A Rare Case of Infective Endocarditis Caused by Gemella haemolysans

Abstract

Gemella haemolysans is a gram-positive coccoid, facultative anaerobe of the mucous membranes. In rare cases, it has been identified as an opportunistic pathogen in the development of endocarditis. Here, we describe a case of infective endocarditis in a patient with a bicuspid aortic valve. A 38-year-old man presented with the complaint of exertional dyspnea of one month duration. He was found to have leucocytosis and his blood cultures grew Gemella haemolysans. Trans-esophageal echocardiography showed a bicuspid aortic valve with 1.5 x 1.5 cm vegetative mass, severe aortic regurgitation, and an aortic root abscess. The patient was started on intravenous ampicillin and gentamycin. He then underwent mechanical aortic valve replacement and bovine reconstruction of the left ventricular outflow tract. Our case highlights the importance of considering atypical pathogens as causative agents of infective endocarditis.

Risk Factors and Patient Profile of Infective Endocarditis due to <i>Gemella spp.</i>

“…All studies were published between 1989 and 2019. The majority of studies were conducted in Europe and the UK [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 30 , 32 , 34 , 35 , 36 , 37 , 38 , 40 , 46 , 47 , 49 , 52 , 56 , 57 , 58 , 60 , 61 , 66 , 68 , 72 , 73 , 75 , 84 , 92 ] followed by North America [ 15 , 17 , 19 , 21 , 29 , 31 , 33 , 39 , 43 , 45 , 48 , 54 , 55 , 64 , 67 , 69 , 71 , 76 , 77 , 78 , 79 , 83 , 86 , 88 , 89 , 90 ] and Asia. [ 14 , 16 , 18 , 20 , 41 , 44 , 50 , 51 , 53 , 62 , 63 , 65 , 74 ,…”

“…[ 14 , 52 , 65 , 77 , 86 ] 71.4% of studies did not include the post-intervention clinical condition of the patients and/or adverse or unanticipated events. [ 14 , 15 , 16 , 18 , 19 , 22 – 26 , 28 – 32 , 34 , 36 – 43 , 46 – 50 , 52 , 53 , 57 – 63 , 65 – 68 , 71 – 73 , 76 – 78 , 80 , 81 , 84 , 85 , 87 , 89 , 90 , 92 ]…”

“…The most common species was Gemella morbillorum (44.6%) [ 14 , 16 – 19 , 23 , 24 , 27 , 28 , 30 , 31 , 35 , 37 , 38 , 42 , 43 , 47 , 49 – 53 , 56 , 58 , 63 , 64 , 70 , 74 – 76 , 80 , 81 , 84 , 90 , 91 ] followed by Gemella haemolysans (26.5%). [ 15 , 21 , 22 , 25 , 26 , 32 , 36 , 40 , 46 , 48 , 52 , 54 , 59 – 61 , 68 , 69 , 72 , 73 , 88 , 92 ] The predominant strains in studies published in Europe and North America were Gemella morbillorum [ 17 , 19 , 23 , 24 , 27 , 28 , 30 , 31 , 35 , 37 , 38 , 43 , 47 , 49 , 52 , 56 , 57 , 64 , …”

“…The average temperature recorded at admission was 38.2 +/− 0.8°C ranging from 36.0°C to 40.4°C, [ 16 – 19 , 21 , 24 , 25 , 28 – 30 , 32 – 37 , 39 , 41 , 45 – 49 , 51 , 52 , 55 , 58 , 63 , 65 , 68 , 70 , 76 , 79 – 85 , 87 , 90 – 92 ] while the average heart rate and blood pressure was 103.0 +/− 21.5 bpm [ 15 – 17 , 21 , 28 , 30 , 32 – 34 , 36 , 39 , 41 , 43 – 45 , 47 – 49 , 51 – 53 , 55 , 57 , 59 , 62 , 65 , 67 , 68 , 76 , 79 – 84 , 86 , 87 , 90 , 92 ] and 120.6/67.9 +/− 25.3/17.0 mmHg [ 16 – 18 , 24 , 28 , 30 , 32 , 34 , 36 , 39 , 41 , 44 , …”

“…Twenty studies reported a history of congenital heart disease. [ 14 , 15 , 17 , 19 , 20 , 24 , 26 , 37 , 50 , 52 , 53 , 55 , 57 , 66 , 67 , 69 , 80 , 85 , 87 , 89 ] Bicuspid aortic valve was observed in 50.0% of these studies, [ 15 , 17 , 19 , 52 , 57 , 69 , 80 , 85 , 87 , 89 ] followed by ventricular septal defect (VSD) (20.0%) [ 20 , 37 , 53 , 76 ] and tetralogy of Fallot (15.0%). [ 24 , 55 , 66 ]…”