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Journal of Investigative Medicine High... 2018is a rare causative pathogen of infective endocarditis that results in a high risk of embolic events. The mortality rate for endocarditis is high. Old age and...
is a rare causative pathogen of infective endocarditis that results in a high risk of embolic events. The mortality rate for endocarditis is high. Old age and underlying urologic conditions are the best-known risk factors for infection. We report the clinical course of the disease in a 49-year-old man who presented symptoms of a urinary tract infection. A few days later, transthoracic echocardiography showed a conspicuous mitral valve with myxomatous alterations. Following the detection of a cerebral embolism with associated stroke symptoms, as well as at the beginning of cardiac failure, the emergency indication for the surgical treatment of mitral valve endocarditis was given. On the second day following the operation, circulatory collapse rapidly developed. Following an unsuccessful attempt at cardiopulmonary resuscitation, the patient died. From 1991 to 2017, 29 cases of -induced endocarditis have been described in PubMed and Medline. One or 2 new cases are published annually. We review all reported cases of endocarditis, with an emphasis on the predisposing factors, course, and outcomes of the disease. endocarditis is a rare disease primarily affecting elderly men with urinary tract pathologies and comorbidities. The course of the disease is severe, and the outcome is often fatal. A 16S rDNA polymerase chain reaction investigation of bacterial genome provides proof of the presence of . Because of the high risk of embolism, rapid treatment should focus on the diseased heart valve. Based on existing data and the experience gained from handling cases, treatment with β-lactam and aminoglycosides is recommended. It is also recommended that operative therapy take place as soon as possible.
PubMed: 29511694
DOI: 10.1177/2324709618758351 -
Federal Practitioner : For the Health... Dec 2022(), considered a rare pathogen, has been identified with increasing frequency in urine cultures. Only 8 cases of spondylodiscitis due to have been reported. Optimal...
BACKGROUND
(), considered a rare pathogen, has been identified with increasing frequency in urine cultures. Only 8 cases of spondylodiscitis due to have been reported. Optimal treatment for invasive infection is undefined. However, the reported cases were treated successfully with diverse antibiotic regimen combinations, all including a β-lactam and beginning with at least 2 weeks of IV antibiotics.
CASE PRESENTATION
A 74-year-old man presented to the emergency department after 2 weeks of midthoracic back pain, lower extremity weakness, gait imbalance, fatigue, anorexia, rigors, and subjective fevers. The patient was presumed to have discitis secondary to a urinary tract infection with possible pyelonephritis and was given empiric vancomycin and ceftriaxone. Spinal magnetic resonance imaging with contrast supported spondylodiscitis. Preliminary results from the admission blood and urine cultures showed gram-positive cocci in clusters.
CONCLUSIONS
urinary tract infection in the absence of obvious predisposing factors should prompt evaluation for urinary outflow obstruction. We suspect a review of a US Department of Veterans Affairs population might uncover a higher incidence of infection than previously suspected.
PubMed: 37025983
DOI: 10.12788/fp.0340 -
European Journal of Pediatrics Feb 2023Aerococcus urinae (A. urinae) is primarily recognized as a common pathogen in the geriatric population, causing urinary tract infection (UTI), sepsis, and endocarditis,...
Aerococcus urinae (A. urinae) is primarily recognized as a common pathogen in the geriatric population, causing urinary tract infection (UTI), sepsis, and endocarditis, predominantly in female patients. In the paediatric population, only a few case reports exist suggesting A. urinae causes malodorous urine in otherwise healthy boys. In this study, we investigated the spectrum of clinical and laboratory presentations of A. urinae detection in children. A retrospective, single-centre, case series including all patients with the detection of A. urinae during a 7-year study period. Patients with detection of A. urinae only in non-urogenital skin swabs were excluded. A total of 40 samples from 33 patients were identified of which 20 patients were included in the final analysis. The median (IQR) age was 6.8 (2.9-9.5) years; 18 (90%) patients were boys. Four patients were diagnosed with a UTI, six had malodorous urine without UTI, three were diagnosed with balanitis and seven showed A. urinae colonization in the urine culture. Urogenital disorders were present in 12 patients. Additional pathogens were detected in 13 patients. Recurrence of detection during our study period was observed in four (20%) patients. Conclusion: Beyond malodorous urine, A. urinae detection is associated with more severe presentations including UTI in the paediatric population. Pre-existing urogenital disorders were frequent, and therefore, a nephro-urological investigation should be considered in all cases of A. urinae detection in the paediatric population. What is Known: • Aerococcus urinae (A. urinae) is known to be a common pathogen in the geriatric population, causing urinary tract infection (UTI), sepsis, and endocarditis, predominantly in female patients. • In the paediatric population, A. urinae is mainly described as a low-grade pathogen. Some case reports describe A. urinae as the cause of extraordinary malodorous urine in otherwise healthy boys. What is New: • Beyond malodorous urine, A. urinae detection is associated with more severe presentations including UTI in the paediatric population. • A. urinae was mainly detected in boys with pre-existing urogenital disorders; therefore, a nephro-urological investigation should be considered in cases of A. urinae detection in the paediatric population.
