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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;

AP

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)

24

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