Logo American Journal of Case Reports

Call: 1.631.629.4328
Mon-Fri 10 am - 2 pm EST

Contact Us

Logo American Journal of Case Reports Logo American Journal of Case Reports Logo American Journal of Case Reports

20 November 2020: Articles  Vietnam

A Case of Bacteremia and Prosthetic Valve Endocarditis in a 68-Year-Old Vietnamese Man

Management of emergency care, Rare disease

Pham Dang Hai1ABDEF, Pham Nguyen Son2AEF, Nguyen Thi Thu Huong3EF, Nguyen Thanh Binh1BF, Le Thi Viet Hoa4ABDEF*, Nguyen Manh Dung1EF

DOI: 10.12659/AJCR.925752

Am J Case Rep 2020; 21:e925752

0 Comments

Abstract

BACKGROUND: Streptococcus thoraltensis is a rare cause of human disease. This report describes a patient with infective endocarditis caused by S. thoraltensis and complicated by ischemic stroke.

CASE REPORT: A 68-year-old man was admitted for a 12-day duration of fever. He had a history of severe aortic valve stenosis, for which he underwent prosthetic valve replacement, and type 2 diabetes mellitus. Echocardiography revealed vegetation attached to the right coronary cusp of the prosthetic aortic valve and rupture of the sinus of Valsalva into the right ventricle. Blood cultures were positive for S. thoraltensis. He experienced an ischemic stroke involving the vegetation of the aortic valve and died of acute heart failure.

CONCLUSIONS: S. thoraltensis may be considered an emerging pathogen in patients with infective endocarditis.

Keywords: Communicable Diseases, Emerging, Endocarditis, Sepsis, Aged, Asians, Bacteremia, Diabetes Mellitus, Type 2, Endocarditis, Bacterial, Heart Valve Prosthesis, Streptococcus

Background

Streptococcus thoraltensis is an unusual species of streptococci, originally isolated from the intestinal tract of swine [1]. Although rarely isolated from humans, S. thoraltensis has been identified in samples from patients with pneumonia, chorioamnionitis, and septicemia [2–4]. The role of S. thoraltensis as the pathogenic bacteria in humans remains poorly understood. This report describes a patient with infective endocarditis due to S. thoraltensis.

Case Report

A 68-year-old man with a fever for 12 consecutive days and highest body temperature of 39.5°C was admitted to our hospital in Vietnam. He had a history of type 2 diabetes mellitus and aortic valve stenosis, for which he underwent prosthetic valve replacement 2 years earlier. He did not report chest pain, shortness of breath, weight loss, or joint pain. He had not been in recent contact with pigs or rabbits and had not undergone a dental procedure or surgical intervention within 6 months before admission.

On examination, the patient’s temperature was 38°C, his heart rate was 80/min, his respiratory rate was 18/min, his blood pressure was 120/70 mmHg, and his oxygen saturation was 92% in room air. A physical examination revealed normal lung sounds and a 3/6 pansystolic murmur at the lower left border of the sternum. The results of other clinical examination were unremarkable.

Initial laboratory analysis showed leukocytosis with a white blood cell (WBC) count of 13.9×109/L, including 92.7% neutrophils, a hemoglobin concentration of 129 g/L, thrombocytopenia with a platelet counts of 138×109/L, hyperglycemia with a glucose concentration of 19.1 mmol/L, and a procalcitonin concentration of 0.613 ng/ml.

Transthoracic and transesophageal echocardiography revealed a 12×8 mm vegetation attached to the right coronary cusp of the prosthetic aortic valve and rupture of the sinus of Valsalva into the right ventricle.

Blood was drawn for culturing 3 times every 12 hours and he was started on empirical antibiotic therapy with linezolid 600 mg twice daily plus levofloxacin 750 mg once daily. He was also administered insulin 30/70 of 30 UI daily for blood glucose control. The Vitek 2 automated system showed that 3 individual blood cultures were positive for S. thoraltensis (probability, 99%). Based on the antibiogram, he was maintained on the same antibiotic regimen (Table 1).

Seven day later, he experienced sudden left hemiparesis and left facial palsy, with a Glasgow score of 12. Urgent computed tomography of the brain revealed an acute ischemic stroke due to middle cerebral artery M1 occlusion. The patient underwent mechanical thrombectomy successfully. On day 15, he was no longer febrile, his WBC count was 9.9×109 L, with 75.9% neutrophils, and his blood culture was negative.

On day 27, he presented with severe dyspnea, tachycardia, and hypotension. Endotracheal intubation was performed, and he was treated with inotropic agents and diuretics. However, he experienced a sudden cardiac arrest and died on day 30.

Discussion

S. thoraltensis is a gram-positive coccus first isolated from the intestinal tracts of swine in 1997 [1]. Although this rare streptococcal species had been detected in human specimens [5,6], its pathogenic role in humans is uncertain.

The first reported human infection with S. thoraltensis was in 2015, in a patient with chorioamnionitis who had a father with a history of occupational exposure to pigs [2]. A patient with pneumonia and bacteremia caused by S. thoraltensis was reported in 2019 [3], as was a patient with sepsis caused by S. thoraltensis [4].

