Enterococcus hirae bacteremia associated with acute pyelonephritis in a patient with alcoholic cirrhosis: a case report and literature review

Abstract

Background Infections caused by Enterococcus hirae are common in animals, with instances of transmission to humans being rare. Further, few cases have been reported in humans because of the difficulty in identifying the bacteria. Herein, we report a case of pyelonephritis caused by E. hirae bacteremia and conduct a literature review on E. hirae bacteremia. Case presentation A 57-year-old male patient with alcoholic cirrhosis and neurogenic bladder presented with fever and chills that had persisted for 3 days. Physical examination revealed tenderness of the right costovertebral angle. Matrix-assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF MS) of the patient’s blood and urine samples revealed the presence of E. hirae, and pyelonephritis was diagnosed. The patient was treated successfully with intravenous ampicillin followed by oral linezolid for a total of three weeks. Conclusion The literature review we conducted revealed that E. hirae bacteremia is frequently reported in urinary tract infections, biliary tract infections, and infective endocarditis and is more likely to occur in patients with diabetes, liver cirrhosis, and chronic kidney disease. However, mortality is not common because of the high antimicrobial susceptibility of E. hirae. With the advancements in MALDI-TOF MS, the number of reports of E. hirae infections has also increased, and clinicians need to consider E. hirae as a possible causative pathogen of urinary tract infections in patients with known risk factors.

Enterococcus hirae Mitral Valve Infectious Endocarditis: A Case Report and Review of the Literature

“…MALDI-TOF MS proved to be an accurate system for the identification of both usual and unusual Enterococci with a high level of species-level discriminatory power [ 3 ]. The low rate of E. hirae incidence may have been the consequence of the limited power of other diagnostic systems; indeed, the identification of E. hirae increased after the development of MALDI-TOF MS [ 14 ]. Both the Bruker Biotyper and VITEK MS systems are able to correctly identify a wide range of bacteria; however, VITEK MS has a higher error rate compared to Bruker Biotyper in the case of unusual microorganisms [ 15 ], as corroborated by our case in which VITEK MS inaccurately identified the microorganism grown in the blood culture as E. faecium .…”

Enterococcus hirae bacteremia associated with perinephric collection and renal abscesses in a diabetic woman

“…Infections caused by E. hirae are common in animals but human infections are relatively rare. Pyelonephritis, biliary tract infections and infective endocarditis due to E. hirae have previously been reported in humans [ 5–8 ].…”

“…E. hirae infection occurs more commonly among patients with diabetes mellitus, liver cirrhosis, and chronic kidney disease [ 5 ]. Our patient had poorly controlled diabetes mellitus which could have predisposed to urinary tract infection caused by E. hirae .…”

Chagas disease is related to structural changes of the gut microbiota in adults with chronic infection (TRIPOBIOME Study)

“…Human E. hirae infections are very rare and opportunistic in nature. Reported cases include urinary tract infections, biliary tract infections, infective endocarditis and catheter-related bloodstream infections [71]. In pregnant women with bacterial vaginosis, E. hirae has been involved as a marker of the disbalance of the vaginal ecosystem, being negatively correlated with a normal Nugent rating [72].…”