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Washington ER, Carius BM, Dougherty C, Ashworth S. Abiotrophia defectiva triple threat: A rare case of infective spondylodiscitis, endocarditis, and brain abscess. Am J Emerg Med 2024; 75:199.e1-199.e4. [PMID: 37230847 DOI: 10.1016/j.ajem.2023.04.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
Abiotrophia defectiva is a pathogen of the oral, gastrointestinal, and urinary tracts that can cause significant systemic disease with uniquely negative blood cultures depending on the growth medium. Prior cases note possible seeding from relatively common procedures such as routine dental work and prostate biopsies, however case literature describes prior infectious complications to include infective endocarditis, brain abscess formation, and spondylodiscitis. While prior cases describe some aspects of these presentations, we highlight a case of a 64-year-old male who presented to the emergency department (ED) f5or acute onset of low back pain with fever symptoms four days after an outpatient transrectal ultrasound-guided needle biopsy of the prostate, with a prior dental extraction described four weeks prior to arrival. Findings on initial ED presentation and subsequent hospitalization revealed infective spondylodiscitis, endocarditis, and brain abscess formation. This is the only cases noted in literature with all three infection locations with dual risk factors of dental and prostate procedures prior to symptom onset. This case highlights the multifocal illness that can complicate Abiotrophia defectiva infections, and the importance of thorough ED evaluation and multiservice approach for consultation and treatment.
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Affiliation(s)
- Eric R Washington
- Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, United States of America
| | - Brandon M Carius
- Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, United States of America.
| | - Christine Dougherty
- Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, United States of America
| | - Simeon Ashworth
- Madigan Army Medical Center, Joint Base Lewis-McChord, Washington, United States of America
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Yang M, Lin Y, Peng X, Wu J, Hu B, He Y, Lu J. Abiotrophia defectiva causing infective endocarditis with brain infarction and subarachnoid hemorrhage: a case report. Front Med (Lausanne) 2023; 10:1117474. [PMID: 37206473 PMCID: PMC10188988 DOI: 10.3389/fmed.2023.1117474] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 04/04/2023] [Indexed: 05/21/2023] Open
Abstract
Introduction A rare pathogen of Infective Endocarditis (IE), the Abiotrophia defectiva, has been known to trigger life-threatening complications. The case discussed here is of a teenager with brain infarction and subarachnoid hemorrhage caused by IE due to A. defectiva. Case report A 15-year-old girl with movement disorders involving the left limbs and intermittent fevers was admitted to the hospital. A head CT scan revealed cerebral infarction in the right basal ganglia and subarachnoid hemorrhage. Moreover, vegetation on the mitral valve were confirmed by echocardiography. The blood cultures were found to be positive for Gram-positive streptococcus and identified by Vitek mass spectrometry as A. defectiva. She was prescribed vancomycin antibacterial therapy and underwent a surgical mitral valve replacement. Conclusion This case is suggestive of the fact that A. defectiva is a rare but crucial pathogen of IE-associated stroke. Obtaining early blood cultures and using microbial mass spectrometry could help achieve an accurate diagnosis. Moreover, reasonable anti-infective medications and surgical interventions need to be combined to avoid and/or manage severe complications.
