PMC9355300_01
The TEE results of the mitral valve and WBC levels. TTE revealed (A) flocculent hypoechoic vegetations of the aortic valve (the red arrow) and (B) a moderate regurgitation bundle on the left ventricular outflow tract side during diastole of the aortic valve. (C) The histochemical analysis of the valve tissue revealed local myxoid and hyaline degeneration, missing endothelial cells, necrotic attached substances (the blue arrow), and neutrophil aggregation (the black arrows). Scale bars approximate 50 mum in length. The (D) WBC count and cell proportions and (E) CRP throughout the course. TTE, transthoracic echocardiography; LA, left atrium; LV, left ventricle; RA, right atrium; RVOT, right ventricular outflow tract; AO, aorta; PA, pulmonary artery; WBC, white blood cell; CRP, C-reactive protein.
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F1
Histochemical analysis of the valve tissue showed local myxoid and hyaline degeneration, missing endothelial cells, and a large number of necrotic attached substances, and there were many neutrophils in the valve wall at the bottom of the necrotic substances (Figure 1C). The WBC count (Figure 1D) and CRP (Figure 1E) remained at high levels post-operation, and intravenous teicoplanin (1 g/day) and meropenem (1 g/8 h) were used for treatment.
The timeline of the case presentation. The patient was discharged with a monthly follow-up 26 days after his admission. BT, body temperature; ESR, erythrocyte sedimentation rate; BCs, blood cultures; IE, infective endocarditis; PCT, procalcitonin.
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F2
Additionally, we present a timeline for the case presentation (Figure 2).
The phylogenetic tree based on the 16S rRNA gene sequences showing the relationship of isolated strain BC1012612 (the black arrow) and members within the genus Streptococcus. The tree was reconstructed by the neighbor-joining method, and Enterococcus faecalis JCM5803T was used as an outgroup. Bootstrap values (>50%) based on 1,000 replicates are shown at branch nodes. T, type strain.
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F3
The phylogenetic tree showed that strain BC1012612 was clustered with strains HKU4T, HDP 2005-0155, and 11026353, and this cluster was strongly supported with a bootstrap value of 100% (Figure 3).