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First case of infective endocarditis caused by Helicobacter cinaedi
BACKGROUND: Up to 20% of all infective endocarditis are blood culture-negative and therefore a diagnostic challenge. Here we present the case of an infective endocarditis due to Helicobacter cinaedi finally diagnosed using different molecular methods. This highly fastidious gram-negative spiral rod...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
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BioMed Central
2014
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4243372/ https://www.ncbi.nlm.nih.gov/pubmed/25403102 http://dx.doi.org/10.1186/s12879-014-0586-0 |
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author | Bartels, Hanni Goldenberger, Daniel Reuthebuch, Oliver Vosbeck, Juerg Weisser, Maja Frei, Reno Bättig, Veronika |
author_facet | Bartels, Hanni Goldenberger, Daniel Reuthebuch, Oliver Vosbeck, Juerg Weisser, Maja Frei, Reno Bättig, Veronika |
author_sort | Bartels, Hanni |
collection | PubMed |
description | BACKGROUND: Up to 20% of all infective endocarditis are blood culture-negative and therefore a diagnostic challenge. Here we present the case of an infective endocarditis due to Helicobacter cinaedi finally diagnosed using different molecular methods. This highly fastidious gram-negative spiral rod is increasingly recognized as a human pathogen, above all in immunocompromised patients. So far H. cinaedi has been associated with bacteremia, cellulitis, arthritis and meningitis. CASE PRESENTATION: A 71-year-old man presented with fever and progressive dyspnea for weeks. He was immunocompromised by long-term steroid therapy. As one major and two minor Duke’s criteria (vegetation, fever and aortic valve stenosis as predisposition) were present, an infective endocarditis was suspected and an empiric therapy with amoxicillin/clavulanic acid and gentamicin was established. The persistent severe aortic regurgitation resulted in a valve replacement. Histological evaluation of the aortic valve showed a polypous-ulcerative endocarditis. Gram stain and culture remained negative. Broad-range bacterial PCR targeting the 16S rRNA gene on the biopsy of the aortic valve identified H. cinaedi as the causative agent. The antibiotic therapy was simplified accordingly to ceftriaxone and gentamicin with a recommended duration of 6 weeks. Ten days after valve replacement the patient was discharged. To complete our molecular finding, we sequenced nearly the complete 16S rRNA gene (accession number KF914917) resulting in 99.9% identity with H. cinaedi reference sequences. Based on this result, 2 species-specific PCR tests amplifying part of the ctd gene were established and applied to the valve specimen. The 2 PCRs confirmed H. cinaedi. In addition, we analyzed stool, urine and saliva from the patient using H. cinaedi PCR. The fecal and urine specimen showed a positive signal, saliva was PCR-negative. CONCLUSION: We identified H. cinaedi as causative agent of a culture-negative endocarditis in an immunocompromised patient using broad-range and specific PCR. In addition to 2 cases from Japan presented on international meetings in 2010 and 2013, our case report shows that H. cinaedi should be recognized as additional causative organism of infective endocarditis. The use of molecular diagnostic techniques proved to be a powerful complement for the detection of blood culture-negative infective endocarditis. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12879-014-0586-0) contains supplementary material, which is available to authorized users. |
format | Online Article Text |
id | pubmed-4243372 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2014 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-42433722014-11-26 First case of infective endocarditis caused by Helicobacter cinaedi Bartels, Hanni Goldenberger, Daniel Reuthebuch, Oliver Vosbeck, Juerg Weisser, Maja Frei, Reno Bättig, Veronika BMC Infect Dis Case Report BACKGROUND: Up to 20% of all infective endocarditis are blood culture-negative and therefore a diagnostic challenge. Here we present the case of an infective endocarditis due to Helicobacter cinaedi finally diagnosed using different molecular methods. This highly fastidious gram-negative spiral rod is increasingly recognized as a human pathogen, above all in immunocompromised patients. So far H. cinaedi has been associated with bacteremia, cellulitis, arthritis and meningitis. CASE PRESENTATION: A 71-year-old man presented with fever and progressive dyspnea for weeks. He was immunocompromised by long-term steroid therapy. As one major and two minor Duke’s criteria (vegetation, fever and aortic valve stenosis as predisposition) were present, an infective endocarditis was suspected and an empiric therapy with amoxicillin/clavulanic acid and gentamicin was established. The persistent severe aortic regurgitation resulted in a valve replacement. Histological evaluation of the aortic valve showed a polypous-ulcerative endocarditis. Gram stain and culture remained negative. Broad-range bacterial PCR targeting the 16S rRNA gene on the biopsy of the aortic valve identified H. cinaedi as the causative agent. The antibiotic therapy was simplified accordingly to ceftriaxone and gentamicin with a recommended duration of 6 weeks. Ten days after valve replacement the patient was discharged. To complete our molecular finding, we sequenced nearly the complete 16S rRNA gene (accession number KF914917) resulting in 99.9% identity with H. cinaedi reference sequences. Based on this result, 2 species-specific PCR tests amplifying part of the ctd gene were established and applied to the valve specimen. The 2 PCRs confirmed H. cinaedi. In addition, we analyzed stool, urine and saliva from the patient using H. cinaedi PCR. The fecal and urine specimen showed a positive signal, saliva was PCR-negative. CONCLUSION: We identified H. cinaedi as causative agent of a culture-negative endocarditis in an immunocompromised patient using broad-range and specific PCR. In addition to 2 cases from Japan presented on international meetings in 2010 and 2013, our case report shows that H. cinaedi should be recognized as additional causative organism of infective endocarditis. The use of molecular diagnostic techniques proved to be a powerful complement for the detection of blood culture-negative infective endocarditis. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12879-014-0586-0) contains supplementary material, which is available to authorized users. BioMed Central 2014-11-18 /pmc/articles/PMC4243372/ /pubmed/25403102 http://dx.doi.org/10.1186/s12879-014-0586-0 Text en © Bartels et al.; licensee BioMed Central Ltd. 2014 This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly credited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated. |
spellingShingle | Case Report Bartels, Hanni Goldenberger, Daniel Reuthebuch, Oliver Vosbeck, Juerg Weisser, Maja Frei, Reno Bättig, Veronika First case of infective endocarditis caused by Helicobacter cinaedi |
title | First case of infective endocarditis caused by Helicobacter cinaedi |
title_full | First case of infective endocarditis caused by Helicobacter cinaedi |
title_fullStr | First case of infective endocarditis caused by Helicobacter cinaedi |
title_full_unstemmed | First case of infective endocarditis caused by Helicobacter cinaedi |
title_short | First case of infective endocarditis caused by Helicobacter cinaedi |
title_sort | first case of infective endocarditis caused by helicobacter cinaedi |
topic | Case Report |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4243372/ https://www.ncbi.nlm.nih.gov/pubmed/25403102 http://dx.doi.org/10.1186/s12879-014-0586-0 |
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