Legionella endocarditis: A case report and review

Andrea Teira; Juan Sánchez; Ignacio Santiago; Jesús Zarauza; Daniel Nan; Ramón Teira

doi:10.1016/j.eimc.2020.10.022

Legionella endocarditis: A case report and review

Enferm Infecc Microbiol Clin (Engl Ed). 2020 Dec 26:S0213-005X(20)30409-2. doi: 10.1016/j.eimc.2020.10.022. Online ahead of print.

[Article in English, Spanish]

Authors

Andrea Teira¹, Juan Sánchez², Ignacio Santiago², Jesús Zarauza², Daniel Nan³, Ramón Teira⁴

Affiliations

¹ Service of Cardiology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain. Electronic address: andreateira@gmail.com.
² Service of Cardiology, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain.
³ Service of Internal Medicine, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, Spain.
⁴ Unit of Infectious Diseases, Service of Internal Medicine, Hospital de Sierrallana, Torrelavega, Cantabria, Spain.

PMID: 33376029
DOI: 10.1016/j.eimc.2020.10.022

Abstract

Background: Legionella is a well known but infrequent cause of bacterial endocarditis.

Methods: We report a case of endocarditis caused by Legionella spp. We reviewed previously reported cases in PubMed, Google Scholar and in references included in previous reports, and summarized relevant clinical data.

Results: A 63-year-old man with a history of aortic valve replacement developed persistent fever and monoarthritis. Transesophageal echocardiography showed perivalvular abscess. He died during surgery. Blood and valve cultures were negative. Legionella spp. was demonstrated with 16S-rRNA PCR from the resected material. Twenty cases of Legionella endocarditis have been reported. Harboring a prosthetic valve was the main risk factor. Prognosis was favorable, both for patients treated with or without surgical valve replacement. Overall mortality was <10%.

Conclusions: Legionella is an infrequent cause of endocarditis. It frequently requires surgical treatment. Prognosis is good. Molecular techniques are likely to become the gold standard for diagnosis.

Keywords: 16S rDNA PCR; Absceso coronario; Coronary abscess; Endocarditis con hemocultivos negativos; Endocarditis infecciosa; Infective endocarditis; Legionella spp; Legionella spp.; Negative culture endocarditis.