Granulicatella adiacens, the Elusive Endocarditis Causative Agent: Highlighting the Challenges Faced by Microbiology Laboratory

Abstract

A 58-year-old man with history of mitral valve prolapse and previous motor vehicle accident presented with one week history of lower back pain and fever. He was initially treated for pyelonephritis and given ceftriaxone. Blood culture grew Granulicatella adiacens after 7 days of incubation. The laboratory then referred the case to infectious disease team in view of possible infective endocarditis. Urgent echocardiogram was done and confirmed the diagnosis. His antibiotic was changed to intravenous benzylpenicillin and gentamicin. Granulicatella adiacens are difficult to be isolated in the laboratory hence they imposed certain challenges in laboratory identification. Most patients with Granulicatella adiacens infective endocarditis present with non-specific symptoms, imposing further challenge in recognizing the condition. These factors posed significant challenges in diagnosing Granulicatella adiacens endocarditis. This case highlighted challenges faced by the laboratories and the need of high index of clinical suspicion and prompt communication to ensure optimum patient care and management.