Enterococcus gallinarum Endocarditis Occurring on Native Heart Valves

Abstract

We report the first case of Enterococcus gallinarum endocarditis developing on normal native heart valves. Using phenotypic and molecular methods, a precise identification of this naturally vancomycin-resistant species allowed an optimal antibiotic therapy and the patient's recovery. CASE REPORTA 62-year-old Vietnamese man was admitted to our hospital in January 2001 because of presumptive endocarditis. He had been living in France since 1952 and worked as a veterinarian. He had a background history of cholecystectomy, gastrectomy for bleeding gastric ulcer in 1965, brucellosis treated with tetracycline in 1967, and polycythemia. The patient did not report any hospitalization stay of more than 1 day (for therapeutic phlebotomy) since 1965. He had no previously damaged cardiac valves. He did not receive any antimicrobial treatment during the months before hospitalization, but in the first days of January, he was treated with roxithromycin (150 mg twice a day [b.i.d.]) and corticosteroids for a putative diagnosis of pneumonia. On 14 January 2001, he was admitted to a local hospital because of heart failure and persistent fever. The combination amoxicillin-clavulanic acid (1 g three times a day [t.i.d.]) was added to the regimen. On 17 January, the transthoracic echocardiography demonstrated the presence of mitral and aortic vegetations. Amoxicillin-clavulanic acid and roxithromycin were switched to cefotaxime (2 g t.i.d.) and gentamicin (100 mg b.i.d.) for presumably infective endocarditis. On the third day of the cefotaxime-gentamicin regimen, the patient required mechanical ventilation because of heart failure and was admitted to our hospital. Transoesophageal echocardiography demonstrated voluminous aortic vegetation with valvular destruction, prolapsus, and aortic regurgitation. There were also two mitral vegetations with mitral regurgitation. Because an Enterococcus species was isolated from two blood cultures, cefotaxime was switched to vancomycin (1 g b.i.d.). The patient underwent replacement of the mitral and aortic valves on 23 January.Based on the disk diffusion method (27), the strain was first reported as susceptible to ampicillin, erythromycin, vancomycin, teicoplanin, trimethoprim-sulfamethoxazole, and rifampin, but resistant to lincomycin. No high-level resistance to gentamicin was detected by a screening test on agar plates containing 500 g of gentamicin per ml. The bacteriological analysis of surgically removed valves obtained 18 h after the beginning of vancomycin therapy yielded growth of an enterococcal strain. Blood culture and valve isolates were identified as Enterococcus gallinarum by physiological and molecular methods (12) and had identical antibiotic susceptibility patterns. Strains grew on a 6-g/ml vancomycin agar plate, on bile esculin agar, were nonhemolytic on sheep blood agar, and were positive for Streptococcus group D antigen by latex agglutination (Slidex Strepto kit; bioMerieux, Marcy l'Etoile, France). They were identified as E. gallinarum by the API Rapid ID 32 Strep system (...

Antimicrobial resistance of Enterococcus sp. isolated from the intestinal tract of patients from a university hospital in Brazil

“…or chronically ill patients, and sometimes are nosocomially acquired (Reid et al 2001, Dargere et al 2002. In this study the prevalence of vanC phenotype enterococci was significantly higher (23.7% of E. gallinarum and 5.2% of E. casseliflavus) than in several studies that reported intestinal colonization by enterococci vanC.…”

Enterococcus gallinarum meningitis in an immunocompetent host: a case report

“…E. faecalis and E. faecium are the two most commonly encountered enterococcal species, together accounting for 90% of isolates 6,8 . Other species, including E. gallinarum are uncommonly encountered in human clinical specimens and are primarily found in the gastrointestinal tracts in poultry 3,8 . Infection by E. gallinarum rarely occurs and has been implicated in a few invasive infections in humans, especially in immunocompromised or chronically ill patients 2,3,5 .…”

“…Other species, including E. gallinarum are uncommonly encountered in human clinical specimens and are primarily found in the gastrointestinal tracts in poultry 3,8 . Infection by E. gallinarum rarely occurs and has been implicated in a few invasive infections in humans, especially in immunocompromised or chronically ill patients 2,3,5 . There are only four cases of CNS involvement reported in literature due to this unusual germ, all reporting on patients with some degree of immunosuppression who had been previously submitted to a neurological procedure 4,8,9,10 .…”

Functional and safety aspects of enterococci in dairy foods

“…Moreover, due to the higher incidence of infections by enterococci in young, older and immunocompromised patients, and to their extended resistance to antibiotics, they are being considered as emerging pathogens [6,7]. The majority of infections are caused by either E. faecalis or E. faecium strains, [8,9] However, strains of E. gallinarum [10], E. hirae [11], and E. mundtii [12] have been also associated with endophtalmitis and native valve endocarditis in humans.…”