George S, Varghese J, Chandrasekhar S, Perumalla R, Reddy MS, Jayanthi V, Rela M. Gram-negative bacteria causing infective endocarditis: Rare cardiac complication after liver transplantation. World J Hepatol 2013; 5(5): 296-297 [PMID: 23717742 DOI: 10.4254/wjh.v5.i5.296]
Corresponding Author of This Article
Dr. Joy Varghese, Department of Hepatology and Liver Transplantation, Global Hospitals and Health City, 439, Cheran Nagar, Sholinganallur-Medavakkam Road, Perumbakkam, Chennai 600100, Tamil Nadu, India. email@example.com
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Susan George, Joy Varghese, Sujatha Chandrasekhar, Rajasekar Perumalla, Mettu Srinivas Reddy, Venkataraman Jayanthi, Mohamed Rela
Susan George, Department of Cardiology, Global Hospitals and Health City, Chennai 600100, India
Joy Varghese, Venkataraman Jayanthi, Mohamed Rela, Department of Hepatology and Liver Transplantation, Global Hospitals and Health City, Chennai 600100, India
Sujatha Chandrasekhar, Department of Microbiology, Global Hospitals and Health City, Chennai 600100, India
Rajasekar Perumalla, Mettu Srinivas Reddy, Mohamed Rela, Institute of HPB and Transplantation, Global Hospitals and Health City, Chennai 600100, India
Author contributions: George S was the cardiologist taking care of the patient; Varghese J worked up the case and drafted the initial manuscript; Chandrasekar S was the microbiologist who did the culture and isolated the organism; Perumalla R and Reddy MS surgeons involved in the liver transplant; Jayanthi V worked up the case and edited the manuscript; Rela M was liver transplant surgeon heading the liver surgery and transplant team.
Correspondence to: Dr. Joy Varghese, Department of Hepatology and Liver Transplantation, Global Hospitals and Health City, 439, Cheran Nagar, Sholinganallur-Medavakkam Road, Perumbakkam, Chennai 600100, Tamil Nadu, India. firstname.lastname@example.org
Telephone: +91-44-22777000 Fax: +91-44-22777100
Received: March 6, 2013 Revised: May 3, 2013 Accepted: May 7, 2013 Published online: May 27, 2013
Bacterial endocarditis is a rare complication amongst solid organ transplant recipients and is often linked to bacteremia. Majority of these recipients do not have underlying valvular heart disease or congenital valvular abnormalities. Staphylococoocusaureus and Enterococcus species are the most commonly isolated organisms. There are very few reports of gram-negative bacteria causing endocarditis in liver transplant recipients. We report a 51-year-old male, a liver transplant recipient, who developed bacterial endocarditis of the mitral valve due to extended spectrum of betalactamase producing strain of Escherichia coli and was managed successfully with antibiotics.
Core tip: A pre-transplant cardiac assessment should include a careful evaluation for underlying valvular pathology. Bacterial endocarditis can however still occur in liver transplant recipients with normal cardiac valves. Gram negative bacteria though rare can be a causative agent for infective endocarditis. High index of suspicion for bacterial endocarditis is essential when investigating transplant recipients for fever of uncertain origin.