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Table 2 Infective endocarditis in patients with HHT

From: Probiotics and infective endocarditis in patients with hereditary hemorrhagic telangiectasia: a clinical case and a review of the literature

Age, sex Cardiac valve Etiology Type of AV malformations Treatment (duration days/weeks) Outcome Notes Ref
62 F MP S.mitis Skin, nose and mouth TA Piperacillin + cefazolin (32 d); valve replacement Success No AVMs in the lung, brain, liver, gastrointestinal tract or urinary bladder. The patient reported frequent episodes of epistaxis 21
79 F MN MSSA Nose TA, hepatic AVMs Oxacillin (4 w) + gentamicin (5 d); valve replacement Dead Nasal packing for epistaxis reported as a likely portal of entry; the authors propose that in patients with HHT treatment of nasal carriage of S.aureus with mupirocine is proposed 22
73 M AP No isolation from blood/valve tissue Nose TA Unspecified broad-spectrum antibiotics; valve replacement Success   23
61 F AN;
MRSA Nose TA, pulmonary/hepatic AVMs Unspecified antibiotics; emergency surgery; reoperation (Bentall operation) Relapse, then success Cardiogenic shock; Relapse of endocarditis on the prosthetic aortic valve; success after reoperation (Bentall operation) and antibiotics
The authors define the pulmonary AVMs of this patient at high risk for infection (they were treated with coil embolization)
65 F AP S.epidermidis Nose TA, pulmonary AVMs Unspecified antibiotics (>6 w); complex surgery Success (alive at 9 month follow-up) The authors propose that PVE in this patient resulted from her anterior nasal packing for recurrent epistaxis with bacteria not trapped because of the pulmonary AVMs. They conclude that recurrent epistaxis may increase the risk of IE, and that patients with HHT and recurrent epistaxis require long-term follow-up. 25
65 M PN S.epidermidis Nose TA, hepatic AVMs Rifampin + linezolid (4 w) then linezolid (2 w); surgery (valvuloplasty) Success (alive at 2 years follow-up) The authors state that the infection probably came from the nasal mucosa 26
  1. AN= aortic, native; AP = aortic, prosthetic; MN = mitral, native; PN = pulmonary, native
  2. MRSA = methicillin-resistant Staphylococcus aureus; MSSA = methicillin-sensitive Staphylococcus aureus;
  3. TA = telangiectasias; AVMs = arteriovenous malformations
  4. PVE = prosthetic valve endocarditis