The vegetation in the prosthetic aortic valve of our patient was large, measuring (12×8 mm). Vegetations larger than 10 mm have been reported to increase the risk of embolism, suggesting that a large vegetation is a risk factor for embolic events [7].

S. thoraltensis is susceptible to chloramphenicol, clindamycin, erythromycin, levofloxacin, tigecycline, and vancomycin, but resistant to ampicillin, oxacillin, cefotaxime, ceftriaxone, and gentamicin [8,9].

Conclusions

S. thoraltensis is an animal pathogen rarely seen in humans. S. thoraltensis should be considered a rare emerging pathogen that can cause infective endocarditis in humans.

References:

1.. Devriese LA, Pot B, Vandamme P: Int J Syst Bacteriol, 1997; 47(4); 1073-77

2.. Vukonich M, Moline H, Chaussee M: S D Med, 2015; 68(7); 298-99

3.. Wazir M, Grewal M, Jain AG, Everett G: Cureus, 2019; 11(9); e5659

4.. Petridis N, Apsemidou A, Kalopitas G: Case Rep Infect Dis, 2018; 2018; 7956890

5.. AlWakeel SS, Microbiological and molecular identification of bacterial species isolated from nasal and oropharyngeal mucosa of fuel workers in Riyadh, Saudi Arabia: Saudi J Biol Sci, 2017; 24(6); 1281-87

6.. Al-Tamimi M, Himsawi N, Abu-Raideh J: Microb Drug Resist, 2019; 25(3); 421-26

7.. Mohananey D, Mohadjer A, Pettersson G, Association of vegetation size with embolic risk in patients with infective endocarditis: A systematic review and meta-analysis: JAMA Intern Med, 2018; 178(4); 502-10

8.. Dhotre S, Suryawanshi N, Nagoba B: Indian J Dent, 2014; 5(Suppl.); 140-41

9.. Bustami N, Mismar A, Obeidat F: J Clin Case Rep, 2019; 9(2); 1212

SARS-CoV-2/COVID-19

29 June 2022 : Case report  USA

A Clinical Case of COVID-19 Vaccine-Associated Guillain-Barré Syndrome

Am J Case Rep In Press; DOI: 10.12659/AJCR.936896  

16 June 2022 : Case report  Ecuador

Multidrug-Resistant Klebsiella pneumoniae in a Patient with SARS-Cov-2 Pneumonia in an Intensive Care Unit ...

Am J Case Rep In Press; DOI: 10.12659/AJCR.936498  

13 June 2022 : Case report  Japan

Stenotrophomonas maltophilia Infection Associated with COVID-19: A Case Series and Literature Review

Am J Case Rep In Press; DOI: 10.12659/AJCR.936889  

13 June 2022 : Case report  Saudi Arabia

Atlantoaxial Subluxation Secondary to SARS-CoV-2 Infection: A Rare Orthopedic Complication from COVID-19

Am J Case Rep In Press; DOI: 10.12659/AJCR.936128  

In Press

30 Jun 2022 : Case report  China (mainland)

Septic Shock Induced by Acute Pyelonephritis Resulting from Kidney Stones Treated by Double-J Ureteral Sten...

Am J Case Rep In Press; DOI: 10.12659/AJCR.936967  

30 Jun 2022 : Case report  USA

A Clinical Case of COVID-19 Vaccine-Associated Guillain-Barré Syndrome

Am J Case Rep In Press; DOI: 10.12659/AJCR.936896  

29 Jun 2022 : Case report  Kuwait

A Challenging Case of Jejunal Dieulafoy’s Lesion: A Rare Cause of Refractory Lower-Gastrointestinal Bleeding

Am J Case Rep In Press; DOI: 10.12659/AJCR.936313  

29 Jun 2022 : Case report  USA

A Rare Case of Synchronous Intraductal Papillary Mucinous Neoplasm-Associated Pancreatic Adenocarcinoma and...

Am J Case Rep In Press; DOI: 10.12659/AJCR.935242  

Most Viewed Current Articles

23 Feb 2022 : Case report  USA

Penile Necrosis Associated with Local Intravenous Injection of Cocaine

DOI :10.12659/AJCR.935250

Am J Case Rep 2022; 23:e935250

17 Feb 2022 : Case report  Oman

Myocarditis, Pulmonary Hemorrhage, and Extensive Myositis with Rhabdomyolysis 12 Days After First Dose of P...

DOI :10.12659/AJCR.934399

Am J Case Rep 2022; 23:e934399

06 Dec 2021 : Case report  Brazil

Lipedema Can Be Treated Non-Surgically: A Report of 5 Cases

DOI :10.12659/AJCR.934406

Am J Case Rep 2021; 22:e934406

09 Feb 2022 : Case report  Saudi Arabia

Extensive Cerebral Venous Sinus Thrombosis (CVST) After the First Dose of Pfizer-BioNTech BNT162b2 mRNA COV...

DOI :10.12659/AJCR.934744

Am J Case Rep 2022; 23:e934744

Your Privacy

We use cookies to ensure the functionality of our website, to personalize content and advertising, to provide social media features, and to analyze our traffic. If you allow us to do so, we also inform our social media, advertising and analysis partners about your use of our website, You can decise for yourself which categories you you want to deny or allow. Please note that based on your settings not all functionalities of the site are available. View our privacy policy.

American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923