocarditis without predisposing heart conditions. Rev Esp Cardiol (Engl Ed). 2015;68(05):445–8.CrossRefGoogle Scholar
  10. 10.
    Colen TW, Gunn M, Cook E, et al. Radiologic manifestations of extra-cardiac complications of infective endocarditis. Eur Radiol. 2008;18(11):2433–45.CrossRefPubMedCentralPubMedGoogle Scholar
  11. 11.
    Habib G, Badano L, Tribouilloy C, et al. Recommendations for the practice of echocardiography in infective endocarditis. Eur J Echocardiogr. 2010;11(2):202–19.CrossRefPubMedCentralPubMedGoogle Scholar
  12. 12.
    Wang A, Athan E, Pappas PA, et al. Contemporary clinical profile and outcome of prosthetic valve endocarditis. JAMA. 2007;297(12):1354–61.CrossRefPubMedCentralPubMedGoogle Scholar
  13. 13.
    Nomura R, Nakano K, Nemoto H, et al. Molecular analyses of bacterial DNA in extirpated heart valves from patients with infective endocarditis. Oral Microbiol Immunol. 2009;24(1):43–9.CrossRefPubMedCentralPubMedGoogle Scholar
  14. 14.
    Li JS, Sexton DJ, Mick N, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30(4):633–8.CrossRefPubMedCentralPubMedGoogle Scholar
  15. 15.
    Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and Management of Complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation. 2015;132(15):1435–86.CrossRefPubMedCentralPubMedGoogle Scholar
  16. 16.
    Habib G, Derumeaux G, Avierinos JF, et al. Value and limitations of the Duke criteria for the diagnosis of infective endocarditis. J Am Coll Cardiol. 1999;33(7):2023–9.CrossRefPubMedCentralPubMedGoogle Scholar
  17. 17.
    Seymour RA, Lowry R, Whitworth JM, et al. Infective endocarditis, dentistry and antibiotic prophylaxis; time for a rethink? Br Dent J. 2000;189(11):610–6.CrossRefPubMedCentralPubMedGoogle Scholar
  18. 18.
    Nakano K, Inaba H, Nomura R, et al. Detection of cariogenic Streptococcus mutans in extirpated heart valve and atheromatous plaque specimens. J Clin Microbiol. 2006;44(9):3313–7.CrossRefPubMedCentralPubMedGoogle Scholar
  19. 19.
    Mello R, da Silva Santos M, Golebiosvki W, et al. Streptococcus bovis endocarditis: analysis of cases between 2005 and 2014. Braz J Infect Dis. 2015;19(2):209–12.CrossRefPubMedCentralPubMedGoogle Scholar
  20. 20.
    Kasmi G, Andoni R, Mano V, et al. Streptococcus bovis isolated in haemoculture a signal of malignant lesion of the colon. Clin Lab. 2011;57(11–12):1007–9.PubMedPubMedCentralGoogle Scholar
  21. 21.
    Cesari W, Stewart C, Panda M. Getting to the heart of rectal bleeding: subacute bacterial endocarditis presenting as anaemia and a GI bleed. BMJ Case Rep. 2011;2011:bcr0920114814.CrossRefPubMedCentralPubMedGoogle Scholar
  22. 22.
    Kenzaka T, Takamura N, Kumabe A, et al. A case of subacute infective endocarditis and blood access infection caused by Enterococcus durans. BMC Infect Dis. 2013;13:594.CrossRefPubMedCentralPubMedGoogle Scholar
  23. 23.
    Elegino-Steffens D, Stratton A, Geimer-Flanders J. Subacute Staphylococcus epidermidis bacterial endocarditis complicated by mitral-aortic Intervalvular Fibrosa Pseudoaneurysm. Case Rep Cardiol. 2012;2012:467210.PubMedPubMedCentralGoogle Scholar
  24. 24.
    Tsuneoka H, Yanagihara M, Otani S, et al. A first Japanese case of Bartonella henselae-induced endocarditis diagnosed by prolonged culture of a specimen from the excised valve. Diagn Microbiol Infect Dis. 2010;68(2):174–6.CrossRefPubMedCentralPubMedGoogle Scholar
  25. 25.
