Autopsy and Case Reports
https://autopsyandcasereports.org/article/doi/10.4322/acr.2016.037
Autopsy and Case Reports
Article / Autopsy Case Report

Gonococcal endocarditis: an ever-present threat

Fernando Peixoto Ferraz de Campos, Vitor Sérgio Kawabata, Márcio Sommer Bittencourt, Silvana Maria Lovisolo, Aloísio Felipe-Silva, Ana Paula Silva de Lemos

Downloads: 36
Views: 683

Abstract

The incidence of severe complications of the Neisseria gonorrhoeae infection has presented variations over recent decades since the advent of penicillin. Gonococcal endocarditis (GE) still remains an ever-present threat afflicting the society’s poor and sexually active young population. This entity frequently requires surgical intervention and usually exhibits a poor outcome. The interval between the onset of symptoms and the diagnosis does not usually exceed 4 weeks. One of the characteristics of GE is a proclivity for aortic valve involvement with large vegetation and valve ring abscess formation. The authors report the case of a young man with a 2-week history of fever, malaise, weakness, and progressive heart failure symptoms, who had no previous history of genital complaints or cardiopathy. The physical examination was consistent with acute aortic insufficiency, which was most probably of an infectious origin. The echocardiogram showed thickened aortic cusps and valve insufficiency. After hospital admission, the patient’s clinical status worsened rapidly and he died on the second day. The autopsy findings disclosed aortic valve destruction with vegetation and a ring abscess besides signs of septic shock, such as diffuse alveolar damage, acute tubular necrosis, and zone 3 hepatocellular necrosis. The blood culture isolated N. gonorrhoeae resistant to penicillin and ciprofloxacin. The authors call attention to the pathogen of this particular infectious endocarditis, and the need for early diagnosis and evaluation by a cardiac surgery team.

Keywords

Endocarditis, Bacterial, Neisseria gonorrhoeae, Aortic valve, Autopsy

References

1. Janda WM, Knapp J. Neisseria and Moraxella catarrhalis. In: Murray PR, Baron EJ, Jorgensen JH, Landry ML, Pfaller MA, editors. Manual of clinical microbiology. 8th ed. Washington, DC: ASM Press; 2003. chap. 38.

2. Clinical and Laboratory Standards Institute (CLSI). Performance standards for antimicrobial disk susceptibility tests, approved standard. 12th ed. Wayne, PA: Clinical and Laboratory Standards Institute; 2015. CLSI document M02-A12.

3. Bolan GA, Sparling PF, Wasserheit JN. The emerging threat of untreatable gonococcal infection. N Engl J Med. 2012;366(6):485-7. http://dx.doi.org/10.1056/NEJMp1112456. PMid:22316442.

4. Thompson EC, Brantley D. Gonococcal endocarditis. J Natl Med Assoc. 1996;88(6):353-6. PMid:8691495.

5. Holmes KK, Counts GW, Beaty HN. Disseminated gonococcal infection. Ann Intern Med. 1971;74(6):979-93. http://dx.doi.org/10.7326/0003-4819-74-6-979. PMid:4996345.

6. Newman AB. The prognosis in gonococcal endocaditis: Review of literature and report of case with spontaneous recovery. Am Heart J. 1933;8(6):821-33. http://dx.doi.org/10.1016/S0002-8703(33)90144-1.

7. Thayer WS, Blumer G. Ulcerative endocarditis due to the gonococcus: gonorrheal spticemia. Bull Johns Hopkins Hosp. 1896;7:57-63.

8. Jackman JD Jr, Glamann DB. Gonococcal endocarditis: twenty-five year experience.Am J Med Sci. 1991;301(3):221-30. http://dx.doi.org/10.1097/00000441-199103000-00012. PMid:2000895

9. Thayer WS. Bacterial or infective endocarditis: the Gibson lectures of 1930. Edinburgh Med J. 1931;38:237-65, 297-329.

10. Stone E. Gonorrheal endocarditis. J Urol. 1934;31:869-95.

11. Williams RH. Gonococcic endocarditis. A study of twelve cases with postmorten examinations. Arch Intern Med (Chic). 1938;61(1):26-38. http://dx.doi.org/10.1001/archinte.1938.00180070031003.

12. Wall TC, Peyton RB, Corey GR. Gonococcal endocarditis: a new look at an old disease. Medicine (Baltimore). 1989;68(6):375-80. http://dx.doi.org/10.1097/00005792-198911000-00005. PMid:2509857.

13. Nie S, Wu Y, Huang L, Pincus D, Tang YW, Lu X. Gonococcal endocarditis: a case report and literature review. Eur J Clin Microbiol Infect Dis. 2014;33(1):23-7. http://dx.doi.org/10.1007/s10096-013-1921-x. PMid:23856883.

14. World Health Organization (WHO). Sexual and reproductive health [Internet]. 2016 [cited 2016 Mar 27]. Available from: http://www.who.int/reproductivehealth/news/stis-estimates-2015/en/

15. Ramos A, García-Pavía P, Orden B, et al. Gonococcal endocarditis: a case report ans review of the literature. Infection. 2014;42(2):425-8. http://dx.doi.org/10.1007/s15010-013-0541-9. PMid:24163221.

16. Romero Tarín E, González Antuña M, Calzón Díaz S, Riesgo Miranda MA. Gonococcal endocarditis. Rev Esp Cardiol. 1987;40(4):293-6. PMid:3659524.

17. Prendergast BD, Tornos P. Surgery for infective endocarditis: who and when? Circulation. 2010;121(9):1141-52. http://dx.doi.org/10.1161/CIRCULATIONAHA.108.773598. PMid:20212293.

18. Britigan BE, Cohen MS, Sparling PF. Gonococcal infection: a model of molecular pathogenesis. N Engl J Med. 1985;312(26):1683-94. http://dx.doi.org/10.1056/NEJM198506273122606. PMid:2860565.


Publication date:
06/29/2016

5773d69a5ce02ae94b000000 autopsy Articles
Links & Downloads

Autops Case Rep

Share this page
Page Sections