title: Infectious endocarditis caused by Helcococcus kunzii in a vascular patient: a case report and literature review.
abstract: BACKGROUND
  Helcococcus kunzii is a facultative anaerobic bacterium that was first described by Collins et al. in 1993, and was initially considered as a commensal of the human skin, in particular of lower extremities. Human infections caused by H. kunzii remain rare with only a few cases published in the pubmed database. Nevertheless recent reports indicate that this microorganism has to be considered as an opportunistic pathogen that can be involved in severe infections in human. To the best of our knowledge, we describe here the first known case of infectious endocarditis caused by H. kunzii.
  
  
  METHODS
  A 79 year-old man reporting severe polyvascular medical history attended the emergency ward for rapid deterioration of his general state of health. After physical examination and paraclinical investigations, the diagnosis of infectious endocarditis on native mitral valve caused by Helcococcus kunzii was established based on Dukes criteria. MALDI-TOF mass spectrometry and 16S rDNA sequencing allowed an accurate identification to the species level of Helcococcus kunzii. The patient was successfully treated by a medico-surgical approach. The treatment consisted in intravenous amoxicillin during four weeks and mitral valve replacement with a bioprosthestic valve. After an in depth review of patient's medical file, the origin of infection remained unknown. However, a cutaneous portal of entry cannot be excluded as the patient and his General Practitioner reported chronic ulcerations of both feet.
  
  
  CONCLUSIONS
  We describe here the first case of endocarditis caused by H. kunzii in an elderly patient with polyvascular disease. This report along with previous data found in the literature emphasizes the invasive potential of this bacterial species as an opportunistic pathogen, in particular for patient with polyvascular diseases. MALDI-TOF mass spectrometry and 16S rDNA sequencing are reliable tools for H. kunzii identification. We also sequenced in this work H.kunzii type strain 103932T CIP and deposited in the Genbank under accession number KM403387. We noticed a 14 base difference between our sequence and the original sequence deposited by Collins et al. under Genbank accession number X69837. Hopefully, the spread of next generation sequencing tools would lead to a more accurate classification of clinical strains.
authors.affiliation: Department of Bacteriology at Nice Academic Hospital, Nice, France. lotte.r@chu-nice.fr.|Nice Medical University, Nice-Sophia Antipolis University, Nice, France. lotte.r@chu-nice.fr.
authors.forename: Romain
authors.initials: R
authors.lastname: Lotte
authors.affiliation: Department of Bacteriology at Nice Academic Hospital, Nice, France. lotte.l@chu-nice.fr.
authors.forename: Laurène
authors.initials: L
authors.lastname: Lotte
authors.affiliation: Department of Bacteriology at Nice Academic Hospital, Nice, France. degand.n@chu-nice.fr.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Degand
authors.affiliation: Department of Bacteriology at Nice Academic Hospital, Nice, France. gaudart.a@chu-nice.fr.
authors.forename: Alice
authors.initials: A
authors.lastname: Gaudart
authors.affiliation: Department of Medical Biology, Monaco Princess Grace General Hospital, Monaco, Monaco. sgabriel@chpg.mc.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Gabriel
authors.affiliation: Department of Cardiology, Monaco Princess Grace General Hospital, Monaco, Monaco. mona_lisa_69@hotmail.fr.
authors.forename: Mouna
authors.initials: M
authors.lastname: Ben H'dech
authors.affiliation: Department of Bacteriology at Nice Academic Hospital, Nice, France. blois.m@chu-nice.fr.
authors.forename: Mathilde
authors.initials: M
authors.lastname: Blois
authors.affiliation: Department of Cardiology, Monaco Princess Grace General Hospital, Monaco, Monaco. jrinaldi@chpg.mc.
authors.forename: Jean-Paul
authors.initials: JP
authors.lastname: Rinaldi
authors.affiliation: Department of Bacteriology at Nice Academic Hospital, Nice, France. ruimy.r@chu-nice.fr.|Nice Medical University, Nice-Sophia Antipolis University, Nice, France. ruimy.r@chu-nice.fr.
authors.forename: Raymond
authors.initials: R
authors.lastname: Ruimy
mesh_terms: D000368:Aged; D017544:Aortic Aneurysm, Abdominal / Q000150:complications; D002340:Carotid Artery Diseases / Q000150:complications; D004275:DNA, Ribosomal / Q000235:genetics*; D004697:Endocarditis, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D016523:Foot Ulcer / Q000150:complications; D016908:Gram-Positive Bacterial Infections / Q000150:complications / Q000175:diagnosis* / Q000382:microbiology; D059014:High-Throughput Nucleotide Sequencing; D006801:Humans; D008297:Male; D008943:Mitral Valve; D017202:Myocardial Ischemia / Q000150:complications; D010462:Peptostreptococcus / Q000235:genetics* / Q000302:isolation & purification; D019032:Spectrometry, Mass, Matrix-Assisted Laser Desorption-Ionization
chemical_list: D004275:DNA, Ribosomal