Rare case report of infective endocarditis due to Kocuria kristinae in a patient with ventricular septal defect

Abstract

Background. Infective endocarditis (IE) is an uncommon but life-threatening infection. It is commonly associated with diseased or damaged valves. Patients with congenital heart disease are more prone to getting IE than the general population. The typical organisms that cause IE include Staphylococcus , Coagulase-negative Staphylococcus, Streptococcus viridians and Enterococci. However, the importance of rare micro-organisms like Kocuria kristinae should not be underestimated especially when isolated from multiple blood cultures in patients suspected of IE. Case presentation. We report a rare case of right-sided infective endocarditis due to K. kristinae in a young non-diabetic, non-addict female of low socioeconomic class who presented with undiagnosed fever for 1 year. She was investigated and treated for fever by several general practitioners without relief. Later on, she was diagnosed by a local cardiologist to have perimembranous ventricular septal defect with a small pulmonary valve vegetation. She was referred to a tertiary care cardiac hospital in Rawalpindi, Pakistan for further management. Transthoracic and transesophageal echocardiography confirmed IE secondary to preexisting congenital heart disease complicated with a small pulmonary vegetation. Her blood cultures yielded growth of K. kristanae, a rare micro-organism to cause IE. The patient responded to the antibiotic therapy. Conclusion. Clinicians should have a high index of suspicion for K. kristanae IE as a possible cause of a prolonged fever especially in the presence of congenital heart disease. Antibiotic susceptibility is required for adequate therapy.

Infective Endocarditis Caused by Streptococcus alactolyticus and Kocuria kristinae Complicated with Severe Thrombocytopenia: A Rare Case

“…The newest case report by Arif et al reported a rare case of right-sided IE due to K. kristinae presenting with undiagnosed fever for 1 year. 6 In our case, the patient also had a history of prolonged fever that increase suspicion for K. kristinae infection. IE is a possible cause of a prolonged fever, especially in the presence of congenital heart disease.…”

“…koji su opisali rijedak slučaj IE-a na desnoj strani srca zbog infekcije bakterijama K. kristinae koja se manifestirala kao nedijagnosticirana povišena temperatura u trajanju od 1 godine. 6 U našem je slučaju bolesnica također imala anamnestičke podatke o dugotrajnoj povišenoj temperaturi, što povećava sumnju na infekciju čiji je uzročnik bila K. kristinae. IE je mogući uzrok dugotrajno povišene temperature, pogotovo uz prisutnost prirođene bolesti srca.…”

Kocuria Species: Important Emerging Pathogens in Pediatric Patients

“…22 In addition, it might be underestimated considering their close similarity to coagulase negative Staphylococci. 7,23 The automated diagnosis by the Vitek 2 database allows for better identification of Kocuria in the recent times. 13 mainly in pediatric patients.…”

Aseptic presentation of interventricular septal abscess with progressive heart block: a case report

“…Infective endocarditis (IE) presents a myriad of clinical features that depend on the causative organism, its virulence, duration of bacteremia, and presence of implantable cardiac devices [ 1 ]. Adding to this clinical complexity, any microorganism is known to cause IE, as described in various case reports [ 2 , 3 ]. Considering these evolving clinical findings, there is a concern for the delay in diagnosis leading to worse outcomes.…”