From the Guidelines
Neisseria elongata endocarditis requires prompt and aggressive treatment with intravenous antibiotics, typically a beta-lactam antibiotic combined with an aminoglycoside, to reduce morbidity and mortality. The clinical presentation of Neisseria elongata endocarditis can be variable, but it often includes fever, new heart murmurs, and systemic embolic phenomena 1. The diagnosis should be suspected in any patient presenting with fever and embolic phenomena, and laboratory signs of infection such as elevated C-reactive protein (CRP) or erythrocyte sedimentation rate (ESR) can strengthen the diagnostic suspicion 1.
Key Considerations
- Blood cultures should be obtained before initiating antibiotics to guide therapy adjustments 1
- Echocardiography is essential for diagnosis and monitoring of Neisseria elongata endocarditis 1
- Surgical intervention may be necessary in cases with severe valve damage, persistent infection despite appropriate antibiotics, large vegetations with embolic risk, or heart failure 1
- Close monitoring for complications including heart failure, embolization, and mycotic aneurysms is crucial 1
Treatment Approach
- The recommended treatment regimen consists of a beta-lactam antibiotic, typically penicillin G or ceftriaxone, combined with an aminoglycoside such as gentamicin for at least the first 2 weeks, followed by beta-lactam monotherapy to complete a total 4-6 week course
- Antibiotic susceptibility testing should guide therapy adjustments 1
- Cardiology and infectious disease consultation is recommended for optimal management of this serious infection 1
Prognosis and Management
- Prognosis in IE is influenced by four main factors: patient characteristics, the presence or absence of cardiac and non-cardiac complications, the infecting organism, and the echocardiographic findings 1
- Patients with complicated IE, such as those with heart failure, periannular complications, and/or S. aureus infection, are at highest risk of death and need for surgery in the active phase of the disease 1
From the Research
Characteristics of Neisseria elongata Endocarditis
- Neisseria elongata is a rare cause of infective endocarditis, typically affecting the left cardiac chambers 2, 3, 4
- The infection is associated with a high risk of embolization and can lead to serious complications such as perivalvular abscess formation and/or valve perforation 2, 4
- N. elongata is a constituent of the normal oropharyngeal bacterial flora, but can become an aggressive organism causing serious infections 2, 3
Diagnosis and Treatment
- A transesophageal echocardiogram should be performed as part of the initial workup to assess the extent of infection 2
- Most patients require prolonged antibiotic therapy and early surgical intervention 2, 3
- Antibiotic therapy alone may not be sufficient, and surgery may be necessary in some cases 3, 5
- The choice of antibiotic therapy may vary, with some cases responding to treatment with ofloxacin and meropenem 6, while others may require a combination of ceftriaxone and gentamicin 5
Clinical Presentation and Outcomes
- N. elongata endocarditis can affect healthy individuals, as well as those with pre-existing heart conditions such as mitral valve prolapse 5
- The infection can lead to severe complications, including valve regurgitation and embolization 2, 4
- With prompt treatment, including antibiotic therapy and surgical intervention, patients can recover from N. elongata endocarditis 2, 6, 5