Aerococcus urinae endocarditis: A report of two cases and review of literature

ABSTRACT

BACKGROUND: Aerococcus urinae is a rare pathogen of endocarditis with high rates of embolic events, valvular damage and mortality.CASE 1:A 24 y/o male, with mitral valve prolapse, presented with recurrent fever and body malaise for four months. ?-hemolytic streptococci was isolated in his blood 3 months prior, antibiotics for 10 days temporarily relieved his symptoms. He denied illicit drug use, recent dental, genitourinary manipulations. On admission, he was febrile with a 4/6 holosystolic murmur at the apex. He had leukocytosis and elevated acute phase reactants. Blood cultures: Aerococcus urinae. A TEE revealed: ruptured chordae and vegetation at the posterior mitral valve leaflet. Gentamicin for 14 days and Ceftriaxone for 28 days was completed. Mitral valve replacement was done and LV dimension returned to normal.CASE 2:A 51 y/o male presented with 9 days of fever, chills, and malaise. He was treated with norfloxacin with no relief of symptoms. On admission, he was febrile, with a grade 2/6 holosystolic murmur at the apex and left parasternal area. He had leukocytosis and blood culture grew Aerococcus urinae. Echocardiogram showed mitral stenosis, aortic stenosis and vegetations at the mitral valve and non coronary cusp. Pen-G plus Gentamicin for 14 days and upon discharge, amoxicillin for 2 weeks was completed.DISCUSSION: Risk factors associated with A. urinae endocarditis are >65 year s of age, male, urologic abnormalities, malignancy and diabetes. Diagnosis isusually made by culture as our cases and both were found to have vegetations by echocardiography. B-lactam and amino glycoside treatment is effective and although mortality is high, both patients improved and were discharged.CONCLUSION: A. urinae endocarditis does occur in a young population and to those without urologic abnormality.