The role of cardiac rehabilitation after Streptococcus agalactiae Infective Endocarditis with Septic Embolic Complication in an Elderly Patient: Case Report

Abstract

Introduction. In the past, Streptococcus agalactiae was known to be associated with invasive infections in pregnant women and newborns. More recently, given a more appropriate antibiotic prophylaxis and treatment, the incidence among pregnant women and infants diminished. However, an increasing number of cases with infective endocarditis with Streptococcus agalactiae has been reported in the recent years in older patients with underlying comorbidities. Case report. An 80-year-old female patient presented with dyspnea, weight loss, fever, fatigue, chills, dry cough and bilateral lower limb edema. The work-up revealed complicated infective endocarditis with Streptococcus agalactiae on the native aortic valve with severe aortic regurgitation as a result of the valvular destruction and a metastatic spleen abscess. Antibiotic treatment was started with resolution of the fever and chills. The patient however developed congestive heart failure due to the valvular regurgitation. A decision was made to proceed urgently with aortic valve replacement and splenectomy, which were performed at the same time, followed by a good recovery. Results and discussion. An increasing number of cases with IE with GBS in elderly patients has been reported in the recent years, with high rate of complications and mortality. The underlying comorbidities are important risk factors for S. agalactiae IE. Considering our case, a patient in her eighties with significant abdominal surgical history and multiple medical conditions could be a typical host. Recovery after cardiac surgery is one of the most important indications of physical training. This includes patients post-coronary artery bypass grafting, after valve prosthetic replacement, after surgery for congenital diseases and after heart transplantation. Early mobilization is particularly important in avoiding immobility and cardiac deconditioning. Conclusions. Despite the fact that mortality in Group B Streptococcus endocarditis is 40%, a combined medical and surgical strategy individualized to the specific situation of each patient have led to a positive outcome in a number of cases. We present such a combined treatment approach in a case of complicated infective endocarditis with metastatic spleen abscess in an elderly patient. The aortic valve replacement and splenectomy were performed at the same time. Keywords: endocarditis, septic emboli, valve replacement, splenectomy