Pneumatose Intestinal e Complicações de Endocardite por Enterococcus faecium: a propósito de um caso clínico

portuguesOs Enterococos pertencem a flora comensal humana e tem sido reconhecidos como importantes agentes causadores de infecoes. As infecoes causadas por estes microrganismos tem vindo a aumentar, especialmente entre os idosos, doentes com doencas cardiacas degenerativas e valvulas cardiacas protesicas, bem como em manipulacoes dos tratos gastrointestinal e urinario. Sao responsaveis por cerca de 8-17% das Endocardites Infeciosas, sendo o Enterococos o terceiro principal responsavel – 90% dos casos devido ao Enterococcus faecalis e com menos de 5% causada por Enterococcus faecium. A morbilidade e mortalidade de endocardite por Enterococos e elevada. A pneumatose intestinal habitualmente e assintomatica, com complicacoes em apenas 3% dos casos, incluindo obstrucao intestinal, perfuracao e hemorragia. Uma vez em circulacao, os Enterococos tem elevada afinidade para valvulas cardiacas espessadas ou protesicas. As principais complicacoes cardiacas sao os abcessos perivalvulares; raramente surgem outras complicacoes, nomeadamente perfuracao do miocardio e aneurismas valvulares. A cirurgia esta indicada em complicacoes graves EnglishEnterococci belong to the commensal human flora and have been recognized as important causative agents of infections. The infections caused by these organisms have been increasing, particularly among the elderly, patients with degenerative heart disease and cardiac prosthetic valves, as well as manipulation of the gastrointestinal and urinary tracts. They are responsible for about 8-17% of infectious endocarditis, being the Enterococci responsible for the main third - 90% of cases due to Enterococcus faecalis and less than 5% caused by Enterococcus faecium. The morbidity and mortality of enterococcal endocarditis is high. The pneumatosis intestinalis is usually asymptomatic, and complications are present in only 3% of cases, including intestinal obstruction, perforation and hemorrhage. Once in circulation, Enterococcus have high affinity for thickened or prosthetic heart valves. The main cardiac complications are the perivalvulares abscesses; rarely arise other complications, including perforation of the myocardium and valvular aneurysms. Surgery is indicated in severe complications