Rothia mucilaginosa Prosthetic Device Infections: a Case of Prosthetic Valve Endocarditis

Abstract

bRothia mucilaginosa is increasingly recognized as an emerging opportunistic pathogen associated with prosthetic device infections. Infective endocarditis is one of the most common clinical presentations. We report a case of R. mucilaginosa prosthetic valve endocarditis and review the literature of prosthetic device infections caused by this organism. CASE REPORTA 36-year-old man was admitted to the hospital in January 2012 with a chief complaint of left foot pain for 1 week. He described redness and swelling on the dorsum of his left foot. He denied trauma to the foot. He had been taking acetaminophen for pain intermittently without relief. He denied fever or chills, visual changes, back pain, muscle weakness, or numbness. He had a history of Streptococcus mitis mitral valve endocarditis and required mechanical mitral valve replacement in 2009. He had no history of peripheral vascular disease or claudication. He had no known drug allergies. His home medications included warfarin, methadone, and acetaminophen. He was an active intravenous heroin user. He was a former tobacco user with a 5-pack-year history who had quit 7 years before.On examination, the patient appeared well. His temperature was 100.9°F (38.3°C), pulse 108 beats per minute, blood pressure 133/64 mm Hg, and respirations 20 per minute. Cardiovascular examination revealed normal S1 and S2 and no murmurs, rubs, or gallops. The dorsum of the left foot had mild erythema, slight edema, and point tenderness of the mid-dorsal region. The left dorsalis pedis pulse was easily palpable. Skin examination revealed track marks at the right antecubital fossa. The remainder of the examination was normal. Laboratory studies revealed a white blood cell count of 20 ϫ 10 3 cells/mm 3 (reference range, 4 ϫ 10 3 to 11 ϫ 10 3 /mm 3 ), neutrophils at 88%, creatinine at 0.8 mg/dl, and an erythrocyte sedimentation rate of 35 mm/h (reference range, 0 to 10 mm/h). Other routine laboratory tests were normal. A leftfoot radiograph revealed no fracture, and an ultrasound of the left lower extremity revealed no deep vein thrombosis. Intravenous vancomycin and piperacillin-tazobactam were administered empirically for a presumptive diagnosis of left-foot cellulitis. The fever resolved, but the patient had persistent pain in the left foot, which subsequently turned blue and felt cold. Computed tomographic angiography revealed left popliteal artery thrombosis. A left popliteal thromboembolectomy was performed on day 4 of hospitalization. The pathology of the left popliteal thrombus revealed an organized thrombus with clusters of Gram-positive cocci. On day 4 of hospitalization, two sets of blood cultures obtained on the day of admission grew Rothia mucilaginosa from the aerobic bottles only.The organism was identified based upon biochemical tests, automated identification platforms (Phoenix system), and phenotypic characteristics. Gram stain revealed Gram-positive cocci that were catalase negative and grew sticky "staph-like" colonies which were whitish to gray in color, nonhemolyt...

Rothia Bacteremia: a 10-Year Experience at Mayo Clinic, Rochester, Minnesota

“…Invasive disease does occur, predominantly in immunocompromised hosts, but has rarely been reported in healthy hosts. The clinical syndromes associated with Rothia infection have included bacteremia (2), endocarditis (3), meningitis (4), peritonitis (5), bone and joint infections (1), pneumonia (6), skin and soft tissue infection, endophthalmitis (7), and prosthetic device infection (3). The main risk factors described for invasive disease have been hematological malignancy and severe neutropenia (8); other risk factors include diabetes mellitus, alcoholism, chronic liver disease, and infection with HIV (3).…”

Rothia mucilaginosa bacteremia: A 10‐year experience of a pediatric tertiary care cancer center

“…The first case of Rothia mucilaginosa infection in a human was described in 1978 in a patient suffering from endocarditis following cardiac catheterization . Since then, various kinds of infections, including bacteremia, pneumonia, meningitis, endocarditis, skin and soft‐tissue infections, prosthetic joint infections, and endophthalmitis, have been reported . However, while most of the available literature refers to adults, data on Rothia mucilaginosa infections in children are scarce and mostly limited to case reports.…”

“…5 Since then, various kinds of infections, including bacteremia, pneumonia, meningitis, endocarditis, skin and soft-tissue infections, prosthetic joint infections, and endophthalmitis, have been reported. [5][6][7][8][9] However, while most of the available literature refers to adults, data on Rothia mucilaginosa infections in children are scarce and mostly limited to case reports. Importantly, two papers Abbreviations: ALL, acute lymphoblastic leukemia; ANC, absolute neutrophil count; HSCT, hematopoietic stem cell transplantation; rRNA, ribosomal ribonucleic acid.…”

Endocarditis por Rothia aeria

“…Se sabe que Rothia aeria coloniza la cavidad oral humana, pero también se ha identificado en la biopsia duodenal como un colonizador del tracto gastrointestinal superior. Los síndromes clínicos asociados a la infección por Rothia han incluido bacteremia 6 , endocarditis, meningitis, periodontitis, infecciones osteoarticulares, neumonía, infección de piel y tejidos blandos, endoftalmitis e infección de dispositivo protésico 8 . En este reporte presentamos el primer caso de endocarditis por Rothia Aeria en Chile, habiendo sólo 8 casos reportados previamente en el mundo.…”