First Report of Granulicatella sp. Endocarditis in a Kidney Transplant Patient

Abstract

Granulicatella and Abiotrophia are genera of fastidious Gram-positive cocci commensal of the oral, genitourinary, and intestinal flora. We report the first case of infective endocarditis caused by Granulicatella sp. in a kidney transplant recipient. A 67-year-old male kidney transplant recipient was admitted to the hospital for investigation of fever, abdominal pain, and diarrhea. On physical examination, he was dehydrated. Laboratory tests identified impaired renal function (creatinine level of 15.5 mg/dl; reference, 3.0 mg/dl), metabolic acidosis, and electrolyte disturbances. Cryptosporidium sp. was identified as the cause of the diarrhea, and the infection was treated with nitazoxanide. On admission, cultures of blood, urine, and stool samples were negative. Echocardiography results were normal. Despite the antimicrobial treatment, the fever persisted. A transthoracic echocardiogram revealed infective endocarditis of the mitral valve, and Granulicatella spp. were isolated in blood cultures. Although the patient was treated with penicillin and amikacin, he evolved to septic shock of pulmonary origin and died. Infective endocarditis caused by Granulicatella sp. should be suspected in cases of culture-negative endocarditis.

High Mortality and Graft Loss after Infective Endocarditis in Kidney Transplant Recipients: A Case-Controlled Study from Two Centers

“…In that respect, the epidemiology in our study is closer to that of the general population [1]. We found that digestive bacteria predominate, with Enterococci as the most frequent pathogen, as previously described in SOTRs [14][15][16][17][18][19][20][21]. A hypothetical mechanism, in the absence of an identified digestive gateway (colonoscopy was performed in most of the cases where a digestive bacterium was identified, even though we did not collect the results of this exam in our study), could be the alteration of the gut microbiota by the combination of antibiotic treatments frequently used after transplantation, and of immunosuppressive drugs.…”