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Aortic Prosthetic Valve Endocarditis Caused by an Unusual Microorganism, Gemella sanguinis

Tiu, Ceres T. MD*; Lin, Yu Shia MD*; Speciale, Peter PhD; Shetty, Vijay MD; Ghitan, Monica MD*; Chapnick, Edward K. MD*

Infectious Diseases in Clinical Practice: January 2012 - Volume 20 - Issue 1 - p 85–87
doi: 10.1097/IPC.0b013e31821d317d
Case Reports

Introduction We report the first case of prosthetic valve endocarditis caused by Gemella sanguinis.

Case A 27-year-old woman with a history of rheumatic heart disease with mechanical aortic and mitral valve replacements reported a recent toothache treated with amoxicillin, with improvement. Several days later, she began to have intermittent fever, weakness, sore throat, and palpitations. A transesophageal echocardiogram revealed a 1.0-cm vegetation and suggestion of a perivalvular abscess, and blood culture grew Gemella sanguinis. The patient underwent a successful valve repair, and treatment with ceftriaxone was continued for a total of 6 weeks from the date of valve replacement.

Discussion and Conclusion Gemella species are bacterial flora of the oropharyngeal, gastrointestinal, and/or urogenital tracts of humans. Most cases of native valve endocarditis reported have been attributed to G morbillorum and G haemolysans. The identification of Gemella isolates is a challenge. 16S ribosomal RNA gene sequencing was used as the method of choice for identifying Gemella; however, with the updated Vitek 2 colorimetric cards, Streptococcaceae including Gemella species were better identified. General principles of therapy for Gemella species are the same as for the nutritionally variant streptococci. Our patient had reported a toothache, and oral infection confirmed by dental evaluation was the likely source of bacteremia and endocarditis. Current recommendations for care at completion of treatment of endocarditis include a thorough dental evaluation. We suggest that oral health should be evaluated even before placement of the prosthesis.

From the *Division of Infectious Diseases, †Department of Clinical Microbiology, and ‡Division of Cardiology, Maimonides Medical Center, Brooklyn, NY.

Correspondence to: Ceres T. Tiu, MD, Division of Infectious Diseases, Maimonides Medical Center, 4719 Fort Hamilton Parkway, Brooklyn, NY 11219. E-mail:

The authors have no funding or conflicts of interest to disclose.

© 2012 Lippincott Williams & Wilkins, Inc.