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Group B Streptococcal Endocarditis After Cesarean Section Presenting as Multifocal Pneumonia FREE TO VIEW

Amit Kachalia, MD; Kinjal Kachalia, MBBS; Erik Perez, MD; Sethu Muralidharan, MD
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Icahn School of Medicine at Mount Sinai Queens, Jamaica, NY

Chest. 2014;146(4_MeetingAbstracts):109A. doi:10.1378/chest.1989231
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SESSION TITLE: Cardiovascular Student/Resident Case Report Posters I

SESSION TYPE: Medical Student/Resident Case Report

PRESENTED ON: Tuesday, October 28, 2014 at 01:30 PM - 02:30 PM

INTRODUCTION: We report a case and review 34 other instances of Group B streptococcus (GBS) endocarditis since the last review in 2006. Till date this is the only case of tricuspid valve GBS endocarditis reported after a caesarean section procedure.

CASE PRESENTATION: Thirty seven year old female with history of uncomplicated caesarean section 18 days ago comes in with dry cough, fever and dyspnea 4 days prior to presentation. No recent cough, cold, sick contacts and travel. Examination was significant for sinus tachycardia, fever, bilateral lower zone lung crackles and bilateral pitting pedal edema. A complete blood count revealed white cell count of 16.4, erythrocyte sedimentation rate 125 and C-reactive protein was 37. Chest X-ray showed bilateral fluffy infiltrates. Computerized tomography chest showed patchy consolidations and ground glass opacities in bilateral upper, lower and right middle lobes consistent with multifocal pneumonia (image:1). Ultrasound pelvis was negative for any focus of infection in genitourinary tract. Culture of vaginal secretions was negative for GBS. Blood culture was positive for GBS. Echocardiogram showed multiple large mobile masses attached to the tricuspid valve largest measuring 22.5 cm in length, normal right and left ventricular size and function with moderate tricuspid regurgitation. Patient was started on penicillin G and repeat echocardiogram revealed significant reduction in the size of tricuspid valve mass. Subsequent blood cultures were negative. Patient completed 6 weeks course of antibiotics uneventfully.

DISCUSSION: Till date 34 cases of pregnancy associated GBS endocarditis have been reported of which 8 cases involved tricuspid valve.1,2,3 None of the cases have occurred after Caesarean section. All other cases like our patient had no apparent tricuspid valve disease.1,2,3 The course for our patient is typical of other 8 cases with major complication being septic pulmonary emboli. The case is unique because of the uncertainty of source of GBS bacteremia due to lack of detectable vaginal colonization, central venous catheters and complications during surgery. This raises further questions on the already existing controversial guidelines for GBS screening and treatment of asymptomatic carriers during pregnancy.

CONCLUSIONS: GBS tricuspid endocarditis is the most common cause of pregnancy related endocarditis in absence of risk factors. This case emphasis the importance of blood cultures and echocardiography in post-partum patients with persistent fever.

Reference #1: Crespo A, Retter AS, Lorber B. Group B streptococcal endocarditis in obstetric and gynecologic practice. Infect Dis Obstet Gynecol 2003;11:109-15.

Reference #2: Shimoni Z, Ben David M, Niven MJ. Postpartum group B streptococcal tricuspid valve endocarditis. Isr Med Assoc J. 2006 Dec; 8(12):883-4.

Reference #3: Salih H, Guellab D, Zoubidi M, Bennis A. Postpartum group B streptococcal endocarditis of the tricuspid valve. Ann Cardiol Angeiol (Paris). 2012 Apr;61(2):121-4.

DISCLOSURE: The following authors have nothing to disclose: Amit Kachalia, Kinjal Kachalia, Erik Perez, Sethu Muralidharan

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