Infective Endocarditis Caused by Streptococcus alactolyticus and Kocuria kristinae Complicated with Severe Thrombocytopenia: A Rare Case

Uvod: Infektivni endokarditis (IE) fokalna je infekcija uzrokovana bakterijskim, virusnim ili gljivičnim mikroorganizmima, koja unutar srca zahvaća endokard i zalistke. Streptococcus alactolyticus, klasificiran po IV DNA klasterom S. bovis / S. equinus kompleksa, bakterija je koja se rijetko nalazi u izolatu te koja malokad uzrokuje IE u ljudi. Kocuria kristinae je gram-pozitivna bakterija. Dosad je objavljeno samo šest slučajeva IE-a uzrokovanih infekcijom bakterijom K. kristinae. Trombocitopenija i disfunkcija trombocita mogu se pojaviti u IE-u te su povezani s kliničkim ishodom. Postoje različite hipoteze o mehanizmima kojima se objašnjava trombocitopenija u IE-u. Prikaz slučaja: Predstavljamo slučaj dvadesetpetogodišnje bolesnice koja se žalila na palpitacije dva tjedna prije primitka u bolnicu. Prvi je simptom bila povišena temperatura šest mjeseci prije primitka. Hemokulture su utvrdile S. alactolyticus i K. kristinae. Ehokardiografskom su pretragom pronađene vegetacije na anteriornom i posteriornom listiću mitralnog zalistka uz tešku mitralnu regurgitaciju. Bolesnica je tijekom hospitalizacije imala tešku trombocitopeniju bez znakova krvarenja. Šesnaestog dana hospitalizacije naglo se počela žaliti na abdominalnu bol i zaduhu. Bolesnica je umrla, a uzrok smrti bili su septički emboli. Zaključak: Prikazan je slučaj IE-a uzrokovana rijetkim bakterijskim patogenima (S. alactolyticus i K. kristinae) koji je pogoršala trombocitopenija. Liječenje IE-a s trombocitopenijom zahtijeva oprez jer je to stanje povezano s lošim ishodima. U ovom se slučaju loši ishodi mogu povezati s trombocitopenijom uz prisutnost specifične bakterije, S . a lactolyticus, koja je poznata kao bakterija koja često uzrokuje septičku emboliju.Introduction: Infective endocarditis (IE) is a focus infection caused by bacterial, viral, or fungal microorganisms within the heart that involves the endocardium and heart valves. Streptococcus alactolyticus, classified under DNA cluster IV of the S. bovis/S. equinus complex, is a sparse isolated bacterium that rarely cause IE in humans. Kocuria kristinae is a gram-positive bacteria. Until now, there have been only six IE cases caused by K. kristinae infections reported in the literature. Thrombocytopenia and platelet dysfunction can manifest in IE cases and are related to the clinical outcome. Different mechanisms have been hypothesized to explain thrombocytopenia in IE. Case report: We report the case of a 25-year-old female patient who complained of palpitation two weeks before admission. Initially, the patient complained of fever arising six months before admission. Blood cultures showed S. alactolyticus and K. kristinae. Echocardiography examination showed vegetation on anterior and posterior mitral valves with severe mitral regurgitation. During hospitalization, the patient also suffered from severe thrombocytopenia without bleeding signs. On day 16 after hospitalization, the patient suddenly complained of abdominal pain and dyspnea. The patient was declared deceased with cause of death due to septic emboli. Conclusion: We reported a case of IE caused by rare bacterial pathogens, S. alactolyticus and K. kristinae, which were aggravated by thrombocytopenia. Management of IE with thrombocytopenia requires caution because it is associated with poor outcomes. In this case, poor outcomes can be connected to thrombocytopenia coupled with the presence of specific bacteria, S. alactolyticus, which is known as a bacterium that often causes septic embolism

Systematic Review: Pre-Stroke Use of Angiotensin Receptor Blockers and Stroke Outcomes