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Affiliation(s)
- Miaojuan Yang
- Department of Neurology, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, China
- The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, China
- Shenzhen Clinical Research Center for Geriatrics, Shenzhen People's Hospital, Shenzhen, China
| | - Yanxia Lin
- Department of Infectious Diseases, Shenzhen University General Hospital, Shenzhen, China
| | - Xin Peng
- Department of Cardiology, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, Guangdong, China
| | - Jingsong Wu
- Department of Laboratory Medicine, Shenzhen People's Hospital, Shenzhen, China
| | - Bo Hu
- Department of Neurology, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, China
- The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, China
- Shenzhen Clinical Research Center for Geriatrics, Shenzhen People's Hospital, Shenzhen, China
| | - Yitao He
- Department of Neurology, The Second Clinical Medical College of Jinan University, Shenzhen, Guangdong, China
- The First Affiliated Hospital of Southern University of Science and Technology, Shenzhen, Guangdong, China
- Shenzhen Clinical Research Center for Geriatrics, Shenzhen People's Hospital, Shenzhen, China
- Yitao He
| | - Jian Lu
- Department of Infectious Diseases, Shenzhen University General Hospital, Shenzhen, China
- *Correspondence: Jian Lu
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Dong W, Wu S, Zhou J. A rare association of invasive infective endocarditis due to Abiotrophia defectiva with ventricular septal defect and recurrent Henoch-Schonlein purpura in a child. J Cardiothorac Surg 2022; 17:320. [PMID: 36528593 PMCID: PMC9758810 DOI: 10.1186/s13019-022-02092-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 12/11/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Henoch-Schonlein purpura is the most common vasculitis in childhood, usually triggered by an upper respiratory tract infection and rarely observed in infective endocarditis patients. Abiotrophia defectiva is a rare causative agent of infective endocarditis associated with pre-existing heart disease, immunocompromised and prosthetic valves. Dental procedures are also a common predisposing factor. CASE PRESENTATION We present the first pediatric congenital heart disease case of infective endocarditis caused by Abiotrophia defectiva combined with recurrent Henoch-Schonlein purpura. A 10-year-old girl with uncorrected congenital heart defects and Henoch-Schonlein purpura developed a purple petechial rash again. Transthoracic echocardiography evaluation revealed multiple irregular vegetations on the right ventricular side of the ventricular septal defect and on the tricuspid valve leaflets. Blood cultures grew Abiotrophia defectiva. The girl received cardiac surgery for vegetation resection as well as congenital heart defect correction and tricuspid valve replacement. Five months after the surgery, the patient was in satisfactory condition without any signs of endocarditis or valve insufficiency and her purpuric rash disappeared. CONCLUSIONS The coexistence of recurrent Henoch-Schonlein purpura and infective endocarditis is possible. Abiotrophia defectiva belongs to the streptococcus with a high virulence. In addition, cardiovascular surgery is often required for pediatric infective endocarditis associated with Abiotrophia defectiva, and bioprosthetic valve replacement is considered feasible for irreparable tricuspid valve in children.
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Affiliation(s)
- Wenpeng Dong
- grid.412679.f0000 0004 1771 3402Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Shushan District, Hefei, 230032 China
| | - Shuibi Wu
- grid.412679.f0000 0004 1771 3402Department of Cardiovascular Surgery, The First Affiliated Hospital of Anhui Medical University, Jixi Road 218, Shushan District, Hefei, 230032 China
| | - Jing Zhou
- grid.460068.c0000 0004 1757 9645Department of Cardiovascular Surgery, The Third People’s Hospital of Chengdu, Chengdu, China
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Abiotrophia defectiva Infective Endocarditis: A Rare and Dangerous Cause of Endocarditis. Case Rep Infect Dis 2022; 2022:7050257. [PMID: 35299935 PMCID: PMC8923800 DOI: 10.1155/2022/7050257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/06/2022] [Accepted: 01/13/2022] [Indexed: 11/22/2022] Open
Abstract
Infective endocarditis is an uncommon heart infection, typically involving heart valves. Abiotrophia defectiva is a rare cause of endocarditis, typically found within the GI tract, and is usually difficult to isolate and requires specialized media. We report a case of Abiotrophia defectiva endocarditis following a root canal.
