Gram-negative bacilli causing infective endocarditis (IE) is rare, even in intravenous drug users. This case report underscores several clinically important aspects of Delftia acidovorans IE: the organism's ability to cause rapid destruction of normal native valves and to cause embolic occlusion of large arteries and its resistance to all aminoglycosides. CASE REPORT In November 2010, a 30-year-old male, with a history of intravenous drug use (IDU), hepatitis C, and posttraumatic stress disorder, presented to the Lexington Veterans Affairs Medical Center (VAMC) with a 2-to 3-week history of malaise and right knee pain. The patient reported having a fever for 2 days prior to presentation, with a temperature of 103°F (noted at home). He was in his usual state of health until a month prior to presentation, when he developed right knee pain, which was first observed when he jogged for exercise. The pain progressively worsened, and he stopped jogging 2 weeks prior to presentation. One week prior to presentation, the patient went to the VAMC emergency room and was diagnosed with a viral illness; flu PCR was negative, and he was instructed to follow up with his primary care physician. No anti-infective medication was given. On the day of hospitalization, he returned to the VAMC emergency department with increased pain in his right leg, fever, and a painful red lesion on the ring finger of his left hand. Upon physical examination, his temperature was 104°F and he was found to have a new grade 3/6 diastolic murmur (not previously noted in his clinic records), diminished pedal pulse and posterior tibial pulse in his right leg, without knee effusion, and a tender erythematous nodule on the 4th digit of his left hand. The patient's laboratory studies were unremarkable. His human immunodeficiency virus test and urine drug screening were both negative. Blood cultures were drawn, and vancomycin and piperacillin-tazobactam (2 days) were started empirically. The echocardiogram demonstrated a severe aortic insufficiency with aortic valve vegetation of 1.0 by 1.4 cm. An arteriogram of his right leg showed occlusions in the right posterior tibial artery and right peroneal artery.The patient's social history was only remarkable for past IDU. He stated that he was in a drug rehabilitation facility for 6 weeks prior to the onset of symptoms but confessed to occasional relapses in his IDU behavior. The patient admitted using the water from the bathroom and kitchen faucets to prepare his drugs for injection. He denied smoking and drinking alcohol regularly.The patient became afebrile on antibiotics in 48 h. He was evaluated by cardiothoracic surgery and, on the third hospital day, was transferred to the adjacent University of Kentucky Hospital (UKH) where he underwent successful aortic valve replacement.Two sets of blood cultures at VAMC and a culture of tissue from the patient's aortic valve at UKH grew a Gram-negative bacillus. The Gram-negative bacillus was identified as Delftia acidovorans, resistant to all aminoglycosides. His anti...
Objective: To determine the prevalence and clonality of non‐toxigenic Corynebacterium diphtheriae biovar gravis in a community with two cases of endocarditis caused by this organism. Setting: A Koorie (Aboriginal) community in Gippsland, eastern Victoria, in 1994. Methods: Nose and throat swabs were collected from 359 community contacts of the cases and cultured for C. diphtheriae. Strains isolated from the contacts were compared by pulsed‐field gel electrophoresis (after digestion with Sma1, Not1 and Sfi1) with those from the invasive cases in the same community, another invasive case in Victoria, a cluster of invasive cases in New South Wales (NSW) (1990–1991), and other stored strains isolated from skin ulcers and sore throats. Results: Non‐toxigenic strains of C. diphtheriae biovar gravis were isolated from throat swabs of five of the case contacts. Uniform DNA patterns were found for the two community cases, the other Victorian case, nine of ten isolates from NSW, and the five throat isolates from case contacts. Conclusion: An invasive clone of C. diphtheriae biovar gravis appears to have been responsible for the three Victorian cases of endocarditis. It was also present among case contacts and responsible for previous invasive cases in NSW. Prophylactic treatment should be considered for clearly defined contacts in all instances where C. diphtheriae is isolated from a normally sterile site, regardless of the toxigenic nature of the strain.
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