Ann Clin Microbiol.  2019 Mar;22(1):23-27. 10.5145/ACM.2019.22.1.23.

Bacterial Endocarditis Caused by Abiotrophia defectiva in a Healthy Adult: A Case Report with Literature Review

• Je H
• Song D
• Chang CL

• KMID: 2441653
• DOI: http://doi.org/10.5145/ACM.2019.22.1.23

Abstract

Infective endocarditis caused by Abiotrophia defectiva is rarely encountered. A 67-year-old male transferred from a local hospital presented with severe dyspnea and pulmonary edema. Preoperative transthoracic echocardiography revealed severe mitral regurgitation with large vegetation. Blood cultures grew A. defectiva, a gram positive, nutritionally deficient streptococcus variant. Emergent mitral valve replacement through right thoracotomy was performed, and after completing six weeks of antibiotic combination therapy (vancomycin, ampicillin, and gentamicin), the patient recovered fully. Because of the need for prompt surgical treatment and long-term antibiotic therapy and lack of laboratory experience with the organism, physicians and laboratory workers should pay close attention to the possibility of A. defectiva infective endocarditis when gram positive cocci are detected in blood cultures.

Keyword

Abiotrophia defectiva; Infective endocarditis; Nutritionally variant streptococci

MeSH Terms

Abiotrophia*
Adult*
Aged
Ampicillin
Dyspnea
Echocardiography
Endocarditis
Endocarditis, Bacterial*
Gram-Positive Cocci
Humans
Male
Mitral Valve
Mitral Valve Insufficiency
Pulmonary Edema
Streptococcus
Thoracotomy
Ampicillin

Reference

1. Giannakopoulos K, Zompolou C, Behnes M, Elmas E, Borggrefe M, Akin I. Infective endocarditis-a word of caution on non-typical bacteria. Eur Rev Med Pharmacol Sci. 2016; 20:4782–4785.

2. Frenkel A. Spontaneous development of L forms of streptococci requiring secretions of other bacteria or sulphydryl compounds for normal growth. Nature. 1961; 191:728–730.

3. Lainscak M, Lejko-Zupanc T, Strumbelj I, Gasparac I, Mueller-Premru M, Pirs M. Infective endocarditis due to Abiotrophia defectiva: a report of two cases. J Heart Valve Dis. 2005; 14:33–36.

4. Carleo MA, Del Giudice A, Viglietti R, Rosario P, Esposito V. Aortic valve endocarditis caused by Abiotrophia defectiva: case report and literature overview. In Vivo. 2015; 29:515–518.

5. Roberts RB, Krieger AG, Schiller NL, Gross KC. Viridans streptococcal endocarditis: the role of various species, including pyridoxal-dependent streptococci. Rev Infect Dis. 1979; 1:955–966.

6. Brouqui P. Endocarditis due to rare and fastidious bacteria. Clin Microbiol Rev. 2001; 14:177–207.

7. Raoult D, Casalta JP, Richet H, Khan M, Bernit E, Rovery C, et al. Contribution of systematic serological testing in diagnosis of infective endocarditis. J Clin Microbiol. 2005; 43:5238–5242.

8. Doig F, Loewenthal M, Lai K, Mejia R, Iyengar A. Infective endocarditis: a Hunter New England perspective. Intern Med J. 2018; 48:1109–1116.

9. Chowdhury S. Rare but not infrequent: infective endocarditis caused by Abiotrophia defectiva. Case Rep Infect Dis. 2018; 2018:5186520.

10. Rudrappa M. Infective endocarditis due to Abiotrophia defectiva and its feared complications in an immunocompetent person: rare, but real. J Glob Infect Dis. 2017; 9:79–81.

11. Planinc M, Kutlesa M, Barsic B, Rudez I. Quadruple-valve infective endocarditis caused by Abiotrophia defectiva. Interact Cardiovasc Thorac Surg. 2017; 25:998–999.

12. Escarcega E, Trovato C, Idahosa O, Gillard J, Stankewicz H. Abiotrophia defectiva endocarditis: an easy miss. Clin Pract Cases Emerg Med. 2017; 1:229–231.

13. Bhattacharya P, Mohammed A, Mizrahi E. Aorto-right ventricular fistula: a rare complication of Abiotrophia endocarditis. Oxf Med Case Reports. 2017; 2017:omx035.

14. Birlutiu V. Endocarditis due to Abiotrophia defectiva, a biofilm-related infection associated with the presence of fixed braces: a case report. Medicine (Baltimore). 2017; 96:e8756.

15. Bozkurt I, Coksevim M, Cerik IB, Gulel O, Tanyel E, Leblebicioglu H. Infective endocarditis with atypical clinical feature and relapse by Abiotrophia defectiva. J Saudi Heart Assoc. 2017; 29:136–138.

16. van Roeden S, Hartog H, Bongers V, Thijsen S, Sankatsing S. (18)F-FDG-PET scanning confirmed infected intracardiac deviceleads with Abiotrophia defectiva. Case Rep Cardiol. 2016; 2016:6283581.

17. Rhodes HM, Hirigoyen D, Shabnam L, Williams DN, Hansen GT. Infective endocarditis due to Abiotrophia defectiva and Granulicatella spp. complicated by infectious intracranial cerebral aneurysms: a report of three cases and review of the literature. J Med Microbiol. 2016; 65:493–499.

18. Park S, Ann HW, Ahn JY, Ku NS, Han SH, Hong GR, et al. A case of infective endocarditis caused by Abiotrophia defectiva in Korea. Infect Chemother. 2016; 48:229–233.

19. Mouyis K, Metaxa S, Missouris C. Abiotrophia defectiva endocarditis complicated by ventricular tachycardia. J Heart Valve Dis. 2016; 25:114–115.

20. Botta L, Merati R, Vignati G, Orcese CA, De Chiara B, Cannata A, et al. Mitral valve endocarditis due to Abiotrophia defectiva in a 14th week pregnant woman. Interact Cardiovasc Thorac Surg. 2016; 22:112–114.

21. Fukui Y, Aoki K, Okuma S, Sato T, Ishii Y, Tateda K. Metagenomic analysis for detecting pathogens in culture-negative infective endocarditis. J Infect Chemother. 2015; 21:882–884.

22. Sinner SW, Tunkel AR. Viridans Streptococci, Nutritionally Variant Streptococci, Groups C and G Streptococci, and Other Related Organisms. In : Bennet JE, Dolin R, Blaser MJ, editors. Mandell, Douglas, and Bennett's Principles and Practice of Infectious Diseases. 8th ed. Philadelphia, PA: Elsevier Saunders;2015. p. 2349–2361.