    Lejko-Zupanc T, Slemenik-Pusnik C, Kozelj M, et al. Native valve endocarditis due to Bartonella henselae in an immunocompetent man. Wien Klin Wochenschr. 2008;120(7–8):246–9.CrossRefPubMedCentralPubMedGoogle Scholar
  26. 26.
    Tse D, Khan S, Clarke S. Bacterial endocarditis complicating body art. Int J Cardiol. 2009;133(1):e28–9.CrossRefPubMedCentralPubMedGoogle Scholar
  27. 27.
    Barkan D, Abu Fanne R, Elazari-Scheiman A, et al. Navel piercing as a cause for Streptococcus viridans endocarditis: case report, review of the literature and implications for antibiotic prophylaxis. Cardiology. 2007;108(3):159–60.CrossRefPubMedCentralPubMedGoogle Scholar
  28. 28.
    Smith CP, Jackson C, Stewart R. Subacute bacterial endocarditis secondary to mastoiditis: a rare complication. BMJ Case Rep. 2012;2012:bcr2012007247.CrossRefPubMedCentralPubMedGoogle Scholar
  29. 29.
    Tsui K, Tsai CR, Lin LC, et al. Aggregatibacter aphrophilus pyogenic liver abscess in an immunocompetent young woman. J Microbiol Immunol Infect. 2012;45(5):385–9.CrossRefPubMedCentralPubMedGoogle Scholar
  30. 30.
    Burstrom G, Andresen M, Bartek J Jr, et al. Subacute bacterial endocarditis and subsequent shunt nephritis from ventriculoatrial shunting 14 years after shunt implantation. BMJ Case Rep. 2014;2014:bcr2014204655.CrossRefPubMedCentralPubMedGoogle Scholar
  31. 31.
    Satake K, Ohsawa I, Kobayashi N, et al. Three cases of PR3-ANCA positive subacute endocarditis caused by attenuated bacteria (Propionibacterium, Gemella, and Bartonella) complicated with kidney injury. Mod Rheumatol. 2011;21(5):536–41.CrossRefPubMedCentralPubMedGoogle Scholar
  32. 32.
    Bonaci-Nikolic B, Andrejevic S, Pavlovic M, et al. Prolonged infections associated with antineutrophil cytoplasmic antibodies specific to proteinase 3 and myeloperoxidase: diagnostic and therapeutic challenge. Clin Rheumatol. 2010;29(8):893–904.CrossRefPubMedCentralPubMedGoogle Scholar
  33. 33.
    Jadhav AP, Pryor JC, Nogueira RG. Onyx embolization for the endovascular treatment of infectious and traumatic aneurysms involving the cranial and cerebral vasculature. J Neurointerv Surg. 2013;5(6):562–5.CrossRefPubMedCentralPubMedGoogle Scholar
  34. 34.
    Sim BW, Koo RM, Hawkins C, et al. Granulicatella adiacens subacute bacterial endocarditis as the underlying cause of type II mixed cryoglobulinaemia. BMJ Case Rep. 2015;2015:bcr2014206091.CrossRefPubMedCentralPubMedGoogle Scholar
  35. 35.
    Lee LC, Lam KK, Lee CT, et al. “Full house” proliferative glomerulonephritis: an unreported presentation of subacute infective endocarditis. J Nephrol. 2007;20(6):745–9.PubMedPubMedCentralGoogle Scholar
  36. 36.
    Tiliakos AM, Tiliakos NA. Dual ANCA positivity in subacute bacterial endocarditis. J Clin Rheumatol. 2008;14(1):38–40.CrossRefPubMedCentralPubMedGoogle Scholar
  37. 37.
    Starosta RT, Rivero R, de Oliveira FH, et al. Misdiagnosis of Streptococcus gallolyticus endocarditis. Autops Case Rep. 2016;6(3):29–33.CrossRefPubMedCentralPubMedGoogle Scholar
  38. 38.
    Hsu WC, Hsu JY, Chen MY, et al. Obturator internus pyomyositis manifested as sciatica in a patient with subacute bacterial endocarditis: a rare case report. Medicine (Baltimore). 2016;95(30):e4340.CrossRefGoogle Scholar
  39. 39.