Topics: Aged; Male; Humans; Child; Female; Retrospective Studies; Anti-Bacterial Agents; Microbial Sensitivity Tests; Urinary Tract Infections; Aerococcus; Sepsis; Endocarditis; Urinary Tract; Gram-Positive Bacterial Infections
PubMed: 36472648
DOI: 10.1007/s00431-022-04730-2 -
Proceedings (Baylor University. Medical... 2022is an alpha-hemolytic, gram-positive coccus that is responsible for 54/1,000,000 cases of all urinary tract infections. Risk factors include male gender, advanced age,...
is an alpha-hemolytic, gram-positive coccus that is responsible for 54/1,000,000 cases of all urinary tract infections. Risk factors include male gender, advanced age, and genitourinary tract abnormalities. It has often been misidentified as or due to its morphological similarities. Fewer than 50 cases of infective endocarditis have been reported, most affecting the mitral or aortic valve. We present the case of a 61-year-old woman who presented with recurrent fevers and worsening dyspnea on exertion and was found to have bacteremia. A transesophageal echocardiogram showed evidence of moderate tricuspid valve regurgitation and vegetations involving its posterior and septal leaflets. The patient was successfully treated with intravenous penicillin G for 6 weeks. She was not deemed a candidate for cardiac surgery.
PubMed: 35754564
DOI: 10.1080/08998280.2022.2054042 -
The American Journal of Case Reports May 2020BACKGROUND Initially presumed as nonpathogenic, the bacterial genus aerococcus now includes 7 distinct virulent and avirulent species. Aerococcus urinae first isolated... (Review)
Review
BACKGROUND Initially presumed as nonpathogenic, the bacterial genus aerococcus now includes 7 distinct virulent and avirulent species. Aerococcus urinae first isolated in 1992 is an uncommon cause of urinary tract infection (UTI) and is seen in only 0.15% to 0.8% of cases. A. urinae associated invasive bacteremia and systemic infection are extremely rare entities. Less than 50 cases of A. urinae associated with infective endocarditis (IE) have been reported in the literature, with the prevalence being 3 per 1 million. CASE REPORT A 59-year-old male presented to our hospital with exertional dyspnea and new-onset atrial flutter. Prior to his current admission patient was treated for A. urinae associated UTI with levofloxacin for 10 days. A transthoracic echocardiogram revealed severe aortic regurgitation with aortic valve endocarditis, which was subsequently confirmed on transesophageal echocardiogram. Blood cultures displayed gram-positive cocci in clusters, ultimately identified as A. urinae. The patient was treated with intravenous vancomycin and underwent surgical aortic valve replacement along with patch repair for underlying aortic wall ulcer. CONCLUSIONS To the best of our knowledge, this is the first-ever reported case of A. urinae associated IE complicated by an aortic wall ulcer. Male gender, age >65 years, and preexisting urinary tract pathology have all been implicated as risk factors for aerococcus infection. A. urinae is almost always sensitive to penicillin, carbapenem, and aminoglycosides.
Topics: Aerococcus; Aortic Valve; Aortic Valve Insufficiency; Atrial Fibrillation; Dyspnea; Echocardiography; Echocardiography, Transesophageal; Endocarditis; Humans; Male; Middle Aged; Risk Factors; Ulcer
PubMed: 32437335
DOI: 10.12659/AJCR.920974 -
The Open Microbiology Journal 2017and are relatively newcomers and emerging organisms in clinical and microbiological practice. Both species have worldwide been associated with urinary tract...
BACKGROUND
and are relatively newcomers and emerging organisms in clinical and microbiological practice. Both species have worldwide been associated with urinary tract infections. More rarely cases of bacteremia/septicemia and infective endocarditis have been reported. Treatment options are therefore important. Just recently, European recommendations on susceptibility testing and interpretive criteria have been released.
OBJECTIVE
In this investigation 120 and isolates were tested for susceptibility to six antimicrobial agents: Penicillin, cefotaxime, meropenem, vancomycin, linezolid, and rifampicin.
