Trouble is, the cavity-causing bacteria in our mouths traveled to Jay Keller’s heart and then his brain, causing a life-threatening aneurysm.
But he wouldn’t know it for a while.
Keller, a 49-year-old architect from Chicago, runs marathons, works out and never gets sick, he said. So when he suddenly started feeling tired in the summer of 2021, he thought it was just a cold. Over the next few months, the symptoms went from manageable to severe.
“I was getting more and more tired at night,” Keller told TODAY.
“Finally, I realized I couldn’t really run anymore. It was very difficult… my wife says: ‘Finally, you are 75 years old.'”
He went to the emergency clinic and the doctors gave him cold medicine. It didn’t help. Keller thought she might have contracted COVID-19 without knowing it.
Then one morning she woke up with a pounding headache, “the worst pain I’ve ever had in my life,” she recalls. “All I had was a terrible headache.”
It took a few days before the pain was manageable. Keller continued to work and go about her daily life, hoping the pain would subside. His annual physical was coming up, so he planned to bring up the symptoms then.
When the doctor tested his blood, he made a surprising discovery.
Infection inside the heart
Keller’s endocarditis, a heart valve, was caused by Streptococcus mutans, a bacteria that lives in the mouth and causes tooth decay.
The overall incidence of infective endocarditis in the general population is low, about 15 cases per 100,000 people, said Dr. Karen Krueger, an infectious disease specialist at Northwestern Medicine who treated Keller. Bacteria often enter the bloodstream from the mouth or other parts of the body and are usually harmless, he noted.
“However, in some cases, bacteria can overcome the body’s immune response or attach to certain areas, such as heart valves, and cause infection,” explained Kruger.
Anyone can develop a heart valve infection, but it is more common in patients with predisposing conditions such as structural or valvular heart disease.
Keller fell into this category because he was born with a bicuspid aortic valve—a congenital heart defect in which he had only two, not three, valves in the aortic valve that regulates blood flow from the heart to the body’s main arteries.
He knew he had a heart condition, but it never really affected his life – until he got the infection. He didn’t have cavities or recent dental work, but the germs still managed to get to his heart.
“In this case, bacteria can enter the bloodstream through food or daily dental hygiene and develop an infection in Mr. Keller’s bicuspid abnormal heart valve. From there, it spreads through the bloodstream to other parts of his body,” Kruger said.
An infection inside the brain
A heart valve infection was just the beginning of Keller’s problems. The heart is the body’s central pump, so if part of that pump is infected, blood will flow past the infected machine, said Dr. Babak Jahromi, a neurosurgeon at Keller Northwestern Medicine.
“These pieces of infected debris can fly off and settle anywhere,” he said. “It happened to Jay … one of them lodged in his brain and infected the cerebral arteries.”
These infected cerebral arteries fail to maintain integrity, causing a mycotic cerebral aneurysm—a dangerous bulging of the artery wall due to infection. According to the National Institute of Neurological Disorders and Stroke, an aneurysm can rupture and bleed into the brain, causing stroke, brain damage, coma and death.
“It was crazy,” Keller recalled. “I just, how am I going to live if I have an aneurysm?”
Keller’s case was rare: An infection of a brain aneurysm is rare, and it’s even more likely to be associated with a heart infection, Jahromi said.
Both issues needed to be addressed, but because of the high risk of the aneurysm rupturing, the doctors decided to treat it first.
They tried to reduce the course of antibiotics, but to no avail. So in February, surgeon K called for a craniotomy, opened the skull, and performed a double “brain bypass” operation on Jahromi.
Because the aneurysm involved important arteries in the brain, Jahromi and his team couldn’t just cut it out and be done with it. According to Jahromi, they took the blood vessels attached to the bulge and rerouted them by connecting them to nearby normal brain arteries.
“It’s basically rewiring or remaking the brain’s tubes by cutting out the part that’s not working and connecting the remaining tubes together,” he noted.
Much to Keller’s relief, he came out of the eight-hour brain surgery clear-headed and bounced back quickly, he said.
Two months later, he was back on the operating table for a heart valve replacement.
Today, he feels “almost 100%” and is back running and training. There are no limits to what he can do and he just needs annual follow-up with his medical team.
“Life is back to normal, minus some beautiful scars,” Keller said. “I feel great.”
She encouraged others to listen to their bodies and not ignore pain or unusual symptoms. Pay more attention to your health and feel comfortable visiting your doctor for basic blood and urine tests that can uncover deeper problems, Keller advised. He wished he had done it sooner.