<i>Gemella bergeri</i>infective endocarditis: a case report and brief review of literature

Zaidi, S. Javed; Husayni, Tarek S.; Collins, Mary

doi:10.1017/s1047951118000070

Cited by 13 publications

(25 citation statements)

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“…Different species of Aerococcus have recently been increasingly recognized as a relatively common cause of bacteremia in certain age groups and tend to cause IE [15–17]. Not within the order, but related, is the genus Gemella that can also cause IE [18].…”

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confidence: 99%

Risk for Endocarditis in Bacteremia With Streptococcus-Like Bacteria: A Retrospective Population-Based Cohort Study

Berge

Kronberg

Sunnerhagen

et al. 2019

Open Forum Infectious Diseases

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BackgroundMany genera and species of Streptococcus-like bacteria (SLB) can cause infective endocarditis (IE), but little is known about the epidemiology of and the risk factors for IE in SLB-bacteremia. The aim of the study was to analyze this in a cohort of patients with SLB-bacteremia, focusing on Abiotrophia, Aerococcus, Gemella, and Granulicatella. We also evaluated whether published scoring systems generated for other Gram-positive bacteria known to cause IE (HANDOC for streptococci and NOVA and DENOVA for enterococci) could be used in SLB bacteremia to decide whether transesophageal echocardiography (TEE) could be omitted.MethodsPositive blood cultures with SLB were retrieved from population-based registries in Sweden (3.2 million inhabitants), from January 2012 to December 2017. Clinical data were collected from medical records. Risk factors for IE were analyzed and the performances of the scoring systems were calculated.ResultsThe incidence of bacteremia with the 4 SLB genera was 30 episodes/1 000 000 population per year, of which Aerococcus contributed with 18. Among 568 episodes of bacteremia, 32 cases of IE were identified (5.6%). Infective endocarditis was most common in bacteremia with Abiotrophia (4 of 19) followed by Granulicatella (9 of 124), Gemella (6 of 87), and Aerococcus (13 of 338). NOVA had 100% sensitivity to identify IE but a low specificity (15%). For HANDOC and DENOVA, the sensitivities were 97% and 91%, respectively, whereas specificities were 85% and 90%, respectively, and numbers needed to screen were 3.6 and 2.8, respectively.ConclusionsBacteremia with these SLB is relatively rare, and the decision whether TEE should be performed or not could be based on either HANDOC or DENOVA.

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confidence: 99%

Risk for Endocarditis in Bacteremia With Streptococcus-Like Bacteria: A Retrospective Population-Based Cohort Study

Berge

Kronberg

Sunnerhagen

et al. 2019

Open Forum Infectious Diseases

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“…While no members of the genus have been detected in rodents previously, metagenomic studies show that they are common inhabitants of the oral cavity and intestinal tracts of other mammals and can be detected in wastewater [17–20]. In addition, they are known to be rare causes of endogenous infection (including abscess) in humans [21–26]. This isolate is phenotypically distinct from other species, while retaining the traits required for inclusion within this genus (i.e., positive Gram stain, coccus shape, lack of motility, and absence of catalase and oxidase production) [27].…”

Section: Discussionmentioning

confidence: 99%

Polymicrobial abscess following ovariectomy in a mouse

et al. 2019

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BackgroundOvariectomy is a common procedure in laboratory rodents used to create a post-menopausal state. Complications including post-surgical abscess are rarely reported, but merit consideration for the health and safety of experimental animals.Case presentationA female C57/black6 mouse was ovariectomized as part of a cohort study. At Day 14 post-surgery, she developed a visible swelling on the right side, which 7 days later increased in size over 24 h, leading to euthanasia of the animal. Gross pathology was consistent with abscess. A core of necrotic tissue was present in the uterine horn. Abscess fluid and affected tissue were collected for Gram stain and bacteriological culture. The abscess core and fluid yielded three distinct types of bacterial colonies identified by 16S ribosomal RNA sequencing as Streptococcus acidominimus, Pasteurella caecimuris, and a novel species in the genus Gemella.ConclusionsThis is the first report of polymicrobial abscess in a rodent as a complication of ovariectomy, and the first description of a novel Gemella species for which we have proposed the epithet Gemella muriseptica. This presentation represents a potential complication of ovariectomy in laboratory animals.

