LAPORAN KASUS : INFEKSI GIGI SEBAGAI PENYEBAB BAKTEREMIA PADA ENDOKARDITIS INFEKTIF

Dian Puspita, Citra Kiki Krevani

Abstract


Pendahuluan: Endokarditis infektif merupakan penyakit yang mematikan dengan angka mortalitas yang tinggi yaitu 20% dalam 30 hari. Penyebab terjadinya endokarditis infektif pada kasus ini adalah Streptococcus viridans yang merupakan flora oral. Pasien didiagnosis dengan endokarditis infektif definite berdasarkan keluhan, temuan klinis, dan pemeriksaan penunjang. Kasus dan Penatalaksanaan: Keluhan utama pasien adalah demam tinggi sejak 2 minggu sebelum masuk rumah sakit. Demam juga disertai dengan munculnya bintik kemerahan pada kulit dan sesak nafas. Pasien juga mengeluhkan sakit gigi dan berlubang sejak 3 minggu ini, namun tidak berobat. Pada pemeriksaan gigi ditemukan infeksi pada gigi molar 1 dan 2 kanan atas yang berlubang. Pada jantung ditemukan bising pansistolik pada apeks jantung yang menjalar ke aksila. Pada ekokardiografi ditemukan severe mitral regurgitation et causa prolaps Anterior Mitral Leaflet (AML) dengan vegetasi menempel di AML. Pasien diberikan terapi vancomycin 2x500 mg(iv), Gentamicin 1x160 mg. Pemeriksaan kultur darah ditemukan Streptococcus viridans. Streptococcus viridans merupakan bakteri oral yang berkontribusi menimbulkan penyakit endokarditis infektif melalui menyikat gigi, pengunyahan, maupun prosedur gigi. Simpulan: Kebersihan dan kesehatan gigi dan mulut sangat penting untuk dijaga. Selain pasien mempunyai riwayat endokarditis infektif sebelumnya, riwayat katup prostetik, atau penyakit jantung bawaan disarankan untuk diberikan profilaksis antibiotik sebelum dilakukan prosedur gigi.

 

Introduction: Infective endocarditis is a life-threatening disease with an overall mortality rate of 20% at 30 days. The cause of endocarditis infective in this case is Streptococcus viridans which is an oral flora bacteriae. Patients was diagnosed as definitive infective endocarditis by anamnesis and clinical findings. Case and Management: The main complaint of this patient was a high fever from 2 weeks before admission. Fever was also accompanied by the appearance of reddish spots on the skin and shortness of breath. Patient also complained of toothache and cavities from 3 weeks ago, but did not seek treatment. Dental examination found a dental infection in the right upper first and second molar. Pansystolic murmur was heard at the apex of the heart and radiates to the axilla. Severe mitral regurgitation caused by prolapsed Anterior Mitral Leaflet (AML) with vegetation attached to
 AML
was identified by echocardiography. Patient was treated with vancomycin 2x500 mg (iv) and gentamicin 1x160 mg (iv). Blood cultures in this case found Streptococcus viridans. Streptococcus viridians is part of the normal flora of the mouth, usually responsible for infective endocarditis through tooth brushing, mastication, and dental procedures. Conclusion: Maintaining the good oral health and hygiene is very important. Patients with previous infective endocarditis, prosthetic valve, or untreated congenital heart disease who will undergo dental procedures should be considered to get antibiotic prophylaxis.

 


Keywords


infeksi gigi, endokarditis infektif, Streptococcus viridans

References


Karchmer AW. Infective endocarditis. In: Libby P, Bonow RO, Mann DL, Zipes DP, editor. Braunwald's Heart Disease: A Textbook of Cardiovascular Medicine. 11th ed. Philadelphia: Saunders Elsevier; 2018:1483-1502.

Vincent LL, Otto CM. Infective endocarditis: update on epidemiology, outcomes, and management. Curr Cardiol Rep. 2018; 86: 1-9.

Slipczuk L, Codolosa JN, Davila CD, Romero-Corral A. Yun J, Pressman GS, et al. Infective endocarditis epidemiology over five decades: a systematic review. PLoS One. 2013; 8(12): e82665.

Keynan Y, Rubinstein E. Pathophysiology of infective endocarditis. Curr Infect Dis Rep. 2013; 15: 342-346.

Thornhill MH. Infective endocarditis: the impact of the NICE guidelines for antibiotic prophylaxis. Dent Update. 2012; 39: 6-10.

Haldar SM, O’Gara PT. Infective endocarditis. In : Hurst JW, Walsh RA, Fang JC, Fuster V, editor. Hurst's The Heart: Manual of cardiology. 13th ed. New York; London: McGraw-Hill Medical; 2013: 424-449

Karchmer AW. Infective endocarditis. In: Loscalzo J, edition. Harrison's cardiovascular medicine. 2nd ed. New York; London: McGraw Hill Medical; 2012: 294-308.

Bickley LS, Bates B, Szilagyi PG. Bates' pocket guide to physical examination and history taking. Philadelphia: Wolters Kluwer Health/Lippincott Williams and Wilkins; 2013.

Habib G, Lancellotti P, Antunes MJ, Bongiorni MG, Casalta JP, Zotti FD, et al. 2015 ESC Guidelines for the management of infective endocarditis. European Heart Journal. 2015; 36(44): 3075-3128.

Birlutiu V, Birlutiu RM, Costache VS. Viridans streptococcal infective endocarditis associated with fixed orthodontic appliance managed surgically by mitral valve plasty. Medicine. 2018; 97:27.

Horder TJ. Infective endocarditis with an analysis of 150 cases and with special reference to the chronic form of the disease. Quart J Med. 1909; 2: 289-324.

Lockhart PB, Brennan MT, Sasser HC, Fox PC, Paster BJ, Bahrani-Mougeot FK. Bacteremia associated with toothbrushing and dental extraction. Circulation. 2008; 117: 3118–3125.

Duval X, Alla F, Hoen B, Danielou F, Larrieu S, Delahaye F, et al. Estimated risk of endocarditis in adults with predisposing cardiac conditions undergoing dental procedures with or without antibiotic prophylaxis. Clin Infect Dis. 2006; 42: e102–e107.

Thornhill MH, Lockhart PB, Prendergast B, Chambers JB, Shanson D. NICE and antibiotic prophylaxis to prevent endocarditis. Br Dent J. 2015; 218: 619-621.

Lockhart PB, Brennan MT, Thornhill MH et al. Poor oral hygiene as a risk factor for infective endocarditis-related bacteraemia. J Am Dent Assoc. 2009; 140: 1238-1244.

Habib G, Hoen B, Tornos P, Thuny F, Prendergast B, Vilacosta I. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009). European Heart Journal. 2009; 30: 2369–2413.

Farmakologi dan Terapi. 4 ed. Jakarta: Fakultas Kedokteran Universitas Indonesia; 2001.

Tsuji BT, Rybak MJ. Short-course gentamicin in combination with daptomycin or vancomycin against Staphylococcus aureus in an in vitro pharmacodynamic model with simulated endocardial vegetations. Antimicrob Agents Chemother. Jul 2005; 49(7): 2735-2745




DOI: https://doi.org/10.33854/jbd.v6i2.303

Refbacks

  • There are currently no refbacks.


Copyright (c) 2019 B-Dent: Jurnal Kedokteran Gigi Universitas Baiturrahmah

Creative Commons License
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.

Creative Commons License
B-Dent: Jurnal Kedokteran Gigi Universitas Baiturrahmah distributed under Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.