Gemella endocarditis: A case report and a review of the literature

Abstract

Infective endocarditis (IE) remains a prevalent disease with a high rate of morbidity and mortality. Recent changes have been noted in the profile of causative microorganisms. In this report, we describe a case of Gemella-related endocarditis and review the related literature. Our patient was an 81-year-old man who presented with dyspnea and fatigue. His initial examination revealed a new systolic murmur. Echocardiogram revealed moderate mitral regurgitation with 1-cm mass on the anterior mitral leaflet, and blood cultures grew Gemella haemolysans. Penicillin and gentamicin were initiated, and workup for possible source was positive for a colonic polyp with high-grade dysplasia. The patient subsequently developed cardiogenic shock and severe pulmonary edema. Comfort care measures were initiated, and he passed away thereafter. We reviewed PubMed for cases of Gemella-related endocarditis. We found 65 documented cases and added our patient’s case to the analysis. Seventy-two percent of the cases occurred in men. The mean age was 51 years and 42% of the patients were older than 60 years. Fever was the most common presenting symptom and most of the cases presented subacutely. The mitral valve was the most affected site and 50% of the patients required surgical intervention. G. morbillorum was the most common subtype and a total of four cases were found to be associated with colorectal neoplasm. As a conclusion, Gemella species rarely cause IE. The absence of a clear source of bacteremia warrants further evaluation for a gastrointestinal source. The infection can be destructive and must be promptly treated to avoid complications.

A novel sialic acid-binding adhesin present in multiple species contributes to the pathogenesis of Infective endocarditis

“…oralis AsaA as a query. AsaA orthologues were identified in other IE-causing bacterial species including S. mitis, Staphylococcus pasteuri, Granulicatella elegans and G. haemolysans [43][44][45][46][47][48][49][50][51][52][53]. Overall, the protein architecture of these AsaA orthologues is similar to that of S. oralis AsaA.…”

“…AsaA orthologues were identified in other IE-causing species including G. haemolysans, G. elegans, S. pasteuri and S. mitis [43,45,46,50,51]. Although the overall architecture of these proteins is similar, some display differences in the domains present in the NRR and the number of DUF1542 repeats.…”

A novel sialic acid-binding adhesin present in multiple species contributes to the pathogenesis of Infective endocarditis

“…pasteuri and S . mitis [ 45 , 47 , 48 , 52 , 53 ]. A previous study identified DUF1542-containing proteins in five S .…”

A case of Gemella morbillorum native valve endocarditis and results of in vitro susceptibility testing

“…A recent review of literature suggested that G. morbillorum is the most common species associated with endocarditis and mitral valve is the most common heart valve involved. Onset of illness was subacute in most cases and fever was the most common presenting complaint [ 7 ]. Predisposing factors for endocarditis include dental infections and procedures, colon malignancies or gastrointestinal diagnostic procedures, immunosuppression, and preexisting cardiac abnormalities [ 8 ].…”

“…Inherent resistance to TMP-SMX and low-level resistance to aminoglycosides has been reported [ 9 ]. Aminoglycosides have been used in combination with beta lactams especially aqueous crystalline penicillin G and ampicillin for synergy and currently this combination is considered the treatment of choice [ 3 , 7 , 11 ]. Intravenous vancomycin can be used in patients with beta lactam allergy.…”