Abhay Patel1 , David Myers2 and Joseph P Myers3 *
1 Internal Medicine Residency, Summa Health/Northeast Ohio Medical University Program, Akron, Ohio, USA 2 Department of Pathology, Division of Laboratory Medicine, Summa Health, Akron, Ohio, USA 3 Department of Medicine, Division of Infectious Disease, Summa Health, Akron, Ohio and Department of Internal Medicine, Infectious Disease Section, Northeast Ohio Medical University, Rootstown, Ohio, USAFulltext PDF
Abstract Introduction: Infection due to Group B Streptococcus (GBS) has historically been associated with pregnant women and neonates. Recently GBS bacteremia has been reported more frequently in patients >65 years of age with multiple comorbid conditions. GBS Endocarditis (GBSE) is unusual. In a recent multinational cohort study of patients with definite infective endocarditis, GBS was the etiology in 95 of 4,794 patients (2.0%). We recently encountered 2 elderly patients with acute GBSE. These encounters prompted us to review the experience with GBSE at our institution from 2002 to 2019 to define the current epidemiology of GBSE in the 21st century. Methods: This was an IRB-approved Quality Improvement project. We reviewed the medical records of all patients with GBS bacteremia from July 1, 2002 to June 30, 2019 and report the incidence, epidemiology, symptoms, comorbid conditions, treatment and outcome for patients with GBSE. We compare these data to previously published series of patients with GBSE in the medical literature. Results: During the study period, there were 258 episodes of GBS bacteremia. 19 patients (7.4%) had definite infective endocarditis. 11 patients were women (58%); 8 patients were men (42%). There were no puerperal or postpartum cases. Ages ranged from 46 to 85 years (mean = 67.5). 13 of 19 patients (68%) were ≥ 64 years. 17/19 patients had multiple comorbidities. The average age adjusted Charlson comorbidity index was 4.6. 7/19 patients were compromised hosts: Cirrhosis (2), multiple sclerosis (1), multiple myeloma (1), non-Hodgkin’s lymphoma (1), colon cancer/chemotherapy (1), end-stage kidney disease (1). Patients usually presented with acute/subacute onset of non-specific symptoms such as fever, chills, fatigue and malaise. Cardiac valve involvement: 9 mitral (8 native, 1 prosthetic); 4 aortic (3 native, 1 prosthetic); 1 tricuspid (1 native); 1 mitral + tricuspid (1 native); 1 aortic + pulmonic (1 native); 3 pacemakers. 5/19 patients (26%) required surgical intervention. All 19 patients received infectious disease consultation and appropriate antimicrobial therapy. 5/19 patients (26%) died from complications of GBSE. Conclusion: GBS bacteremia and endocarditis are currently diseases of older adults. Neonatal, puerperal and postpartum cases are rare. Endocarditis is infrequent, presents with non-specific manifestations, is seen in patients with multiple comorbid conditions, and has a high mortality rate (26%) despite appropriate antimicrobial, universal infectious disease consultation and appropriate surgical intervention. Internists, family practitioners, emergency physicians and surgeons must be aware of the change in epidemiology of GBS bacteremia and endocarditis. Most severe GBS infections now occur in the elderly and have a high mortality rate.
Streptococcus agalactiae; Group B streptococcus; Endocarditis; Bacteremia
Patel A, Myers D, Myers JP. Group B Streptococcal Infective Endocarditis: Report of 19 Cases of Definite Endocarditis from a Single Medical Center and Review of the Literature. Ann Clin Med Res. 2020; 1(2): 1007..