A rare case of Aerococcus urinae infective endocarditis in an atypically young male: case report and review of the literature

Abstract

BackgroundAerococcus urinae is a gram-positive, alpha-hemolytic coccus bacterium primarily implicated in less than 1 % of all symptomatic urinary tract infections. Risk factors for disease include male gender, advanced age, and comorbid genitourinary tract pathology. Infections beyond the genitourinary tract are rare, though spondylodiscitis, perineal abscesses, lymphadenitis, bacteremia, meningitis, and endocarditis have been reported. Less than fifty cases of A. urinae infective endocarditis (IE) have been described in the literature. The rare occurrence of A. urinae in human infections and resultant lack of randomized controlled trials have resulted in a significant degree of clinical uncertainty in the management of A. urinae IE.Case presentationWe present an unusual case of a forty-three year-old male with A. urinae infective endocarditis (IE) who was successfully treated with mitral valve replacement and six weeks of penicillin/gentamicin therapy. In addition, we include a comprehensive review of all reported cases of IE due to A. urinae with specific attention to therapeutic regimens and treatment durations.ConclusionRecent advances in diagnostic technology have led to an increase in the frequency A. urinae is diagnosed. Reviewing cases of Aerococcus urinae infections, their clinical courses and subsequent management can assist future healthcare providers and their patients.

Aerococcus urinae – A potent biofilm builder in endocarditis

“…FISH provides information not only about the identity of the pathogen(s) present but also about their state of activity and spatial organization as planktonic or biofilm microorganisms. One of the rare bacterial species recently associated with culture-negative IE is Aerococcus urinae (A urinae) [6][7][8][9][10].…”

Actinotignum schaalii and Aerococcus urinae as Etiology of Infected Kidney Cyst: A Diagnostic Challenge

“…The growth of A. urinae in one of six blood-culture bottles taken on admission gave a suspicion of a urogenital focus. A. urinae is a known cause of infective endocarditis [3] and involvement of the aortic valve graft had to be ruled out by echocardiography. Though previously described, a marked reduced height of corpus of TH12 could have had a relation to the observed back pain.…”

“…A. urinae is a Gram-positive coccus resembling staphylococci by microscopy and fastidious alphahemolytic streptococci by growth [4]. It has primarily been implicated in less than 1% of all symptomatic urinary tract infections, especially in elderly men [7], causing severe and invasive infections including urosepticemia and infective endocarditis [3,4]. Sporadic cases of soft tissue infections mostly, but not exclusively, with relation to the urinary tract have been reported [8,9].…”

Prosthetic valve endocarditis caused by Aerococcus Urinae

“…This complication occurs in 0.5–3 cases per 1 million people per year [ 5 , 6 ]. Less than 50 cases of A. urinae IE have been reported in literature [ 7 ] of which prosthetic valve involvement is exceedingly rare, primarily due to misidentification as Streptococci or Staphylococci species. It has been reported as one of the causes of culture negative IE [ 9 ].…”