Case report: Infective endocarditis caused by Streptococcus pneumonia at Prof. Ngoerah Hospital, Denpasar, Bali

Introduction: Infective endocarditis (IE) is a rare infection of the endocardial surface that can be caused by Streptococcus pneumoniae (pneumococcal endocarditis/PE), with an incidence of between 1.4–12.7 per 100,000 people each year, and a mortality rate of <3%. Infective endocarditis is associated with several complications including stroke and congestive heart failure. Here we report a case of IE in an adult caused by S. pneumoniae. Case Description: A 27-year-old woman complained of swelling in both legs, red spots, and a history of fever since 2 days before admission. Physical and supporting examinations including echocardiography and three-sided blood culture were carried out using VITEK-2. Streptococcus pneumoniae was identified from the culture which sensitive to Benzylpenicillin group including Cefotaxime, Ceftriaxone, Levofloxacin, Erythromycin, Clindamycin, Tetracycline, and Trimethoprim/Sulfamethoxazole. Infective endocarditis due to S. pneumoniae in adult is very rare. The attachment of S. pneumoniae to the heart valve, may be facilitated by its capsule, which is considered essential in bacteremia. Patient received empirical intravenous antibiotics with 3 grams Ampicillin every 6 hours and 150 mg Gentamicin every 24 hours. The patient improved and treatment was continued by intramuscular injections of 1.2 million IU Benzathine Penicillin G were given every 28 days until age 40. Conclusion: Infective endocarditis cases in adult patients are associated with high morbidity. Pneumococcal vaccination and adhering to rational antibiotic administration guidelines provide good prognosis to the patients.