RRML - Posterior mitral valve endocarditis accompanied by bacteraemia with Granulicatella adiacens. A Case Report
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Nr. 16(3)/2009
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Posterior mitral valve endocarditis accompanied by bacteraemia with Granulicatella adiacens. A Case Report

Annamária Főldes, Mihaela Oprea, Doina-Veronica Bilca, László Attila Farkas, Edit Székely, Monica Străuț, Minodora Dobreanu


Abstract:

Granulicatella species, formerly known as nutritionally variant streptococci (NVS) are rarely implicated in infective endocarditis (IE). We report the case of a 65-year-old woman with ischemic cardiopathy and mitral valve incompetence who developed IE. She accused progressive dyspnea and two weeks prior to admission developed vesperal fever (38–39°C) without chills and sweating. Transoesophageal echocardiography (TEE) revealed a vegetation established on the ventricular face of posterior mitral valve. G. adiacens was recovered in pure culture from five sets of consecutive blood cultures collected before antibiotic treatment. The phenotypic identification was based on morphological characteristics, special cultural requirements (satellitism, capnophilia, anaerobic atmosphere) and Vitek 2 Compact System. Molecular identification was performed by 16S rDNA gene sequence analysis. The resulting sequence was compared with sequences from the National Center for Biotechnology Information (NCBI) on-line database and was confirmed as G. adiacens. The patient was successfully treated intravenously with ceftriaxone and gentamicin. The conventional diagnosis of a G. adiacens infection relies on the bacterial polymorphism in Gram-stained smear, the discrepancy between direct smear result and the difficulty of growth using standard techniques, in association with cultural dimorphism. This case emphasizes the importance of bacteriologic identification of G. adiacens and rapid initiation of an adequate antibiotherapy.

Keywords: Granulicatella adiacens,nutritionally variant streptococci (NVS),satellitism,infective endocarditis.

 
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How to cite
Főldes A, Oprea M, Bilca DV, Farkas LA, Székely E, Străuț M, et al. Posterior mitral valve endocarditis accompanied by bacteraemia with Granulicatella adiacens. A Case Report. Rev Romana Med Lab. 2009;16(3):49-57