Gemella morbillorum: an underestimated aetiology of central nervous system infection?

Gemella morbillorum infective endocarditis: A case report and literature review

Infective endocarditis (IE) caused by Gemella morbillorum is rare. Consequently, little is known about the natural course of endocarditis caused by this pathogen. This report describes the case of a 37-year-old male patient with G. morbillorum endocarditis. The patient was hospitalized for a fever of unknown origin. He complained of intermittent fever of unknown origin for 2 months. He had also undergone root canal therapy for pulpitis a month ago. After admission, the infectious pathogen G. morbillorum was identified using metagenomic next-generation sequence technology. The anaerobic blood culture bottle showed only Gram-positive cocci. Transthoracic echocardiography showed 10 mm vegetation on the aorta, which met the IE diagnostic Duke's criteria, and the patient was diagnosed with G. morbillorum IE. Because no bacterial colonies were formed on the culture, the drug sensitivity test could not be conducted. Ceftriaxone anti-infective drugs are based on careful consideration of the literature and patient. Six days after antibiotic treatment in our department, the patient was discharged from the hospital in stable condition and had no adverse reactions at 1 week of follow-up. To help clinicians better understand the disease of G. morbillorum IE, we also reviewed and discussed the relevant cases published after 2010 when presenting the report.

A Rare Pathogen of Bones and Joints: A Systematic Review of Osteoarticular Infections Caused by Gemella morbillorum

Osteoarticular infections (OAIs) caused by Gemella morbillorum (G. morbillorum) are a rare clinical entity. This study aimed to review all published cases of OAI due to G. morbillorum. A systematic review of PubMed, Scopus, and Cochrane Library was conducted to report the demographic and clinical characteristics, microbiological data, management, and outcome of OAIs caused by G. morbillorum in the adult population. A total of 16 studies reporting on 16 patients were included in this review. Eight patients had arthritis and eight patients had osteomyelitis/discitis. The most reported risk factors were immunosuppression, poor dental hygiene/dental infections, and recent gastrointestinal (GI) endoscopy. Five cases of arthritis occurred in a native joint while three patients had prostheses. The potential source of G. morbillorum infection was documented in more than half of the cases (56%) (most commonly odontogenic and GI sources (25% and 18%, respectively). The knee and hip joints were the most frequently affected joints in patients with arthritis, while the thoracic vertebrae were the most common sites for osteomyelitis/discitis. The blood cultures were positive in three patients with arthritis (37.5%) and five patients with osteomyelitis/discitis (62.5%). Associated endovascular infection was found in five patients with bacteremia. Contiguous spread (adjacent mediastinitis) was documented in two patients with sternal osteomyelitis and thoracic vertebral osteomyelitis. Surgical interventions were performed for 12 patients (75%). Most strains of G. morbillorum were susceptible to penicillin and cephalosporins. All patients with reported outcomes had achieved complete recovery. G. morbillorum is an emerging pathogen for OAIs in certain susceptible populations with specific risk factors. This review reported the demographic, clinical, and microbiological features of OAIs caused by G. morbillorum. A careful evaluation of an underlying infectious focus is warranted to control the source. When G. morbillorum bacteremia is present, it is also necessary to have a high index of suspicion to rule out an associated endovascular infection.

Acute Hematogenous Periprosthetic Hip Infection by Gemella morbillorum, Successfully Treated with Debridement, Antibiotics and Implant Retention: A Case Report and Literature Review of Osteoarticular Gemella morbillorum Infections

Gemella morbillorum is a facultative anaerobic, catalase-negative and non-spore forming Gram-positive cocci. It can be found as part of the normal oropharyngeal flora, in the gastrointestinal tract and the female genital tract. However, it can be a causal agent of infections such as endocarditis, meningitis or brain abscesses, and very rarely can cause osteoarticular infections. Herein, a case report of an acute hematogenous prosthetic hip infection caused by Gemella morbillorum, successfully treated with a DAIR and beta-lactam antibiotic therapy, is presented. We provide a literature review of the other orthopedic-related infections caused by this microorganism.

