ABSTRACT
A fatal case of Erysipelothrix rhusiopathiae mitral valve endocarditis is described in a 45 years old male, with a history of chronic alcohol abuse and without animals contact. He presented intermittent fever, polyarthralgia, weight loss, and low back pain. In blood cultures (2 bottles), gram-positive pleomorphic rods grew after 48 hours of incubation. The subculture on blood agar media showed a small, alpha-hemolytic colony, catalase and oxidase negative, PYR and LAP positive and the production of H2S in triple sugar iron agar, was demonstrated. The isolate was initially identified as E. rhusiopathiae, and confirmed by API Coryne (BioMérieux). On the basis of these findings and a transthoracic echocardiogram, an endocarditis was confirmed. Intravenous ampicillin and gentamicin treatment was initiated. The patient became afever, nevertheless he died on day 19 after admission as a consequence of acute pulmonary edema. Susceptibility testing by E-test showed that the microorganism was resistant to vancomycin and gentamicin, and susceptible to penicillin and cefotaxime. We emphasize the importance to consider the isolates of gram-positive pleomorphic rods, catalase and oxidase negative, and the addition of H2S production test in TSI medium. Vancomycin-resistance helps in the identification, and to establish the correct antimicrobial therapy. Although E. rhusiopathiae is usually reported as an occupational pathogen, the contact with pigs and other farm animals may be underestimated.
Subject(s)
Endocarditis, Bacterial/microbiology , Erysipelothrix Infections/microbiology , Erysipelothrix/isolation & purification , Mitral Valve/microbiology , Alcoholism/complications , Ampicillin/therapeutic use , Deafness/complications , Diabetes Mellitus, Type 2/complications , Drug Resistance, Multiple, Bacterial , Drug Therapy, Combination , Endocarditis, Bacterial/diagnosis , Endocarditis, Bacterial/diagnostic imaging , Endocarditis, Bacterial/drug therapy , Erysipelothrix/drug effects , Erysipelothrix Infections/diagnosis , Erysipelothrix Infections/drug therapy , Fatal Outcome , Gentamicins/therapeutic use , Humans , Male , Middle Aged , Mitral Valve/diagnostic imaging , Pulmonary Edema/etiology , UltrasonographyABSTRACT
The bacterial species Erysipelothrix rhusiopathiae is found worldwide as a commensal or a pathogen in a variety of animals. One well-defined pattern of human infection is an uncommon bacteremic form, with or without cutaneous involvement, usually complicated by endocarditis. We report the case of a 38-year-old male butcher with E. rhusiopathiae bacteremia, native aortic valve endocarditis and perivalvular abscess. The patient was released after six weeks of intravenous ceftriaxone and aortic valve replacement because of severe regurgitation.
Subject(s)
Abscess/microbiology , Bacteremia/complications , Endocarditis, Bacterial/microbiology , Erysipelothrix Infections/complications , Heart Valve Diseases/microbiology , Abscess/drug therapy , Adult , Aortic Valve/microbiology , Aortic Valve Insufficiency/microbiology , Aortic Valve Insufficiency/surgery , Bacteremia/drug therapy , Ceftriaxone/therapeutic use , Cephalosporins/therapeutic use , Endocarditis, Bacterial/drug therapy , Erysipelothrix Infections/drug therapy , Heart Valve Diseases/drug therapy , Heart Valve Diseases/surgery , Heart Valve Prosthesis Implantation , Humans , MaleABSTRACT
The bacterial species Erysipelothrix rhusiopathiae is found worldwide as a commensal or a pathogen in a variety of animals. One well-defined pattern of human infection is an uncommon bacteremic form, with or without cutaneous involvement, usually complicated by endocarditis. We report the case of a 38-year-old male butcher with E. rhusiopathiae bacteremia, native aortic valve endocarditis and perivalvular abscess. The patient was released after six weeks of intravenous ceftriaxone and aortic valve replacement because of severe regurgitation (AU)