Neisseria elongata endocarditis complicated by brain embolism and abscess

Abstract

We report a case of Neisseria elongata endocarditis with thalamic septic embolization and subsequent brain abscess formation, which to the best of our knowledge has never been reported in the literature. The brain abscess completely resolved after a surgical repair of the infected mitral valve and an additional 4 weeks of antimicrobial therapy. Based on a review of all previous reports of N. elongata endocarditis, including ours, this will remind physicians that invasive N. elongata infections should be managed and followed up cautiously, as surgical intervention is often required.

Native Valve Endocarditis Caused by <i>Neisseria elongata</i> Subsp. <i>nitroreducens</i>

“…Antecedent dental procedures and odontogenic infections are also considered to be risk factors for N. elongata endocarditis (9). In contrast, reports of seven definitive cases, including the present case, excluded the presence of preceding intraoral complications (10)(11)(12)(13)(14)(15).…”

“…However, this organism is generally considered to be susceptible to a wide range of antibiotics (20). Most patients with N. elongata endocarditis are treated with beta-lactams, often in combination with aminoglycosides, for four to six weeks (9,21). In the present case, the administration of ampicillin and ceftriaxone, which inhibited the growth of the recovered organism at low concentrations (!…”

“…In contrast to the immediate improvement in the patient's general condition, the regurgitation of the affected valve worsened and valve replacement was required. A review of definitive or possible cases of N. elongata endocarditis showed that approximately half of the patients underwent surgical treatment (9), with a similar frequency to that noted in an entire cohort of endocarditis cases (22). In addition, N. elongata endocarditis occasionally results in serious complications, such as brain abscesses (9) and spondylodiscitis (10), although, to our knowledge, no deaths directly associated with N. elongata infection have been reported.…”

Infective Endocarditis Caused by Neisseria elongata on a Native Tricuspid Valve and Confirmed by DNA Sequencing

“…5,10,11 Dental procedures can be a risk factor for IE, because N. elongata is part of the normal oropharyngeal flora. Neisseria elongata is typically susceptible to a wide range of antimicrobial agents, so prophylactic antibiotics should be recommended for high-risk patients (such as those with valvular or congenital heart disease) before they undergo dental procedures.…”

“…Neisseria elongata endocarditis, although very rare, can cause a variety of severe conditions, such as systemic embolization, congestive heart failure, and myocardial abscess. [1][2][3][4][5] We describe the case of a patient with N. elongata endocarditis, an incidentally detected Gerbode ventricular septal defect (VSD), and septicemia.…”