Dataset Information

Prosthetic valve endocarditis presenting as meningoencephalitis complicated by pseudo-aneurysms in a remote Aboriginal healthcare setting in Australia: a case report.

ABSTRACT:

Background

The Australian Aboriginal population has a high burden of cardiac conditions predisposing patients to infective endocarditis. Pseudo-aneurysms are a rare and potentially fatal complication of both prior valvular surgery and endocarditis.

Case summary

A 31-year-old female with a history of bicuspid aortic valve requiring valve replacement presented with meningoencephalitis. Transoesophageal echo and positive blood cultures for Staphylococcus aureus confirmed prosthetic valve endocarditis (PVE). Aortic root mycotic pseudo-aneurysms developed during antimicrobial therapy and two large pseudo-aneurysms remain post-redo valve, root and arch replacement.

Discussion

Complications associated with PVE are common, especially due to S. aureus. Redo cardiac surgery is high risk, percutaneous treatments may be technically difficult due to altered post-operative anatomy, and medication adherence issues and lack of healthcare engagement further compromise optimal care in this patient population.

SUBMITTER: Watson AL

PROVIDER: S-EPMC8374982 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:ObjectivesWe aimed to compare the incidence, subtypes and aetiology of stroke, and in-hospital death due to stroke, between Aboriginal and non-Aboriginal people in Central Australia, a remote region of Australia where a high proportion Aboriginal people reside (40% of the population). We hypothesised that the rates of stroke, particularly in younger adults, would be greater in the Aboriginal population, compared with the non-Aboriginal population; we aimed to elucidate causes for any identified disparities.DesignA retrospective population-based study of patients hospitalised with stroke within a defined region from 1 January 2011 to 31 December 2014.SettingAlice Springs Hospital, the only neuroimaging-capable acute hospital in Central Australia, serving a network of 50 healthcare facilities covering 672 000 km2.Participants161 residents (63.4% Aboriginal) of the catchment area admitted to hospital with stroke.Primary and secondary outcome measuresRates of first-ever stroke, overall (all events) stroke and in-hospital death.ResultsOf 121 residents with first-ever stroke, 61% identified as Aboriginal. Median onset-age (54 years) was 17 years younger in Aboriginal patients (p<0.001), and age-standardised stroke incidence was threefold that of non-Aboriginal patients (153 vs 51 per 100 000, incidence rate ratio 3.0, 95% CI 2 to 4). The rate ratios for the overall rate of stroke (first-ever and recurrent) were similar. In Aboriginal patients aged <55 years, the incidence of ischaemic stroke was 14-fold greater (95% CI 4 to 45), and intracerebral haemorrhage 19-fold greater (95% CI 3 to 142) than in non-Aboriginal patients. Crude prevalence of diabetes mellitus (70.3% vs 34.0%, p<0.001) and hypercholesterolaemia (68.9% vs 51.1%, p=0.049) was greater, and age-standardised in-hospital deaths were fivefold greater (35 vs 7 per 100 000, 95% CI 2 to 11) in Aboriginal patients than in non-Aboriginal patients.ConclusionsStroke incidence (both subtypes) and in-hospital deaths for remote Aboriginal Australians are dramatically greater than in non-Aboriginal people, especially in patients aged <55 years.