Recurrent Aortic Valve Endocarditis Caused by Gemella Morbillorum. Report of a Case and Review of the Literature.

Abstract

emella morbillorum (G. morbillorum), which is a nutritive variant of Streptococcus and was formerly classified as Streptococcus morbillorum, is an anaerobic to aerotolerant Gram-positive coccus. It is part of the commensal flora of the upper respiratory tract and the intestinal tract, and infections caused by this organism are unusual. We present a case of recurrent an active aortic valve endocarditis caused by G. morbillorum resulting in massive regurgitation, which was successfully treated surgically. Previously reported cases are also reviewed. Case ReportA 55-year-old man with persistent fever and nocturnal dyspnea was referred to hospital. He had a history of noninsulin dependent diabetes mellitus and type B hepatitis. Without any history of rheumatic fever, he had been diagnosed as having aortic regurgitation 35 years prior, and he had a history of infective endocarditis caused byhemolytic streptococcus, which was treated 5 years prior in another hospital with several different antibiotics with bacteriological cure. However, he had developed agranulocytosis because of gentamycin sulfate and piperacilin sodium therapy, and then suffered acute renal failure from interstitial nephritis following the administration of cefoperazon sodium. Fosfomycin and minocycline hydrochloride was able to be used without any side effects. The cardiac catheterization data showed a normal left end-diastolic pressure of 6 mmHg. Upon admission to hospital, his temperature was 39.3°C, blood pressure was 130/58 mmHg, and the heart rate was regular at 88 beats/min. He had extensive caries destruction of the teeth. Osler's nodes or splinter hemorrhage was not detected. On auscultation, a to-and-fro murmur with an intensity of Levine 3/6 was heard at the Erb's area. Dilatation of the neck vein was detected at the Fowler's position. A bounding pulse was palpable in the left femoral artery, but pulsation of the right femoral artery was not. Hepatosplenomegaly or pretibial edema was not observed.Laboratory examination showed a leukocyte count of 9,600 cells/m 3 , a hematocrit of 28.2%, and a hemoglobin of 9.3 g/dl. C-reactive protein (CRP) was 5.19 mg/dl. Urinaly-

Cerebellar abscess by Gemella morbillorum in a patient with inter-atrial communication

“…Gemella species, including Gemella morbillorum, a microaerophilic Gram-positive coccus, are part of the normal fl ora of the human oropharynx, upper respiratory, urogenital and gastrointestinal tract rarely causing human infection. Although uncommonly pathogenic, they have been implicated in a variety of human infections, some of them with serious consequences, most notably infective endocarditis [1][2][3][4][5][6][7] . Dental instrumentation appears to be the usual source of infection 1 .…”

PCR-Electrospray Ionization Mass Spectrometry for Direct Detection of Pathogens and Antimicrobial Resistance from Heart Valves in Patients with Infective Endocarditis

“…A case report has described the use of PCR/ ESI-MS to detect Bartonella species in an abdominal aortic mycotic aneurysm (30), and a recent publication has described the use of this technology for the analysis of synovial fluid from subjects with prosthetic joint infections (25). Organisms detected in this study included common IE pathogens (S. aureus, S. epidermidis, and E. faecalis) and not-so-common pathogens (T. whipplei, Granulicatella adiacens, G. morbillorum, C. hominis, and M. fortuitum) (31,32), which speaks to the potential applications of the assay studied.…”

Sternal Osteomyelitis with a Mediastinal Abscess Caused by Gemella <i>morbillorum</i> following Blunt Force Trauma

“…Intravenous drug abuse, alcoholism, cardiovascular disease, chronic obstructive pulmonary disease, diabetes, renal disease and poor oral hygiene are known predisposing factors (2). Reported cases primarily include G. morbillorum endocarditis and bacteremia and rarely spondylodiscitis, arthritis, hepatic abscesses and meningitis (3)(4)(5)(6).…”