Culture-negative Infective Endocarditis of the Aortic Valve due to Aerococcus urinae: A Rare Aetiology

Alozie, Anthony; Yerebakan, Can; Westphal, Bernd; Steinhoff, Gustav; Podbielski, Andreas

doi:10.1016/j.hlc.2011.08.005

Cited by 9 publications

(6 citation statements)

References 11 publications

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“…Moreover, both of these present an urologic abnormality that is usual in most cases. Since the first case of A urinae endocarditis was published in 1991, 11 surgical procedures (including our case), 5 mitral valve replacements, 8 , 25 , 30 , 32 and 6 aortic valve replacements 7 , 12 , 16 , 29 , 31 , 33 have been performed. All of these were performed during this millennium.…”

Section: Discussionmentioning

confidence: 93%

“…The course of A urinae endocarditis is not always the same. Usually, it combines with the clinical incidence of a cerebral infarct—hemiplegia, 16 , 22 , 28 , 30 or transient ischemic attack. 21 In other cases, sepsis with multiple organ failure 7 , 8 , 17 , 24 , 26 is often associated with endocarditis generally, and is the predominant reason for the lethal course of disease.…”

Section: Discussionmentioning

confidence: 99%

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Aerococcus urinaeMitral Valve Endocarditis-Related Stroke: A Case Report and Literature Review

Adomavicius

Bock

Vahl

et al. 2018

Journal of Investigative Medicine High Impact Case Reports

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Background. Aerococcus urinae is a rare causative pathogen of infective endocarditis that results in a high risk of embolic events. The mortality rate for A urinae endocarditis is high. Old age and underlying urologic conditions are the best-known risk factors for infection. Case Description. We report the clinical course of the disease in a 49-year-old man who presented symptoms of a urinary tract infection. A few days later, transthoracic echocardiography showed a conspicuous mitral valve with myxomatous alterations. Following the detection of a cerebral embolism with associated stroke symptoms, as well as at the beginning of cardiac failure, the emergency indication for the surgical treatment of mitral valve endocarditis was given. On the second day following the operation, circulatory collapse rapidly developed. Following an unsuccessful attempt at cardiopulmonary resuscitation, the patient died. Review of the Literature. From 1991 to 2017, 29 cases of A urinae–induced endocarditis have been described in PubMed and Medline. One or 2 new cases are published annually. We review all reported cases of A urinae endocarditis, with an emphasis on the predisposing factors, course, and outcomes of the disease. Conclusion. A urinae endocarditis is a rare disease primarily affecting elderly men with urinary tract pathologies and comorbidities. The course of the disease is severe, and the outcome is often fatal. A 16S rDNA polymerase chain reaction investigation of bacterial genome provides proof of the presence of A urinae. Because of the high risk of embolism, rapid treatment should focus on the diseased heart valve. Based on existing data and the experience gained from handling cases, treatment with β-lactam and aminoglycosides is recommended. It is also recommended that operative therapy take place as soon as possible.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 99%

Aerococcus urinaeMitral Valve Endocarditis-Related Stroke: A Case Report and Literature Review

Adomavicius

Bock

Vahl

et al. 2018

Journal of Investigative Medicine High Impact Case Reports

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“… Age (yrs) Sex Risk Factors Valve Surgery (y/n) Antibiotic Regimen Duration Survived(y/n) Ref No. 1 69 M Cystoscopy Av N β Lactam/AG 6wks Y [ 13 ] 2 54 M Phimosis Mv Y β Lactam 6wks Y [ 32 ] 3 43 M Hepatitis C Av N β Lactam/AG 5 days N [ 19 ] 4 68 M Indwelling Catheter Av Y β Lactam/AG 6/2wks Y [ 29 ] 5 80 M Malignancy Av Y β Lactam 6wks Y [ 33 ] 6 77 M BPH Av N β Lactam/Van – N [ 10 ] 7 68 M BPH Mv N β Lactam/AG; oral regimen 3wks; unknown Y [ 14 ] 8 75 M Cystoscopy Av Y β Lactam/AG 6wks Y [ ...…”

Section: Discussionmentioning

confidence: 99%

“…The patient voiced his desire for both the longer duration as well as combination therapy, which also influenced our final treatment regimen. Death rates of A. urinae IE were previously thought to be increased compared to IE due to other infective etiologies [ 14 , 16 , 29 ]. Overall mortality of A. urinae IE has since been shown to be equivalent to that of other etiologies and previous reports were likely skewed due to the tendency of case reports to focus on the dramatic and spectacular [ 5 ].…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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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.

