Prosthetic Ball Valve Endocarditis due to Gemella Species

Abstract

A case is presented of endocarditis that was affecting a prosthetic ball valve (Starr-Edwards) and which was caused by Gemella species. A 57-year-old man was admitted with a 3-day history of abdominal pain with fever. At the time of admission, his temperature was 37.7°C and laboratory tests showed elevated inflammatory parameters and an increased neutrophil count. However, transthoracic echocardiogram showed no vegetation. During hospitalization, Gemella spp. were detected by blood culture, and a transesophageal echocardiogram showed vegetation on the prosthetic valve. He was treated with intravenous ampicillin and astromycin, and also underwent valve replacement. This is the first case in Japan of infective endocarditis of a prosthetic valve due to Gemella spp. (Jpn Circ J 1998; 62: 626 -628)

Risk Factors and Patient Profile of Infective Endocarditis due to <i>Gemella spp.</i>

“…A summary of laboratory tests is found in Table 3. All population groups showed anemia, [16][17][18]23,24,27,28,[32][33][34][35][36]41,44,46,49 [14,15,[18][19][20][21][22]24,30,31,33,39,[41][42][43]48,49,52,56,68,70,71,73,75,76,78,79,82,86,90] The mitral valve was the most common location of vegetation in the pediatric and geriatric populations, whereas the aortic valve vegetation predominated in the adult age group. Gemella haemolysans, Gemella bergeriae, Gemella sanguinis were mainly found on aortic valves [15-17,19-22,29,30, 33,34,38,39,43,44,49,52,54,56,57,59-61,63,68,6...…”

“…Five studies, however, demonstrated antibiotic resistance, in particular penicillin, [49,62] aminoglycoside [49] and fluoroquinolone. [41,62] In studies where patients survived the course of treatment, more patients showed clinical improvement after receiving six weeks or more of antibiotic therapy [16,19,21,25,[30][31][32][33][34]38,39,41,[47][48][49][50][51]55,57,62,66,67,71,72,76,80,82,87,89] than patients who received under six weeks of antibiotic therapy, [15,23,24,27,[35][36][37]46,52,53,58,59,61,63,65,…”

“…Twenty-three studies reported complications following treatment. [17,20,21,27,33,35,44,45,51,52,55,56,64,69,70,74,75,79,82,83,86,88,91] This included implications to the cardiovascular (10.8%), [17,21,33,52,56,70,76,86,88,91] neurological (9.6%), [20,27,44,45,74,75,79,82] and renal (6.0%) [21,33,55,64,75] systems. However, there were no reported recurrent infections following successful antibiotic treatment.…”

“…[14,16, 18,20,41,44,50,51,53,62,63,65,74,80,81,82,87,91] USA[15,17,21,29,39,43,45,48,54,55,64,69,76,77,78,79,83,86,88,89,90] reported the most number of cases in the world, followed by the UK [23,25,26,58,68,73]. Japan[16,41,63,74,81,82] reported the most cases among Asia, Oceania, and South America.…”

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

“…It has been implicated in several diseases primarily in adults, including meningitis and septic shock but rarely IE. [1314] The genus currently includes six subspecies that cause similar clinical illness: morbillorum, haemolysans , bergeriae , sanguinis , palaticanis , and cuniculi , in addition to other subspecies that are restricted to animals. [15] Gemella morbillorum was initially thought to be part of the genus Streptococcus until 1988 when it was found to be related to G. haemolysans at the genus level.…”