METHODS
Three susceptibility testing methods were used; disk diffusion according to The European Committee on Antimicrobial Susceptibility Testing (EUCAST) standardized disk diffusion methodology and MIC determination with Etest and broth microdilution (BMD). All testing was performed with EUCAST media for fastidious organisms.
RESULTS
Data obtained in this study were part of the background data for establishing EUCAST breakpoints. MIC values obtained by Etest and BMD were well correlated with disk diffusion results.
CONCLUSION
All isolates were found susceptible to all six antimicrobial agents: penicillin, cefotaxime, meropenem, vancomycin, linezolid, and rifampicin.
PubMed: 29151992
DOI: 10.2174/1874285801711010160 -
Journal of Medical Case Reports Nov 2022Aerococcus urinae is a bacterium of emerging clinical interest that most commonly causes urinary tract infections (UTI) but can also result in invasive infections. It is...
BACKGROUND
Aerococcus urinae is a bacterium of emerging clinical interest that most commonly causes urinary tract infections (UTI) but can also result in invasive infections. It is a catalase-negative, alpha-haemolytic gram-positive coccus that grows in clusters or tetrads and usually causes urinary tract infections. While rare, infective endocarditis must be considered when A. urinae is isolated in blood culture. The mortality rate of A. urinae infective endocarditis is similar to overall endocarditis mortality. We report a rare case of aortic root abscess caused by A. urinae.
CASE PRESENTATION
An 82-year-old Caucasian man presented to hospital with behavioural change and severe malnutrition and was managed for psychotic depression. On day 34 of his inpatient stay, a febrile episode prompted blood cultures, which grew Aerococcus. urinae. Investigations revealed a bicuspid aortic valve, aortic valve endocarditis and aortic root abscess. He also had prostatomegaly. He underwent aortic valve replacement, received 6 weeks of intravenous ceftriaxone and recovered.
CONCLUSION
Infective endocarditis should be considered in patients with persistent Aerococcus urinae bacteraemia. Accurate identification with mass spectrometry is recommended to avoid misidentification as staphylococcus, streptococcus or enterococcus, which is a possibility with conventional laboratory methods.
Topics: Male; Humans; Aged, 80 and over; Aerococcus; Abscess; Gram-Positive Bacterial Infections; Endocarditis, Bacterial; Endocarditis; Urinary Tract Infections; Stomatognathic Diseases
PubMed: 36397095
DOI: 10.1186/s13256-022-03564-8 -
The American Journal of Case Reports Oct 2022BACKGROUND Aerococcus species are a rare cause of endocarditis. Micro-organism identification and antibiotic choice can pose significant management challenges to...
BACKGROUND Aerococcus species are a rare cause of endocarditis. Micro-organism identification and antibiotic choice can pose significant management challenges to clinicians who care for patients with this infection. Aerococcus is a gram-positive micro-organism which is commonly misidentified because it shares many similarities with streptococcus and enterococcus species. Aerococcus urinae is usually found to cause urinary tract infections and occurs more frequently in patients with structural urinary tract abnormalities associated with urethral and ureteral obstruction such as kidney stones, phimosis, and prostate hyperplasia. However, it is reported to rarely cause endocarditis. CASE REPORT A 48-year-old man with a history of cocaine abuse and right hip replacement presented to our emergency department with acute encephalopathy. Through a complicated hospital course, he was found to be septic and the bacteria were initially misidentified as an alpha-hemolytic strep before being correctly identified as Aerococcus urinae. He was found to have multiple cerebral, likely septic, embolic infarcts and aortic valve endocarditis. Identification of the micro-organism on blood cultures was challenging, as were decisions about antibiotic choice. He died despite efforts of a multidisciplinary care team. CONCLUSIONS Our case highlights a unique case of Aerococcus endocarditis and shows the difficulty in initially identifying the bacteria. To our knowledge this is the first case reported in the setting of substance abuse. It also highlights the lack of appropriate guideline-directed therapy with regards to antibiotic choices in this group of patients, emphasizing the importance of further research in this regard.
Topics: Aerococcus; Anti-Bacterial Agents; Aortic Valve; Endocarditis; Endocarditis, Bacterial; Gram-Positive Bacterial Infections; Humans; Male; Middle Aged; Sepsis
PubMed: 36251625
DOI: 10.12659/AJCR.937596 -
Journal of Microscopy and Ultrastructure 2021is a Gram-positive, catalase- and oxidase-negative, microaerophilic, nonmotile bacteria species rarely associated with human infections such as arthritis, bacteremia,...
