Active infective endocarditis due to Erysipelothrix rhusiopathiae: zoonosis caused by vancomycin-resistant gram-positive rod.
A 42-year-old female who was a voluntary worker in a school for handicapped children was referred to us for surgery for active infective endocarditis. Trans-esophageal echocardiography showed 2 large mobile vegetations on the aortic valve and severe aortic regurgitation. Aortic valve replacement was performed to prevent septic embolism and deterioration of congestive heart failure. The empiric therapy with vancomycin, ampicillin, and gentamycin was initiated because a pathogen was not identified. But Erysipelothrix rhusiopathiae (gram-positive rod) was isolated on the 4th day after surgery. The target therapy with penicillin G and clindamycin was started and continued for 4 weeks after surgery. The inflammatory parameters improved steadily and the patient was discharged on the 36th day after surgery. Infective endocarditis due to gram-positive rods can be easily mistaken for streptococci or dismissed as a skin contamination. But, E. rhusiopathiae endocarditis should be considered in the differential diagnosis.
Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, 852-8501, Japan. takashirensou@yahoo.co.jp
Takashi
T
Miura
Koji
K
Hashizume
Tsuneo
T
Ariyoshi
Takashi
T
Miwa
Akitsugu
A
Furumoto
Mai
M
Izumida
Katsunori
K
Yanagihara
Kiyoyuki
K
Eishi
D000328:Adult; D000667:Ampicillin / Q000627:therapeutic use; D000818:Animals; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001021:Aortic Valve / Q000382:microbiology; D001022:Aortic Valve Insufficiency / Q000601:surgery; D004697:Endocarditis, Bacterial / Q000188:drug therapy / Q000382:microbiology*; D004888:Erysipelothrix / Q000187:drug effects*; D004889:Erysipelothrix Infections / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D005839:Gentamicins / Q000627:therapeutic use; D006801:Humans; D010400:Penicillin G / Q000627:therapeutic use; D014640:Vancomycin / Q000627:therapeutic use; D015047:Zoonoses / Q000382:microbiology*
D000900:Anti-Bacterial Agents; D005839:Gentamicins; D014640:Vancomycin; D000667:Ampicillin; D010400:Penicillin G