Enterococcus hirae is a rare isolate in clinical specimens. We describe a case of native aortic-valve endocarditis that was caused by Enterococcus hirae in a 72-year-old man. This is the first reported case of endocarditis due to this organism. CASE REPORTA 72-year old man presented with a 1-month history of fever, chills, progressive malaise, and generalized weakness. During this period, the patient received several short courses of antibiotics, including trimethoprim-sulfamethoxazole, levofloxacin, and pristinamycin. He had a history of coronary artery disease and, 7 years previously, had undergone percutaneous transluminal coronary angioplasty. On arrival, he was found to have an oral temperature of 36.5°C and a blood pressure of 122/64 mm Hg. Cardiac examination revealed 2/6 systolic and 2/6 diastolic murmurs. Physical examination revealed no evidence of local or systemic infection and no peripheral embolic or immunologic stigmata of infectious endocarditis. Laboratory evaluation showed the following values: white blood cells, 11.6 ϫ 10 9 /liter with 86% neutrophils; hemoglobin, 9.2 g/dl; and platelets, 256 ϫ 10 9 /liter. Examination of cardiac enzymes showed no evidence of myocardial injury. Blood samples of four sets of culture were all positive and yielded an Enterococcus sp. A transesophageal echocardiography showed vegetations involving the left and right aortic-valve leaflets with aortic insufficiency.The isolated strain was identified by phenotypic methods and genetic analysis. In phenotypic analysis, the strain hydrolyzed esculin in the presence of 4% bile and reacted with Lancefield group D antiserum. It was not possible to identify this strain to the species level with the API 20 Strep system (bio-Mérieux, Marcy l'Etoile, France). With the rapid ID 32 Strep system (bioMérieux), which has greater reliability in the identification of enterococci (3), the strain was misidentified as Enterococcus durans. The strain was correctly identified to the species level as Enterococcus hirae by genetic methods using sodA int gene sequencing (7). Sequence analysis of the strains yielded 99.5 and 85.6% identities with the sequences of the type strains of E. hirae (accession no. AJ387916) and E. durans (accession no. AJ387911), respectively. The strain was sensitive to ampicillin (MIC, 0.75 mg/liter; measured by E-test), vancomycin, teicoplanin, and chloramphenicol and resistant to clindamycin, erythromycin, rifampin, and tetracycline and exhibited low-level resistance to streptomycin, kanamycin, and gentamicin.Intravenous ampicillin (200 mg per kg of body weight per day) and gentamicin (3 mg/kg/day) were administered for 4 weeks. Rifampin (25 mg/kg/day) was added 2 weeks after the initiation of antimicrobial treatment for 15 days. The patient improved clinically; and blood cultures performed 1 month later were negative. Five weeks after admission, the patient was discharged from the hospital in good condition and continued to receive oral ampicillin and rifampin for 3 weeks. The patient was readmitted for control ...

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Aims To assess the prevalence, type and clinical factors associated with left ventricular (LV) dysfunction in patients with type 2 diabetes mellitus (T2DM) by performing a comprehensive echocardiographic Doppler assessment including speckle tracking. Methods Two hundred T2DM patients without overt cardiovascular disease were prospectively enrolled in a single‐centre cohort study between 2018 and 2019. Results Left ventricular mass was increased in 24 patients (12%) and relative wall thickness (h/r) was increased in 46 patients (23%). Left atrial (LA) enlargement was observed in 27 patients (13.6%) and global longitudinal strain (GLS) was reduced in 38 patients (20.3%). In univariate analysis, LV hypertrophy (LVH) or increased h/r were associated with age, renal function, hypertension and B‐type natriuretic peptide (BNP) plasma level. LA dilation was associated with age, history of hypertension, diabetes duration and complications, insulin treatment, BNP level and renal function. GLS was associated with body mass index (BMI) and, in a borderline manner, with diabetes duration. In multivariate analysis, hypertension was associated with LVH and with h/r and a borderline relationship was observed for female gender (LVH), age and insulin treatment (h/r). Age, hypertension and, in a borderline manner, insulin treatment were associated with LA dilation. BMI and shorter diabetes duration were associated with reduced GLS. Conclusion A high prevalence of asymptomatic cardiac dysfunction/structural abnormalities was observed in patients with T2DM without overt cardiac disease and was associated with either age, diabetes duration or treatment and with comorbidities including hypertension and obesity. Whether these preclinical abnormalities are associated with poor outcomes warrants further study.

Introduction:We aimed to describe patients with coexisting infective endocarditis (IE) and bacterial meningitis (BM). Methods: We merged two large prospective cohorts, an IE cohort and a BM cohort, with only cases of definite IE and community-acquired meningitis. We compared patients who had IE and BM concurrently to patients with IE only and BM only. Results: Among the 1030 included patients, we identified 42 patients with IE-BM (4.1%). Baseline characteristics of patients with IE-BM were mostly similar to those of patients with IE, but meningitis was the predominant presentation at admission (39/42, 92.3%). Causative pathogens were predominantly Streptococcus pneumoniae (18/42, 42.9%) and Staphylococcus aureus (14/42, 33.3%). All pneumococcal IE were associated with BM (18/18). BM due to oral and group D streptococci, Streptococcus agalactiae, and S. aureus were frequently associated with IE Bruno Hoen and Xavier Duval contributed equally.The members of the AEPEI and the COMBAT study groups are listed in the Acknowledgements section.G. Be ´raud (&)