Acute infective endocarditis in elderly woman visiting Ayub Medical Institute with history of dental procedure: A case report

Infective endocarditis is a fatal, disastrous, and lethal disease and can lead to death if not diagnosed and treated immediately. This disease stereotypically affects the cardiac valves and the most commonly involved valve is the tricuspid valve, but the mitral and aortic valves can also be convoluted. Infective endocarditis produces both intra cardiac effects e.g., valvular inadequacy and a great variety of systemic effects, both from emboli which could either be sterile or infected and a variety of immunological mechanisms. Infective endocarditis is a disease that can easily be misdiagnosed and the physicians should be alert, vigilant with all the abilities to maintain the attention in manifestations of considering infective endocarditis to avoid missing the diagnosis. Here is a case report of a 55 years old woman who presented to the emergency department of Ayub Medical Institute, Abbottabad, Pakistan with history of high grade fever for last 5 days [103⁰ at time of visiting in hospital’s emergency department], sinus tachycardia with the heart rate of 115 beats/minute, body aches and pains and sudden onset of shortness of breath and chest pain. She also had history of some dental procedures about three weeks back. In this patient blood sampling was done. Three sets of blood samples prior to start of antimicrobial treatment, were collected and then sent to laboratory for the culture to isolate the causative or involved organism. The result was; isolated organism was Streptococcus Viridan was isolated on culture. Blood investigations revealed; Streptococcus Viridan was screened following culture, CRP which was raised up to 230, raised ESR up to 60, leucocytosis characterized by a TLC of 16800/cc, Hb 7.5mg/dl. An immediate and aggressive treatment was started with Ceftazidime 1g intravenously 8 hourly which was later switched to Ceftriaxone 1g along with Vancomycin 1.5g intravenously every 12 hours until the fever was subsided and CRP was reduced to 10. Following a treatment plan that spanned over fourteen days and after the settlement of the fever and other symptoms, the patient was discharged on prescription of antibiotics. It is concluded that Ceftriaxone and Vancomycin have proven better treatment strategies than the commonly prescribed antibiotics as given in European’s treatment guidelines.