Prosthetic valve endocarditis due to Listeria monocytogenes. Report of two cases and reviews.
BACKGROUND
Endocarditis due to Listeria monocytogenes is a rare but serious disease often leading to valve dysfunction and heart failure. Two cases of listerial prosthetic valve endocarditis are reviewed along with 66 cases previously reported.


RESULTS
The mean age of patients with listerial endocarditis increased from 47.1 years in the decades from 1955-1984 to 65.5 years from 1985-2000. Chronic debilitating diseases, solid tumours and immunosuppression associated with organ transplantation, hematologic neoplasia or AIDS were found in 41.1% of cases. Listerial endocarditis was a vegetative and destructive process, with dehiscense of the prosthesis and occasionally, abscess formation, fistulization and pericarditis. Treatment with penicillin or ampicillin alone or combined with gentamicin was adequate therapy in most cases. Vancomycin together with gentamicin may be a reasonable alternative therapy.


CONCLUSIONS
Despite problems associated with microbial persistence and relapses in other forms of human listeriosis, antimicrobial therapy alone may be a successful treatment for listerial endocarditis, including cases occurring on prosthetic valves. Valve replacement may be reserved for complicated cases with valve dehiscense, cardiac failure or myocardial abscess. Overall mortality was 35.3%, although most patients who died did so before 1985 and since then mortality has been significantly reduced to 12%.
Fernández Guerrero
Manuel L
ML
División of Infectious Diseases, Cardiology and Department of Cardiac Surgery, Fundación Jiménez Di;az, Universidad Autónoma de Madrid, Spain. mlfernandez@fjd.es
Rivas
Pablo
P
Rábago
Rosa
R
Núñez
Antonio
A
de Górgolas
Miguel
M
Martinell
Jorge
J
D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D004697:Endocarditis, Bacterial / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*; D005500:Follow-Up Studies; D006333:Heart Failure / Q000209:etiology; D006349:Heart Valve Diseases / Q000209:etiology; D006350:Heart Valve Prosthesis / Q000009:adverse effects* / Q000382:microbiology; D006801:Humans; D008089:Listeria monocytogenes / Q000472:pathogenicity*; D008088:Listeriosis / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*; D016239:MEDLINE; D008297:Male; D016459:Prosthesis-Related Infections / Q000150:complications / Q000188:drug therapy / Q000382:microbiology*
D000900:Anti-Bacterial Agents