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“…The valve showed acute necrotizing inflammation, confirming the diagnosis of endocarditis. As the valve culture remained sterile, we performed a broad-range 16S rRNA gene PCR [3], which revealed the presence of A. urinae, a pathogen that has already been reported in culture-negative endocarditis [4,5]. The Aerococcus strains isolated in our diagnostic laboratory were generally susceptible to beta-lactam antibiotics (of 176 strains, five exhibited intermediate susceptibility to ceftriaxone and two were resistant to cefriaxone).…”

mentioning

confidence: 93%

Diagnosis of Aerococcus urinae infections: Importance of matrix-assisted laser desorption ionization time-of-flight mass spectrometry and broad-range 16S rDNA PCR

Opota

Prod’hom

Andreutti-Zaugg

et al. 2016

Clinical Microbiology and Infection

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An increasing number of clinical reports are associating Aerococcus urinae with severe infections such as endocarditis, joint infections, and osteomyelitis. A. urinae identification has been hampered for years by morphotype ambiguity with streptococci or coagulase-negative staphylococci as this is a Grampositive α-haemolytic bacteria able to grow in pairs and clusters. In our university hospital, A. urinae was rarely identified before 2009. The identification rate of A. urinae started to increase significantly after the introduction of a matrix-assisted laser desorption ionization time-of-flight (MALDI-TOF) mass spectrometry (MS) system (Bruker Daltonics, Leipzig, Germany) in our diagnostic laboratory in May 2009 ( Fig. 1) [1,2]. It is noteworthy that five of 11 severe infections due to A. urinae that we documented (bloodstream infections, endocarditis, and joint infections) occurred in the setting of negative cultures, and were documented by the use of eubacterial 16S rDNA PCR. The recent literature, our data and the two cases that we describe herein suggest that the prevalence of A. urinae in clinical samples and its pathogenic role might have been underestimated in the pre-molecular diagnostic era.Our first case, a 78-year-old male, presented with persistent fever of 39°C that had lasted for 2 weeks, and that had not responded to 5 days of oral amoxicillin-clavulanate treatment. Cardiac auscultation revealed a systolic heart murmur with axillary irradiations. Intravenous amoxicillin-clavulanate was administered empirically after several blood cultures that remained sterile. Transoesophageal echocardiography revealed a 17-mm mitral valve vegetation and severe valvular insufficiency, which required rapid valvular replacement. The valve showed acute necrotizing inflammation, confirming the diagnosis of endocarditis. As the valve culture remained sterile, we performed a broad-range 16S rRNA gene PCR [3], which revealed the presence of A. urinae, a pathogen that has already been reported in culture-negative endocarditis [4,5]. The Aerococcus strains isolated in our diagnostic laboratory were generally susceptible to beta-lactam antibiotics (of 176 strains, five exhibited intermediate susceptibility to ceftriaxone and two were resistant to cefriaxone). A combination of amoxicillin for 6 weeks and gentamicin for 2 weeks was given, with a favourable clinical evolution.The second patient was a 60-year-old woman who was hospitalized 2 days after a high fever with signs of hip prosthetic joint infection. A one-stage exchange procedure had been performed 4 months earlier because of mechanical failure. She was receiving chronic methotrexate therapy for rheumatoid arthritis, and daily doxycycline for hidradenitis suppurativa. There was no evidence of urinary tract or cardiac infection, and the blood cultures remained sterile. A debridement with retention strategy was chosen. The culture of the sonicated mobile parts of the prosthesis remained sterile, but two of the five perioperative biopsies became positive for Gram-posit...

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Culture-negative Infective Endocarditis of the Aortic Valve due to Aerococcus urinae: A Rare Aetiology

Cited by 9 publications

References 11 publications

Aerococcus urinaeMitral Valve Endocarditis-Related Stroke: A Case Report and Literature Review

Aerococcus urinaeMitral Valve Endocarditis-Related Stroke: A Case Report and Literature Review

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

Diagnosis of Aerococcus urinae infections: Importance of matrix-assisted laser desorption ionization time-of-flight mass spectrometry and broad-range 16S rDNA PCR

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