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Eur J Cardiothorac Surg 2002;21:370
© 2002 Elsevier Science NL

Letter to the Editor

A rarely seen cause of prosthetic mitral valve endocarditis: Salmonella enteritidis

^a Department of Infectious Diseases, Medical School of Selcuk University, 42080 Meram, Konya, Turkey
^b Department of Cardiovasculary Surgery, Medical School of Selcuk University, 42080 Meram, Konya, Turkey

Received 25 September 2001; received in revised form 14 November 2001; accepted 15 November 2001.

* Corresponding author. Tel.: +90-332-3232600/2033; fax: +90-332-3232643
e-mail: eturk{at}selcuk.edu.tr

Reports of infective endocarditis due to Salmonella species are extremely rare [1]. There are only nine case reports in English medical literature on this subject till date [1–5]. Here, we report the tenth case of Salmonella prosthetic valve endocarditis.

A 62-year-old woman was admitted with complaints of fever, fatigue, and lack of appetite for a duration of 2 months. Three months prior to admission, she had developed Salmonella gastroenteritis, and had been treated. She had had a mitral valve replacement operation 9 years ago with bileaflet prosthetic valve. At the time of admission she had no fever. On physical examination, a metallic valve sound was heard on the apex without any sufle and hepatomegaly was present. Laboratory tests yielded a leukocyte count of 18,600/mm³, an erythrocyte sedimentation rate 131 mm/h, an RF 54.2 IU/ml, and CRP 29.3 mg/l. A chest X-ray showed cardiomegaly. Two days after the admission her fever reached 39°C. After taking blood cultures intravenous chemotherapy was administrated. In at least four of the five blood cultures Salmonella enteritidis was isolated (group D). The gaita culture was normal. There was no infection focus on abdominal sonography examination. A transesophageal echocardiography revealed a 0.8x0.3 cm sized, mobile vegetation on the functional prosthetic mitral valve annulus. These findings were considered a prosthetic mitral valve endocarditis case due to Salmonella enteritidis. Cephtriaxone was continued for 6 weeks. However, because of persistent fever, and persistent vegetation image on the prosthetic mitral valve annulus, despite this treatment, operation was indicated. On operation, under open-heart surgery conditions, the prosthetic valve seemed to be functional, therefore, only the vegetation was removed. Postoperative period was uneventful. The patient was followed-up postoperatively, and no recurrence was found.

Parenteral chemotherapy prompt valve replacement surgery following Salmonella endocarditis is the choice of treatment. However, the time of surgery still remains controversial [1,2]. In the diagnosed case reports with prosthetic valve endocarditis chemotherapy prompt surgery treatment had been advised [2,4]. In the present case, because of functional and stable prosthetic mitral valve without any paravalvulary infection focus, valve replacement was not considered during the operation. Only the vegetation was removed totally. Sixteen weeks after the termination of chemotherapy no signs of recurrence were observed. As a result, in the Salmonella prosthetic valve endocarditis diagnosed cases surgical treatment should be considered if fever recurrence occurs with stable hemodynamic conditions during the chemotherapy treatment.

References

1. Lee Y.H., Lai L.P., Shyu K.G., Kuan P., Lien W.P. Salmonella prosthetic valve endocarditis. A case report. Angiology 1994;3:245-247.
2. Choo P.W., Gantz N.M., Anderson C., Maguire J.H. Salmonella prosthetic valve endocarditis. Diagn Microbiol Infect Dis 1992;15:273-276.[Medline]
3. Fukushima N., Ishikawa N., Shimazaki Y., Taniguchi K., Tanemura M., Matsuyama A., Matsuyama Y., Matsuda H. Salmonella prosthetic valve endocarditis. J Thorac Cardiovasc Surg 1996;12(3):840-842.
4. Miyamato M.I., Hutter A.M., Jr, Blum J.H., Torchiana D.F. Cardiac conduction abnormalities preceding transoesophageal echocardiographic evidence of perivalvar extension of infection in a case of Salmonella prosthetic valve endocarditis. Heart 1997;78(4):416-418.[Abstract/Free Full Text]
5. Goerre S., Malinverni R., Aeschbacher B.C. Successful conservative treatment of nontyphoid Salmonella endocarditis involving a bioprosthetic valve. Clin Cardiol 1998;21(5):368-370.[Medline]

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