    Yombi J, Belkhir L, Jonckheere S, et al. Streptococcus gordonii septic arthritis: two cases and review of literature. BMC Infect Dis. 2012;12:215.CrossRefPubMedCentralPubMedGoogle Scholar
  40. 40.
    Bonfante HL, Bonfante HL, Azevedo CB, et al. Endocarditis with negative blood cultures and immunological alterations: a grand challenge. Acta Reumatol Port. 2011;36(3):282–6.PubMedPubMedCentralGoogle Scholar
  41. 41.
    De Socio GV, Mencacci A, Bini P, et al. Fusobacterium nucleatum endocarditis mimicking polymyalgia rheumatica. South Med J. 2009;102(10):1082–4.CrossRefPubMedCentralPubMedGoogle Scholar
  42. 42.
    Lusco MA, Fogo AB, Najafian B, et al. AJKD atlas of renal pathology: subacute bacterial endocarditis-associated glomerulonephritis. Am J Kidney Dis. 2016;68(2):e11–2.CrossRefPubMedCentralPubMedGoogle Scholar
  43. 43.
    Uh M, McCormick IA, Kelsall JT. Positive cytoplasmic antineutrophil cytoplasmic antigen with PR3 specificity glomerulonephritis in a patient with subacute bacterial endocarditis. J Rheumatol. 2011;38(7):1527–8.CrossRefPubMedCentralPubMedGoogle Scholar
  44. 44.
    Fukasawa H, Hayashi M, Kinoshita N, et al. Rapidly progressive glomerulonephritis associated with PR3-ANCA positive subacute bacterial endocarditis. Intern Med. 2012;51(18):2587–90.CrossRefPubMedCentralPubMedGoogle Scholar
  45. 45.
    Chong Y, Han SJ, Rhee YJ, et al. Classic peripheral signs of subacute bacterial endocarditis. Korean J Thorac Cardiovasc Surg. 2016;49(5):408–12.CrossRefPubMedCentralPubMedGoogle Scholar
  46. 46.
    Peng H, Chen WF, Wu C, et al. Culture-negative subacute bacterial endocarditis masquerades as granulomatosis with polyangiitis (Wegener’s granulomatosis) involving both the kidney and lung. BMC Nephrol. 2012;13:174.CrossRefPubMedCentralPubMedGoogle Scholar
  47. 47.
    Sugiyama H, Sahara M, Imai Y, et al. Infective endocarditis by Bartonella quintana masquerading as antineutrophil cytoplasmic antibody-associated small vessel vasculitis. Cardiology. 2009;114(3):208–11.CrossRefPubMedCentralPubMedGoogle Scholar
  48. 48.
    Chirinos JA, Corrales-Medina VF, Garcia S, et al. Endocarditis associated with antineutrophil cytoplasmic antibodies: a case report and review of the literature. Clin Rheumatol. 2007;26(4):590–5.CrossRefPubMedCentralPubMedGoogle Scholar
  49. 49.
    Riding AM, D’Cruz DP. A case of mistaken identity: subacute bacterial endocarditis associated with p-antineutrophil cytoplasmic antibody. BMJ Case Rep. 2010;2010:bcr0920103299.CrossRefPubMedCentralPubMedGoogle Scholar
  50. 50.
    Wang KY, Shimajiri S, Yoshida T, et al. An autopsy case of microscopic polyangiitis associated with bacterial endocarditis. J UOEH. 2010;32(3):273–9.CrossRefPubMedCentralPubMedGoogle Scholar
  51. 51.
    Konstantinov KN, Harris AA, Hartshorne MF, et al. Symptomatic anti-neutrophil cytoplasmic antibody-positive disease complicating subacute bacterial endocarditis: to treat or not to treat? Case Rep Nephrol Urol. 2012;2(1):25–32.CrossRefPubMedCentralPubMedGoogle Scholar
  52. 52.
    Hirai K, Miura N, Yoshino M, et al. Two cases of proteinase 3-anti-neutrophil cytoplasmic antibody (PR3-ANCA)-related nephritis in infectious endocarditis. Intern Med. 2016;55(23):3485–9.CrossRefPubMedCentralPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Internal Medicine, Faculty of MedicineCairo UniversityCairoEgypt
  2. 2.Department of Cardiology, Faculty of MedicineCairo UniversityCairoEgypt

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