title: Legionella micdadei prosthetic valve endocarditis complicated by brain abscess: case report and review of the literature.
abstract: Legionella endocarditis is extremely uncommon, and embolic phenomena have never been reported. We report the first case of Legionella micdadei prosthetic valve endocarditis complicated by brain abscess. A 57-y-old immunocompromised woman with a history of mitral valve replacement developed confusion and left-sided weakness. Brain magnetic resonance imaging showed a 3-cm peripheral-enhancing mass. Transoesophageal echocardiography suggested a perivalvular abscess. Blood cultures and valve cultures were negative. She was diagnosed with 16S rRNA polymerase chain reaction and silver stain, and was discharged with levofloxacin after a redo mitral valve replacement. Twelve cases of Legionella endocarditis were reviewed. Only one case had a native valve, and her endocarditis occurred after pneumonia. All cases were cured. The duration of antibiotic therapy was variable. Legionella species should be considered in the differential diagnosis of culture-negative endocarditis in both immunocompetent and immunocompromised patients. Molecular techniques and silver impregnation stains are useful, especially when cultures using buffered charcoal-yeast extract agar are negative.
authors.affiliation: Division of Infectious Diseases, University of Pittsburgh, Pittsburgh 15213, USA. konoy2@upmc.edu
authors.forename: Yuriko
authors.initials: Y
authors.lastname: Fukuta
authors.forename: Isil Z
authors.initials: IZ
authors.lastname: Yildiz-Aktas
authors.forename: A
authors.initials: A
authors.lastname: William Pasculle
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Veldkamp
mesh_terms: D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001431:Bacteriological Techniques; D001921:Brain / Q000000981:diagnostic imaging / Q000473:pathology; D001922:Brain Abscess / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D004699:Endocardium / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D006801:Humans; D007875:Legionella / Q000145:classification / Q000302:isolation & purification*; D007876:Legionellosis / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D064704:Levofloxacin; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D015242:Ofloxacin / Q000008:administration & dosage; D016459:Prosthesis-Related Infections / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D011859:Radiography
chemical_list: D000900:Anti-Bacterial Agents; D064704:Levofloxacin; D015242:Ofloxacin