Prosthetic valve infective endocarditis due to Burkholderia pseudomallei: A case report and review of the literature

Abstract

Endocarditis is a very rare complication of Burkholderia pseudomallei infection and prosthetic valve endocarditis rarer still. We present, to our knowledge, the first confirmed Australian case of prosthetic valve endocarditis in a patient with melioidosis. Blood cultures were persistently positive for B. pseudomallei, a transoesophageal echocardiogram demonstrated a mobile vegetation on his bioprosthetic aortic valve, and computed tomography and magnetic resonance imaging identified no other focus of infection. Infection of prosthetic material appears to be rare in cases of melioidosis, however, if present, its removal should be strongly considered to effect cure. Fortunately, in our case, clinical response to 8 weeks of intravenous therapy and 6 months of high-dose oral co-trimoxazole obviated the requirement for valve replacement surgery. However, sadly, the patient died from complications of a stroke 4 months after cessation of his antibiotic treatment. The stroke was not felt to be directly related to his infection; however, his clinical course highlights the importance of aggressively addressing the comorbidities that predispose an individual to melioidosis and which also increase their risk of premature death.