Cryptogenic cervical intramedullary abscess with rapidly progressive myelopathy: illustrative case

BACKGROUND

The purpose of the present case report is to highlight the presentation, workup, clinical decision making, and operative intervention for a 68-year-old woman who developed rapidly progressive myelopathy secondary to idiopathic cervical intramedullary abscess.

OBSERVATIONS

The patient underwent laminectomy and aspiration/biopsy of the lesion. Intraoperatively, division of the posterior median sulcus released a large volume of purulent material growing the oral pathogens Eikenella corrodens and Gemella morbillorum. Broad-spectrum antibiotics were initiated postoperatively. At the 6-month follow-up, the patient had almost completely recovered with some persistent hand dysesthesia. Complete infectious workup, including full dental assessment and an echocardiogram, failed to reveal the source of her infection.

LESSONS

The authors report the first case of cryptogenic spinal intramedullary abscess secondary to Eikenella spp. and Gemella spp. coinfection. Intramedullary abscesses are exceptionally rare and most commonly develop in children with dermal sinus malformations or in the context of immunosuppression. In adults without risk factors, they can readily be mistaken for more common pathologies in this age group, such as intramedullary neoplasms or demyelinating disease. Prompt diagnosis and management based on rapidly progressive myelopathy, assessment of infectious risk factors and/or symptoms, and targeted imaging are critical to avoid potentially devastating neurological sequelae.

Polymicrobial abscess following ovariectomy in a mouse

Background

Ovariectomy is a common procedure in laboratory rodents used to create a post-menopausal state. Complications including post-surgical abscess are rarely reported, but merit consideration for the health and safety of experimental animals.

Case presentation

A female C57/black6 mouse was ovariectomized as part of a cohort study. At Day 14 post-surgery, she developed a visible swelling on the right side, which 7 days later increased in size over 24 h, leading to euthanasia of the animal. Gross pathology was consistent with abscess. A core of necrotic tissue was present in the uterine horn. Abscess fluid and affected tissue were collected for Gram stain and bacteriological culture. The abscess core and fluid yielded three distinct types of bacterial colonies identified by 16S ribosomal RNA sequencing as Streptococcus acidominimus, Pasteurella caecimuris, and a novel species in the genus Gemella.

Conclusions

This is the first report of polymicrobial abscess in a rodent as a complication of ovariectomy, and the first description of a novel Gemella species for which we have proposed the epithet Gemella muriseptica. This presentation represents a potential complication of ovariectomy in laboratory animals.

Gemella morbillorum Cryptogenic Brain Abscess: A Case Report and Literature Review

A case of cryptogenic brain abscess caused by Gemella morbillorum is reported in a 28-year-old immunocompetent man who presented with seizures and hemiparesis. The patient underwent successful stereotactic drainage of the abscess with complete resolution of symptoms and radiographic evidence of resolution. We report the significant pathogenic potential of a normal commensal rarely identified in neurologic infections.

Pneumonia and bacteraemia caused by Gemella morbillorum in a previously healthy infant: first reported case in literature

A 5-month-old baby presented with a low-grade fever and tachypnoea and was found to have right upper lobe consolidation on chest radiograph. He was admitted with the diagnosis of bronchopneumonia and the treatment protocol for pneumonia was initiated. Blood culture samples were collected, and he was started on a course of intravenous amoxicillin-clavulanate. Blood culture results displayed pansensitive Gemella morbillorum bacteraemia and he was continued on intravenous antibiotic to which he responded in a short period and was discharged in good condition on the fourth day.