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Oliveira D, Reis J, Ferreira P. [Endocarditis by Abiotrophia defectiva]. Med Clin (Barc) 2021; 157:e273-e274. [PMID: 32843218 DOI: 10.1016/j.medcli.2020.06.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/20/2020] [Accepted: 06/24/2020] [Indexed: 11/19/2022]
Affiliation(s)
- Diana Oliveira
- Internal Medicine Resident at Centro Hospitalar São João, Department of Internal Medicine, Portugal.
| | - Joana Reis
- Medical Oncoloy Resident at Centro Hospital São João, Department of Medical Oncology, Portugal
| | - Pestana Ferreira
- Internal Medicine Assistant at Centro Hospitalar São Joao, Department of Internal Medicine, Portugal
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Urbaniak C, Lorenzi H, Thissen J, Jaing C, Crucian B, Sams C, Pierson D, Venkateswaran K, Mehta S. The influence of spaceflight on the astronaut salivary microbiome and the search for a microbiome biomarker for viral reactivation. MICROBIOME 2020; 8:56. [PMID: 32312311 PMCID: PMC7171750 DOI: 10.1186/s40168-020-00830-z] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Accepted: 03/18/2020] [Indexed: 05/05/2023]
Abstract
BACKGROUND Spaceflight impacts astronauts in many ways but little is known on how spaceflight affects the salivary microbiome and the consequences of these changes on astronaut health, such as viral reactivation. In order to understand this, the salivary microbiome was analyzed with 16S rRNA gene amplicon sequencing, and saliva viral titers were analyzed with quantitative polymerase chain reaction (qPCR) with primers specific for Epstein-Barr virus (EBV), herpes simplex virus (HSV), and varicella zoster virus (VZV) from 10 astronauts pre-flight, in-flight, and post-flight. RESULTS Streptococcus was the most abundant organism in the saliva, making up 8% of the total organisms detected, and their diversity decreased during spaceflight. Other organisms that had statistically significant changes were Proteobacteria and Fusobacteria which increased during flight and Actinobacteria which decreased during flight. At the genus level, Catonella, Megasphera, and Actinobacillus were absent in more than half of saliva samples collected pre-flight but were then detected during flight. In those subjects that already had these genera pre-flight, their relative abundances increased during flight. Correlation analyses between the microbiome and viral titers revealed a positive correlation with Gracilibacteria, Absconditabacteria, and Abiotrophia and a negative correlation between Oribacterium, Veillonella, and Haemophilus. There was also a significant positive correlation between microbiome richness and EBV viral titers. CONCLUSIONS This is the first study to look at how the salivary microbiome changes as a result of spaceflight and the search for bacterial biomarkers for viral reactivation. Further studies examining the role of specific organisms that were shown to be correlative and predictive in viral reactivation, a serious problem in astronauts during spaceflight, could lead to mitigation strategies to help prevent disease during both short and long duration space missions. Video abstract.
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Affiliation(s)
- Camilla Urbaniak
- NASA Jet Propulsion Laboratory, California Institute of Technology, Pasadena, CA, USA
| | - Hernan Lorenzi
- Department of Infectious Diseases, J. Craig Venter Institute, Rockville, MD, USA
| | - James Thissen
- Lawrence Livermore National Laboratory, Livermore, CA, USA
| | - Crystal Jaing
- Lawrence Livermore National Laboratory, Livermore, CA, USA
| | | | | | | | | | - Satish Mehta
- JES Tech, NASA Johnson Space Center, Houston, TX, USA
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Elashery AR, Stratidis J, Patel AD. Double-Valve Heart Disease and Glomerulonephritis Consequent to Abiotrophia defectiva Endocarditis. Tex Heart Inst J 2020; 47:35-37. [PMID: 32148451 DOI: 10.14503/thij-17-6575] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Abiotrophia defectiva, a nutritionally deficient streptococcus, is a rare cause of infective endocarditis. It has been associated with hemophagocytic syndrome. We present the first case of A. defectiva infective endocarditis that led to antineutrophil cytoplasmic antibody-associated glomerulonephritis. The patient was a 55-year-old man whose endocarditis affected the mitral and aortic valves. His course was complicated by atrial fibrillation, stroke, and glomerulonephritis. He was successfully treated with antibiotics and dual valve replacement.