INTRODUCTION
is a Gram-positive, catalase- and oxidase-negative, microaerophilic, nonmotile bacteria species rarely associated with human infections such as arthritis, bacteremia, endocarditis, and meningitis. The bacteria are also often confused with streptococci species or treated as a contaminant.
PATIENTS AND METHODOLOGY
We conducted a retrospective, observational cohort study on all patients with isolates in blood samples from July 2010 to June 2019. All categorical data were presented as counts and proportions, whereas continuous data were presented as median and interquartile ranges.
RESULTS
A total of 20 isolates were identified over the study period of 9 years. Of these, was isolated in 10 (50%), in 6 (30%), and (not speciated) in 4 (20%). The median age was 74.3 years (12 males and 8 females). The two most frequent presentations were fever (15 of 20) and altered mentation (6 of 15). Most of the patients (11 of 15) had at least one predisposing comorbidity related to the urinary tract system (8 with recurrent urinary tract infection, 7 with urinary incontinence, 3 with an indwelling catheter, 2 with renal stones, and 1 each with benign prostatic hyperplasia and a recent cystoscopy). The median white blood cell count was 18,426 cells/mL, median hemoglobin 10.96 g/dL, median platelet count 191,000 cells/μL, median blood urea nitrogen 28.6 mg/dL, and median creatinine 1.54 mg/dL. The urinary tract was the most likely source of bacteremia (10 of 20) based on either imaging findings (5 cases), positive urine culture for (4 cases), or instrumentation history (1 case). In the rest, the cause of bacteremia could not be found. Endocarditis was suspected in 9 out of 20 patients. Transthoracic echocardiography/transesophageal echocardiography (TEE) confirmed 3 cases (2 aortic valves, 1 mitral valve and pacemaker). Interestingly, one case had septic emboli causing a right frontal stroke with a normal TEE and normal Doppler study for deep venous thrombosis. Blood cultures were positive in 35% (7 of 20) with polymicrobial growth, 3 with coagulase-negative staphylococci, 2 with , and the other 2 each with and Of the 20 cases, 9 and 10 required intensive care unit level care and vasopressor support, respectively. Most of the patients were treated for 5-14 days except the 3 cases with infective endocarditis (IE). The median hospital stay duration was 6.55 days with 2 fatalities (2 out of 20 patients).
CONCLUSION
Old age and underlying urologic conditions are the best-known risk factors for infection. Recent advances in diagnostic technology have led to an increase in detection of -related infections. The rare occurrence of in human infections and resultant lack of randomized control trials have resulted in a significant degree of clinical uncertainty in the management of IE.
PubMed: 33850708
DOI: 10.4103/JMAU.JMAU_61_19 -
Infection and Immunity Oct 2010The Gram-positive bacterium Aerococcus urinae can cause infectious endocarditis (IE) in older persons. Biofilm formation and platelet aggregation are believed to...
The Gram-positive bacterium Aerococcus urinae can cause infectious endocarditis (IE) in older persons. Biofilm formation and platelet aggregation are believed to contribute to bacterial virulence in IE. Five A. urinae isolates from human blood were shown to form biofilms in vitro, and biofilm formation was enhanced by the presence of human plasma. Four of the A. urinae isolates caused platelet aggregation in platelet-rich plasma from healthy donors. The Au3 isolate, which induced platelet aggregation in all donors, also activated platelets, as determined by flow cytometry. Platelet aggregation was dependent on bacterial protein structures and on platelet activation since it was sensitive to both trypsin and prostaglandin E(1). Plasma proteins at the bacterial surface were needed for platelet aggregation; and roles of the complement system, fibrinogen, and immunoglobulin G were demonstrated. Complement-depleted serum was unable to support platelet aggregation by Au3 and complement blockade using compstatin-inhibited platelet activation. Platelet activation by Au3 was inhibited by blocking of the platelet fibrinogen receptor, and this isolate was also shown to bind to radiolabeled fibrinogen. Removal of IgG from platelet-rich plasma by a specific protease inhibited the platelet aggregation induced by A. urinae, and blockade of the platelet FcRγIIa hindered platelet activation induced by Au3. Convalescent-phase serum from a patient with A. urinae IE transferred the ability of the bacterium to aggregate platelets in an otherwise nonresponsive donor. Our results show that A. urinae exhibits virulence strategies of importance for IE.
Topics: Aerococcus; Biofilms; Blood Platelets; Complement System Proteins; Endocarditis, Bacterial; Fibrinogen; Humans; Immunoglobulin G; Plasma; Platelet Activation; Virulence
PubMed: 20696834
DOI: 10.1128/IAI.00469-10