An Uncommon Case of Pyogenic Spondylodiscitis Caused by Gemella morbillorum

An 81-year-old man presented with severe back pain. Magnetic resonance imaging detected L5/S discitis without signs of epidural abscess. Punctures of the disc revealed that the causative organism was Gemella morbillorum (G. morbillorum), which is part of the normal flora of the oral cavity and an uncommon causative pathogen of spondylodiscitis. The E-test method was useful for rapid susceptibility testing. Intravenous penicillin G treatment was effective, and the patient recovered without surgery.

Intracranial subdural abscess with polymicrobial infections due to frontal sinusitis in an adolescent: life-threatening complication of a common disease

Intracranial abscess is one of the most serious complications of frontal sinusitis, particularly among adolescents, even in the absence of odontogenic infection. Polymicrobial infections due to anaerobes are common. Because antibiotic therapy alone is usually ineffective, early endoscopic sinus surgery is the key for infection control and good clinical outcomes.

Bibles as a possible source of pathogens in hospitals? A pilot observation

It is a century-old tradition of furnishing Bibles in the bedside drawers of hospitalized patients. But since the books cannot be disinfected, it might be possible that bacterial pathogens survive on the bibles. The aim of this study was to determine whether Bibles in patient's rooms can act as a vehicle for the spread of nosocomial infections from one to the next patient. We took samples from 50 Bibles in various general wards of the hospital. During the same period, we took contact samples of 99 hymnals from the hospital chapel. The hospital chapel is visited by patients from all departments of the hospital. As expected, microorganisms were detected on all books. They were mainly apathogenic organisms. Molds (Aspergillus spp.) were identified on the surfaces of five books. Two Bibles showed pathogen bacteria in a low number. No invasive infections with those pathogens could be documented during the investigation period, retrospectively. In conclusion, our results do not support Bibles as a possible source of nosocomial infections.

Cardiogenic shock due to Gemella morbillorum native mitral valve endocarditis

Gemella morbillorum is a rare cause of infective endocarditis. Consequently, little is known about the natural course of endocarditis secondary to this pathogen. Herein, we report a case of cardiogenic shock as a complication of acute mitral valve regurgitation following Gemella morbillorum native valve endocarditis.

Unreported neurological complications of Gemella bergeriae infective endocarditis

We report the first case of native aortic and mitral valve endocarditis due to Gemella bergeriae from the Middle East in a young patient with rheumatic heart disease. Our case illustrates a fulminant course of infection with G. bergeriae endocarditis that was complicated by embolic stroke, as well as intracerebral and subarachnoid haemorrhage secondary to rupture of a mycotic aneurysm in the right middle cerebral artery. This case highlights the dire, unreported neurological complications of infective endocarditis due to a rare causative organism-G. bergeriae.

Immunocompetent young man with cerebral abscess and cortical venous infarction mimicking cerebritis caused by Gemella morbillorum

Gemella morbillorum is an anaerobic gram-positive diplococcus and in most cases a harmless commensal, which occasionally causes infections in the central nervous system. We report on an immunocompetent young man with focal neurological symptoms and cephalgia caused by a cerebral abscess. Although successful treatment was done with neurosurgical intervention and antibiotic therapy, he suffered from a venous infarction 5 weeks after first diagnosis, which mimicked cerebritis as an early stage of relapsing abscess. Imaging and investigation of cerebrospinal fluid was necessary for sufficient differential diagnosis and antibiotic therapy could be stopped after altogether 8 weeks of treatment. In summary, G morbillorum causes not only biphasic infections, but also can be accompanied by infarction in the central nervous system despite sufficient antibiotic therapy.

Gemella morbillorum bacteremia after anti-tumor necrosis factor alpha as acne inversa therapy

We present a case of fever, brain abscesses, and Gemella morbillorum bacteremia after anti-tumor necrosis factor alpha (TNF-α) therapy in a 21-year-old acne inversa patient currently taking long-term dapsone. To the best of our knowledge, this is the first report describing such a case. During antimicrobial therapy, the patient developed systemic varicella infection with severe thrombocytopenia.