Background: Hypertension is the major risk factor and the most important modifiable risk factor for stroke. Angiotensin Receptor Blockers (ARB) are widely used in patient at high risk of cardiocerebrovascular events. The objective of this literature review was to determine the efficacy of pre-stroke use of ARB on stroke outcomes.Methods: Major medical databases (PubMed, MEDLINE, Clinical Key, Cochrane Library, EMBASE) were systematically searched using keyword: “hypertension”, “ARB”, “stroke”, and “outcome”. The search were limited to clinical trials published within the last 10 years, written in English, with full-text availability. We used GRADE Working Group to measure the quality of evidence.Results: Four clinical studies, three retrospective studies and one nationwide population-based cohort study met our inclusion criteria with total of 102.644 patients for analysis. The scientific quality of the studies varied from poor (1 study), moderate (1 study), and high quality (2 studies). Generally, the subjects of the studies were acute ischemic stroke patients. Three studies showed pre-stroke use of ARB were significantly associated with better stroke outcomes. Only one study found different result whereas pre-stroke use of ARB did not appear to affect stroke outcomes. Outcome of the studies was explored according to morbidity (severity and functional status upon discharge) and mortality (30-days mortality or in-hospital mortality). Several limitations were present, including non-random treatment assignment, retrospective study design, and lack of data for longitudinal medication exposure in observational studies.Conclusions: This systematic review shows evidence that there is possible benefit of pre-stroke ARB treatment in relation to better ischemic stroke outcomes. However, further studies with better research method quality are still needed. The efficacy of ARB treatment in relation to other type of stroke outcomes also needs to be furtherly examined.Keywords: ARB, pre-stroke, benefit, prognosis Makalah ini dipresentasikan dalam Poster Session 11th Scientific Meeting of Indonesian Society of Hypertension, 24-26 February 201

The role of vitamin D and cardiovascular risk in COVID-19 patients

Vitamin D deficiency has long been associated with the incidence of cardiovascular disease. It also thought to play a role in the severity of COVID-19 patients. A serum concentration of 25(OH) D 70 years. It is estimated that for every 100 IU of vitamin D, the 25(OH)D level increases by 2.5 nmol/L

Pearls of exercise-based cardiac rehabilitation frame in post coronary artery bypass graft

ABSTRACT Patients undergoing coronary artery bypass grafting (CABG) have a risk of postoperative complications resulting in long hospital stays and even death. In patients undergoing CABG, cardiac rehabilitation is recognized as an essential adjunct therapy for secondary prevention. Encouraging exercise-based cardiac rehabilitation might help speed up the postoperative recovery process, decrease in-hospital stay, prevent complications, and reduce public health costs. Exercise-based cardiac rehabilitation in both pre and post CABG surgery, consist of exercise or physical activity, education and counselling, inspiratory strength muscle conditioning, effective cough exercises, chest physiotherapy, breathing exercises, and gymnastics for respiratory muscle stretching. This literature review aims to analyze the exercise-based cardiac recovery of patients undergoing CABG and its effects in terms of physiological and clinical criteria, such as cardiovascular outcomes, aerobic ability, quality of life, and mortality

The Role of Contractile Reserve by Stress Test Echocardiography for Predicting Cardiac Resynchronization Therapy Responder: Systematic Review and Meta-analysis

Abstract Introduction: Up to one-third of patients who received resynchronization devices do not experience full benefit of cardiac resynchronization therapy (CRT). Echocardiography plays an important role in heart failure patients treated with CRT. Contractile reserved is a strong prognostic factor to predict positive response to CRT (CRT responder). Objective: We perform a systematic review and meta-analysis of published data to assess the relationship between contractile reserve (CR) and response to CRT. Methods: We conduct a systematic search from major medical databases on all clinical trials published up to June 2020, written in English, full-text availability, and human subject. We used Newcastle-Ottawa Scale to measure the quality of evidence. We employed the Mantel–Haenszel random-effects meta-analysis of using RevMan 5.4. Results: We identified 17 studies involving 1399 patients. The type of stress was either dobutamine (n=15) or exercise (n=2). The presence of CR was associated with a higher chance of CRT responder (OR 7.68, 95%CI 4.27–13.82, p<0.001) using a random-effects model. The ORs slightly differed when studies were analyzed separately based on the stress test type and definition of CR. Contractile reserve, assessed with dobutamine stress echocardiography (DSE), defined as an increase in LVEF (OR 5.10, 95% CI 2.29–11.32, P <0.00001) was numerically lower than defined as increased LV contractility (OR 6.86, 95% CI 3.36–12.88, P <0.00001). The presence of CR assessed with exercise stress test are associated with higher chance of CRT responder (OR 49.11, 95% CI 15.04–160.36, P <0.00001). From our meta-analysis, we found non-ischemic has better respond to CRT compare to patient with ischemic etiology (OR 0.41; 95% CI 0.31-0.55, P <0.01). Conclusion: The presence of CR during stress test echocardiography with either dobutamine or exercise stress test is associated with a higher chance of CRT responder