title: Aortic vascular graft infection caused by Cardiobacterium valvarum: a case report.
abstract: A 53-year-old man with a past medical history of total arch replacement surgery and severe aortic regurgitation presented with a 1-month history of persistent general malaise, anorexia, body weight loss and night sweats. His recent history included gingival hyperplasia for 6 years, gingivitis after tooth extraction 3 years before, prolonged inflammatory status for 4 months, fundal hemorrhage and leg tenderness for 2 months. A pathogen was detected from blood culture, but conventional microbiological examination failed to identify the pathogen. The organism was eventually identified as Cardiobacterium valvarum by 16S rRNA analysis, and the patient was diagnosed with infective endocarditis and prosthetic vascular graft infection. The patient received intravenous antibiotic therapy using a combination of ceftriaxone and levofloxacin for 5 weeks and was discharged with a good clinical course. C. valvarum is a rare human pathogen in clinical settings. Only 10 cases have been reported to date worldwide, and therefore, the clinical characteristics of C. valvarum infection are not fully known. This is a first well-described case of C. valvarum infection in Japan, and further, a first report of aortic prosthetic vascular graft infection worldwide. Identification of C. valvarum is usually difficult due to its phenotypic characteristics, and molecular approaches would be required for both clinicians and microbiologists to facilitate more reliable diagnosis and uncover its clinical picture more clearly.
authors.affiliation: Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan. Electronic address: e_dai_for_all@hotmail.com.
authors.forename: Hideharu
authors.initials: H
authors.lastname: Hagiya
authors.affiliation: Department of Oral Microbiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Kokeguchi
authors.affiliation: Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Hiroko
authors.initials: H
authors.lastname: Ogawa
authors.affiliation: Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Tomohiro
authors.initials: T
authors.lastname: Terasaka
authors.affiliation: Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Kimura
authors.affiliation: Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Koichi
authors.initials: K
authors.lastname: Waseda
authors.affiliation: Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Yoshihisa
authors.initials: Y
authors.lastname: Hanayama
authors.affiliation: Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Kaori
authors.initials: K
authors.lastname: Oda
authors.affiliation: Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Hisatoshi
authors.initials: H
authors.lastname: Mori
authors.affiliation: Department of Cardiology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Toru
authors.initials: T
authors.lastname: Miyoshi
authors.affiliation: Department of General Medicine, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan.
authors.forename: Fumio
authors.initials: F
authors.lastname: Otsuka
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001013:Aorta, Thoracic / Q000382:microbiology* / Q000601:surgery; D001807:Blood Vessel Prosthesis / Q000382:microbiology*; D044066:Cardiobacterium / Q000302:isolation & purification*; D004697:Endocarditis, Bacterial / Q000382:microbiology*; D005885:Gingival Hyperplasia / Q000382:microbiology; D016905:Gram-Negative Bacterial Infections / Q000382:microbiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010518:Periodontitis / Q000382:microbiology; D016459:Prosthesis-Related Infections / Q000382:microbiology*
chemical_list: D000900:Anti-Bacterial Agents
keywords: Aortic vascular graft; Cardiobacterium; Hyperglobulinemia; Infective aneurysm; Infective endocarditis; Septic embolism