BACKGROUND: Aerococcus urinae is a rare pathogen of endocarditis with high rates of embolic events, valvular damage and mortality.
CASE 1:A 24 y/o male, with mitral valve prolapse, presented with recurrent fever and body malaise for four months. ?-hemolytic streptococci was isolated in his blood 3 months prior, antibiotics for 10 days temporarily relieved his symptoms. He denied illicit drug use, recent dental, genitourinary manipulations. On admission, he was febrile with a 4/6 holosystolic murmur at the apex. He had leukocytosis and elevated acute phase reactants. Blood cultures: Aerococcus urinae. A TEE revealed: ruptured chordae and vegetation at the posterior mitral valve leaflet. Gentamicin for 14 days and Ceftriaxone for 28 days was completed. Mitral valve replacement was done and LV dimension returned to normal.
CASE 2:A 51 y/o male presented with 9 days of fever, chills, and malaise. He was treated with norfloxacin with no relief of symptoms. On admission, he was febrile, with a grade 2/6 holosystolic murmur at the apex and left parasternal area. He had leukocytosis and blood culture grew Aerococcus urinae. Echocardiogram showed mitral stenosis, aortic stenosis and vegetations at the mitral valve and non coronary cusp. Pen-G plus Gentamicin for 14 days and upon discharge, amoxicillin for 2 weeks was completed.
DISCUSSION: Risk factors associated with A. urinae endocarditis are >65 year s of age, male, urologic abnormalities, malignancy and diabetes. Diagnosis isusually made by culture as our cases and both were found to have vegetations by echocardiography. B-lactam and amino glycoside treatment is effective and although mortality is high, both patients improved and were discharged.
CONCLUSION: A. urinae endocarditis does occur in a young population and to those without urologic abnormality.

Human ; Male ; Middle Aged ; Young Adult ; Aerococcus ; Amoxicillin ; Anti-bacterial Agents ; Aortic Valve Stenosis ; Diabetes Mellitus ; Endocarditis ; Mitral Valve ; Risk Factors ;

OBJECTIVES

Pre-impaired glucose tolerance (pre-IGT) is a prediabetes stage characterized by normoglycemia and compensatory hyperinsulinemia due to insulin resistance. Hyperinsulinemia increases cardiovascular disease (CVD) risk, especially, endothelial dysfunction (ED). However, there is paucity of studies on ED with hyperinsulinemia alone, particularly in individuals with pre-IGT. This study aimed to determine the presence of ED using brachial artery flow-mediated dilatation (FMD) among adult participants with pre-IGT and its correlation with insulin levels and other related clinical parameters.

METHODOLOGY

This is a cross-sectional analytical study. We screened adult patients with risk factors for developing diabetes (first-degree relative with type 2 diabetes mellitus, obesity, history of gestational diabetes and polycystic ovary syndrome). Brachial artery FMD was performed among participants with pre-IGT and findings were correlated with CVD risk factors using Pearson’s correlation and linear regression.

RESULTS

Of the 23 pre-IGT patients, 5 (21.74%) had decreased FMD values with significant associations with serum insulin and HbA1c. It was further observed that for every 1-unit increase in second-hour serum insulin and in HbA1c, there was a decrease in FMD values by 0.38% and 0.50%, respectively. Serum insulin was elevated, while other biochemical parameters were normal. Moreover, participants with low FMD were older, with higher BMI and had higher HBA1c, total cholesterol and low-density lipoprotein (LDL) cholesterol.

CONCLUSION

As early as the pre-IGT stage, endothelial dysfunction using the FMD test is already present, with red flags on other CVD risk factors already developing.

Human ; Insulin Resistance (ir) ; Hyperinsulinism ; Hyperinsulinemia ; Diabetes Mellitus, Type 2 ; Cardiovascular Diseases