Complicated infectious endocarditis in a patient with human immunodeficiency virus: A case report

Abstract

INTRODUCTION: Infectious endocarditis (IE) in injecting drug patients with human immunodeficiency virus (HIV) is manifested predominantly by damage to the tricuspid valve (TV). The pathogen of the disease is Staphylococcus aureus. The IE peculiarities of the TV in this category of patients are multiple septic emboli in the small circulation, which may result from flotation vegetations, and predominance of pulmonary symptomatology over cardiac phenomena.

CASE PRESENTATION: A 30-year-old female HIV-infected injecting drug user was dynamically monitored for the laboratory-confirmed IE development by transthoracic echocardiography during a year. The patient was twice admitted to the intensive care unit in a serious condition with purulent-septic complications in the lungs in the form of bilateral polysegmental destructive (septic) pneumonia confirmed by X-ray and multispiral computed tomography. After intensive therapy, the patient refused further ARV treatment and consultations with a cardiac surgeon. A clinical follow-up demonstrated IE of the TV and right-sided lower lobe pneumonia in an HIV-infected drug-dependent patient after a cesarean section. Immunodeficiency without appropriate ARV therapy had a negative impact on the course of the disease. According to transthoracic echocardiography, an increase in TV vegetations from 7 mm to 16 mm and regurgitation were observed, whereas left ventricular ejection fraction decreased from 60% to 47% during the follow-up. Complications of cesarean section, immunodeficiency, and absence of ARV therapy could be the trigger factors of the IE development. Injection drug use with possible violations of asepsis and circulation of microorganisms of the causative agents in the blood contributed to the rapid development of the disease and was a determining factor of the infectious process in the TV.

CONCLUSIONS: Echocardiography remains the primary radiological diagnostic method for examining HIV-infected drug-dependent patients with fever and/or after medical manipulations. However, this group of patients more frequently clinically manifests the disease with bright pulmonary pathology. Therefore, radiological methods should necessarily be a priority during the diagnostic search. The sources of septic embolism in the small circulation in IE may be loose and floating TV vegetations.

Keywords

echocardiography / infectious endocarditis / HIV / septic pneumonia

References

[1] Vinokurov AS, Belenkaya OI, Yudin AL. Actual aspects of radiological diagnosis of septic pulmonary embolism. Medical Visualization. 2022;26(4):44–59. (In Russ). doi: 10.24835/1607-0763-1107

[2] Винокуров А.С., Беленькая О.И., Юдин А.Л. Современные аспекты лучевой диагностики септической эмболии лёгких // Медицинская визуализация. 2022. Т. 26, № 4. С. 44–59. doi: 10.24835/1607-0763-1107

[3] Voytsekhovskiy VV, Korzhova NV, Goborov ND, et al. Lung damage in patients with narcotic dependence. Bûlleten’ fiziologii i patologii dyhaniâ. 2018;(68):79–91. (In Russ). doi: 10.12737/article_5b19d77f5e9a60.82681424

[4] Войцеховский В.В., Коржова Н.В., Гоборов Н.Д., и др. Поражение лёгких у больных с наркотической зависимостью // Бюллетень физиологии и патологии дыхания. 2018. № 68. С. 79–91. doi: 10.12737/article_5b19d77f5e9a60.82681424

[5] Demin AA, Kobalava ZhD, Skopin II, et al. Klinicheskie rekomendatsii. Infektsionnyi endokardit i infektsiya vnutriserdechnykh ustroistv [Internet] [cited 2023 Jan 02]. Available from: https://scardio.ru/content/Guidelines/2020/KP_Inf_Endokardit-unlocked.pdf. (In Russ).

[6] Дёмин А.А., Кобалава Ж.Д., Скопин И И., и др. Клинические рекомендации. Инфекционный эндокардит и инфекция внутрисердечных устройств [интернет]. Дата обращения: 02.01.2023. Доступ по ссылке: https://scardio.ru/content/Guidelines/2020/KP_Inf_Endokardit-unlocked.pdf.