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Abstract
Infective endocarditis (IE) refers to an infection involving the endocardial surface of the heart. Most of the cases of IE are known to occur due to infection by viridans Streptococci or Staphylococci species. Abiotrophia defectiva is known to cause less than 1% of cases of IE. Though rare, this organism can cause life-threatening complications such as septic embolization, destruction of heart valves, and heart failure if not detected and treated timely. Here we discuss a case of a 44-year-old female who presented to our tertiary care centre with complaints of fever and easy fatiguability for two weeks. After further investigations, she was finally diagnosed to have IE due to Abiotrophia defectiva. Imaging demonstrated the presence of embolic and valvular complications as well. Through this case, we highlight the importance of early detection and timely management of this condition in order to decrease the occurrence of fatal complications and mortality.
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Je H, Song D, Chang CL. Bacterial Endocarditis Caused byAbiotrophia defectivain a Healthy Adult: A Case Report with Literature Review. ANNALS OF CLINICAL MICROBIOLOGY 2019. [DOI: 10.5145/acm.2019.22.1.23] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Hyunggon Je
- Department of Thoracic Surgery, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Duyeal Song
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Chulhun L. Chang
- Department of Laboratory Medicine, Pusan National University Yangsan Hospital, Yangsan, Korea
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Oka K, Nakano Y, Sazumi Y, Michitani T, Horiguchi S, Ocho K, Iwamuro M, Otsuka F. Clival Osteomyelitis with Cavernous Sinus Thrombosis Due to Fusobacterium nucleatum and Campylobacter rectus Induced by Tooth Extraction. Intern Med 2018; 57:3325-3328. [PMID: 29984751 PMCID: PMC6288000 DOI: 10.2169/internalmedicine.1025-18] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
A 70-year-old woman who had suffered from aseptic meningitis complained of chronic headache after dental treatment including tooth extraction. She developed a fever and respiratory failure. Based on chest computed tomography and head magnetic resonance imaging (MRI), she was diagnosed with osteomyelitis in the clivus accompanying moderate pituitary involvement, cavernous sinus thrombosis and septic pulmonary embolism. Both of the causal bacteria, Fusobacterium nucleatum and Campylobacter rectus, were isolated from her blood. Dual infection leading to clival osteomyelitis and cavernous sinus thrombosis has not been reported. It is important to perform enhanced MRI and blood culture for patients with chronic headache related to dental treatment.
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Affiliation(s)
- Kosuke Oka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yasuhiro Nakano
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Yosuke Sazumi
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Tomo Michitani
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Shigeru Horiguchi
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | | | - Masaya Iwamuro
- Department of Gastroenterology and Hepatology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
| | - Fumio Otsuka
- Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Japan
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Rare but Not Infrequent: Infective Endocarditis Caused by Abiotrophia defectiva. Case Rep Infect Dis 2018; 2018:5186520. [PMID: 29780647 PMCID: PMC5892255 DOI: 10.1155/2018/5186520] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2017] [Revised: 02/02/2018] [Accepted: 02/18/2018] [Indexed: 12/04/2022] Open
Abstract
Endocarditis (IE) is defined by an infection of a native or prosthetic heart valve, the mural endocardium, or an indwelling cardiac device. Although viridan-group streptococci (VGS) and Staphylococci species have collectively been considered as the most common cause of endocarditis, uncommon pathogens may also lead to the disease with significant morbidity and mortality. Abiotrophia defectiva, a nutritionally variant streptococci (NVS), is a virulent bacterium that preferentially affects endovascular structure and is implicated in many culture-negative endocarditis with dreadful complications such as heart failure, septic embolization, and valve destruction. Here, we report a case of a 60-year-old male patient, with a past medical history significant for hypertrophic obstructive cardiomyopathy, who was incidentally found to have mitral valve vegetative mass with an uncommon agent, A. defectiva. The patient was successfully treated with antimicrobial therapy. The objective of this article is to describe the possibility of uncommon cause of common diseases and raises awareness of infective endocarditis caused by A. defectiva among clinicians and microbiologists. Early and proper identification of this pathogen is important to achieve a better outcome.
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