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

The Effect of Dual Antiplatelet Post Percutaneous Coronary Intervention On Aggregation of Platelet In Myocardial Infarction Patients With Diabetes Mellitus and Non Diabetes Mellitus

To analyze the differences in the effect of dual antiplatelet post PCI on the percentage of aggregation in myocardial infarction patients with DM and non DM. Percentage of aggregation were analyzed using light transmission aggregometry (LTA) before loading dose, after PCI, and after maintenance dose of dual antiplatelet (aspirin 100mg and clopidogrel 75mg). Total 22 patients were participated in this study divided into 10 and 12 patients in diabetic and non diabetic group. Percentage of aggregation after taking dual antiplatelet maintenace dose decrease significantly in both group (p=0.006 in diabetic group and p=0.002 in non diabetic group). Mean reduction of percentage of aggregation in diabetic group (3.30±2.91%) is less than non diabetic group (6.83±5.97%). Statistical analysis shows that the mean reduction of percentage of aggregation between two groups were not significantly different (p>0.05). Mean percentage of aggregation after dual antiplatelet maintenance dose was higher in diabetic group and mean reduction of percentage of aggregation was higher in non diabetic group, although statistically in both group it is not significantly different

Acetosal Resistance In Coronary Artery Disease Between And Within Type 2 Diabetes Mellitus Patients.

Acetosal reduces the odds of an arterial thrombotic event in high risk patients. However, 10%-20% of patients with an arterialthrombotic event who are treated with acetosal have a recurrent arterial thrombotic event during long-term follow up. Acetosalresistance has been described in some patient populations such as those with an acute coronary syndrome, ischemic stroke, andpercutaneous coronary intervention with drug-eluting stent, stent re-stenosis, and Type 2 Diabetes Mellitus. Patients were dividedinto two groups of ten patients each, 10 patients Coronary Artery Diseases with Type 2 Diabetes Mellitus and 10 patients non-Type 2Diabetes Mellitus. The sampling of this cross sectional study was conducted at departement of Cardiology Dr. Soetomo HospitalSurabaya during July-August 2014. Data from 20 patients were analyzed after exclusion due to protocol violations. All subjects wereon Asetosal 100 mg/day. Four (40%) patients with Type 2 Diabetes Mellitus were acetosal non-responders, acetosal resistance wasobserved in 3 (30%) of nondiabetic patients (p=1.000). In conclusion, no difference has been found on acetosal resistance incoronary artery disease patients with or without Type 2 Diabetes Mellitus. (FMI 2015;51:137-141

Case Report: Complete heart block as a manifestation of cardiac metastasis of oral cancer [version 2; peer review: 2 approved]

Metastatic tumors of the heart presenting with complete heart block (CHB) is an extremely uncommon case. There are no available guidelines in managing CHB in terminal cancer. Permanent pacemaker implantation in such cases is a challenge in terms of clinical utility and palliative care. We report a case of a 24-year-old man suffering from tongue cancer presenting with CHB. An intracardiac mass and moderate pericardial effusion were present, presumed as the metastatic tumor of tongue cancer. We implanted a temporary pacemaker for his symptomatic heart block and cardiogenic shock, and pericardiocentesis for his massive pericardial effusion. We decided that a permanent pacemaker would not be implanted based on the low survival rate and significant comorbidities. Multiple studies report a variable number of cardiac metastasis incidence ranging from 2.3% to 18.3%. It is rare for such malignancies to present with CHB. The decision to implant a permanent pacemaker is highly specific based on the risks and benefits of each patient. It needs to be tailored to the patient’s functional status, comorbid diseases, prognosis, and response to conservative management

The correlation between serum TG/HDL-c ratio and arterial stiffness using the cardio-ankle vascular index in overweight or obese patients

Abstract. Background. The effect of increasing TG/HDL-c serum ratio, as a result of insulin resistance, is considered to have an important role in the occurrence of arterial stiffness. Increased arterial stiffness is an important marker in the development of cardiovascular disease and is a predictor of heart attack and stroke. Aims. This research was conducted to determine the relationship between the arterial stiffness assessed through non-invasive cardio-ankle vascular index (CAVI) examination and the TG/HDL-c ratio in overweight and obese individuals. Cardio-Ankle Vascular Index (CAVI) is a non-invasive clinical measurement to evaluate arterial stiffness manner and independent of blood pressure. Methods. This study is considered as correlational study using purposive sampling as the technique. Thirty-two subjects participated in this research and each of them was subjected a CAVI examination to assess arterial stiffness. Their blood samples were collected for lipid profile measurement. The data were analyzed using Pearson Correlation Test. Results. The correlation between TG/HDL-c serum level and arterial stiffness using CardioAnkle Vascular Index (CAVI) in overweight or obese patients (p <0,01) proved to be positive and significant