[7] Demko IV, Pelinovskaya LI, Mankhayeva MV, et al. Features of infective endocarditis in injection drug users. Russian Journal of Cardiology. 2019;(24(6)):97–102. (In Russ). doi: 10.15829/1560-4071-2019-6-97-102

[8] Демко И.В., Пелиновская Л.И., Манхаева М.В., и др. Особенности течения инфекционного эндокардита у инъекционных наркоманов // Российский кардиологический журнал. 2019. № 24 (6). С. 97–102. doi: 10.15829/1560-4071-2019-6-97-102

[9] Ivannikov NYu, Mitichkin AE, Dimitrova VI, et al. Modern approaches to the treatment of postpartum purulent-septic diseases. Meditsinsky Sovet. 2019;(7):58–69. (In Russ). doi: 10.21518/2079-701X-2019-7-58-69

[10] Иванников Н.Ю., Митичкин А.Е., Димитрова В.И., и др. Современные подходы в лечении послеродовых гнойно-септических заболеваний // Медицинский совет. 2019. № 7. С. 58–69. doi: 10.21518/2079-701X-2019-7-58-69

[11] Ponomareva EYu, Rebrov AP. Infective endocarditis in HIV-infected patients. Therapy. 2021;(7):152–158. (In Russ). doi: 10.18565/therapy.2021.7.152-158

[12] Пономарёва Е.Ю., Ребров А.П. Инфекционный эндокардит у ВИЧ-инфицированных пациентов // Терапия. 2021. № 7. С. 152–158. doi: 10.18565/therapy.2021.7.152-158

[13] Ulanova VI, Mazurov VI, Zinzerling VA. Clinical and morphological characteristics of infective endocarditis. Klinicheskaya meditsina. 2020;98(2):115–121. (In Russ). doi: 10.30629/0023-2149-2020-98-2-115-121

[14] Уланова В.И., Мазуров В.И., Цинзерлинг В.А. Клинико-морфологическая характеристика инфекционного эндокардита // Клиническая медицина. 2020. Т. 98, № 2. С. 115–121. doi: 10.30629/0023-2149-2020-98-2-115-121

[15] Kharlamova TV, Voznesenskiy SL, Ermak TN, Kozhevnikova GM, Klimkova PV. Infectious endocarditis in HIV-infected intensive care unit patients. Žurnal infektologii. 2022;14(2):73–79. (In Russ). doi: 10.22625/2072-6732-2022-14-2-73-79

[16] Харламова Т.В., Вознесенский С.Л., Ермак Т.Н., Кожевникова Г.М., Климкова П.В. Инфекционные эндокардиты у ВИЧ-инфицированных больных отделения интенсивной терапии // Журнал инфектологии. 2022. Т. 14, № 2. С. 73–79. doi: 10.22625/2072-6732-2022-14-2-73-79

[17] Chipigina NS, Karpova NYu, Belova MV, Savilov NP. Infective endocarditis: diagnostic difficulties. The Clinician. 2020;14(1–2):82–90. (In Russ). doi: 10.17650/1818-8338-2020-14-1-2-82-90

[18] Чипигина Н.С., Карпова Н.Ю., Белова М.В., Савилов Н.П. Инфекционный эндокардит: трудности диагностики // Клиницист. 2020. Т. 14, № 1–2. С. 82–90. doi: 10.17650/1818-8338-2020-14-1-2-82-90

[19] Meel R. Right-Sided Infective Endocarditis Secondary to Intravenous Drug Abuse. Infective Endocarditis. 2019. doi: 10.5772/intechopen.84319

[20] Meel R. Right-Sided Infective Endocarditis Secondary to Intravenous Drug Abuse // Infective Endocarditis. 2019. doi: 10.5772/intechopen.84319

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