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“…G. bergeri was isolated for the first time by Collins et al in 1998 [ 3 ]. Since then to our knowledge, thirteen cases have been reported [ 4 – 11 ] (Table 1 ). Three of these reports did not specifically mention a clinical diagnosis and were not described in detail.…”

Section: Discussionmentioning

confidence: 99%

“…Fortunately, the susceptibility of G. bergeri was good, and the patient was therefore treated adequately. However, although intravenous ceftriaxone, gentamicin and oral rifampicin are effective antibiotics [ 4 , 6 – 9 , 11 ] (Table 1 ), one study showed evidence of resistance to drugs such as penicillin [ 16 ], erythromycin [ 17 ], levofloxacin and aminoglycosides [ 1 ] for Gemella. Therefore, obtaining an accurate diagnosis of Gemella using a 16S rRNA gene sequence analysis should be considered if the pathogens are not identified by Gram staining or commercial biochemical tests.…”

Section: Discussionmentioning

confidence: 99%

“…G. bergeri belongs to the normal flora of the oral cavity, and digestive and urinary tract, and was isolated for the first time by Collins et al in 1998 [ 5 ]. Since then, it is gradually being recognized and so far, 13 cases have been reported [ 4 – 11 ] (Table 1 ). Except for one case associated with cardiogenic shock due to perforation of the mitral valve [ 4 ], there are no cases of septic shock due to G. bergeri infection.…”

Section: Introductionmentioning

confidence: 99%

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Purpura fulminans with Lemierre’s syndrome caused by Gemella bergeri and Eikenella corrodens: a case report

et al. 2018

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BackgroundGemella bergeri is one of the nine species of the genus Gemella and is relatively difficult to identify. We herein describe the first case of septic shock due to a Gemella bergeri coinfection with Eikenella corrodens.Case presentationA 44-year-old Asian man with a medical history of IgG4-related ophthalmic disease who was prescribed corticosteroids (prednisolone) presented to our hospital with dyspnea. On arrival, he was in shock, and a purpuric eruption was noted on both legs. Contrast enhanced computed tomography showed fluid retention at the right maxillary sinus, left lung ground glass opacity, and bilateral lung irregular opacities without cavitation. Owing to suspected septic shock, fluid resuscitation and a high dose of vasopressors were started. In addition, meropenem, clindamycin, and vancomycin were administered. Repeat computed tomography confirmed left internal jugular and vertebral vein thrombosis. Following this, the patient was diagnosed with Lemierre’s syndrome. Furthermore, he went into shock again on day 6 of hospitalization. Additional soft tissue infections were suspected; therefore, bilateral below the knee amputations were performed for source control. Cultures of the exudates from skin lesions and histopathological samples did not identify any pathogens, and histopathological findings showed arterial thrombosis; therefore it was concluded that the second time shock was associated with purpura fulminans. Following this, his general status improved. He was transferred to another hospital for rehabilitation. The blood culture isolates were identified as Gemella bergeri and Eikenella corrodens. Gemella bergeri was identified by matrix-assisted laser desorption ionization-time of flight mass spectrometry and confirmed by 16S rRNA gene sequencing later. The primary focus of the infection was thought to be in the right maxillary sinus, because the resolution of the fluid retention was confirmed by repeat computed tomography.ConclusionsGemella bergeri can be the causative pathogen of septic shock. If this pathogen cannot be identified manually or through commercial phenotypic methods, 16S rRNA gene sequencing should be considered.

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Gemella bergeriinfective endocarditis: a case report and brief review of literature

Cited by 13 publications

References 5 publications

Risk for Endocarditis in Bacteremia With Streptococcus-Like Bacteria: A Retrospective Population-Based Cohort Study

Risk for Endocarditis in Bacteremia With Streptococcus-Like Bacteria: A Retrospective Population-Based Cohort Study

Polymicrobial abscess following ovariectomy in a mouse

Purpura fulminans with Lemierre’s syndrome caused by Gemella bergeri and Eikenella corrodens: a case report

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