title: Neisseria elongata subsp elongata infective endocarditis following endurance exercise.
abstract: A 31-year-old Argentinian woman presented with a 3-week history of fever, night sweats, myalgia and lethargy following a work trip to Uganda where she ran a marathon. Malarial screens were negative but C reactive protein, erythrocyte sedimentation rate and neutrophil count were raised and she was anaemic. A new pansystolic murmur was heard over the mitral valve and the transthoracic echocardiogram showed a large vegetation (>1 cm) with at least moderate mitral regurgitation. Blood cultures grew Neisseria elongata, subsp elongata treated initially with ceftriaxone then oral ciprofloxacin to complete 4 weeks of treatment. CT scan revealed a wedge-shaped area of low attenuation in the spleen in keeping with a splenic infarct. Seven days postadmission, the patient underwent a successful mitral valve repair. Recovery was complicated by a likely embolic infarct in the right frontal lobe, but the patient was discharged 12 days postoperative with no neurological sequelae.
authors.affiliation: King's College Hospital, London, UK.
authors.forename: Joanne May
authors.initials: JM
authors.lastname: Jenkins
authors.affiliation: Department of Microbiology, King's College Hospital, London, UK.
authors.forename: Amanda
authors.initials: A
authors.lastname: Fife
authors.affiliation: Department of Cardiothoracic Surgery, King's College Hospital, London, UK.
authors.forename: Max
authors.initials: M
authors.lastname: Baghai
authors.affiliation: Department of Cardiology, King's College Hospital, London, UK.
authors.forename: Rafal
authors.initials: R
authors.lastname: Dworakowski
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002443:Ceftriaxone / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000627:therapeutic use; D004452:Echocardiography; D004697:Endocarditis, Bacterial / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D005260:Female; D006801:Humans; D058386:Mitral Valve Annuloplasty; D008944:Mitral Valve Insufficiency / Q000175:diagnosis* / Q000209:etiology / Q000601:surgery; D042805:Neisseria elongata / Q000302:isolation & purification*; D016870:Neisseriaceae Infections / Q000175:diagnosis* / Q000188:drug therapy; D010807:Physical Endurance; D012420:Running; D013159:Splenic Infarction / Q000175:diagnosis* / Q000209:etiology; D014195:Travel; D014454:Uganda; D006113:United Kingdom
chemical_list: D000900:Anti-Bacterial Agents; D002939:Ciprofloxacin; D002443:Ceftriaxone