A patient with a congenital bicuspid aortic valve was initially seen with C hominis bacterial meningitis. Septic emboli from an underlying endocarditis were probably the source of the infection. Cardiobacterium hominis : Endocarditis Manifesting as Bacterial Meningitis. Arch Intern Med. Coronavirus Resource Center. All Rights Reserved.

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Metrics details. Cardiobacterium is a fastidious Gram-negative bacillus, and is a rare human pathogen in clinical settings. Herein, we describe a case of Cardiobacterium valvarum C. A year-old woman who had a history of gingivitis developed into infective endocarditis due to the infection of C.

The indicators of patient tended to be normal until the abrupt cerebral hemorrhage occurred on day 15 after operation. This is the first well-described case of C. We reported the first case of C. The genus Cardiobacterium encompasses two species, Cardiobacterium valvarum C. Therefore, the clinical characteristics of C. Identification of C. In this work, we present a case of infective endocarditis in a year-old woman with mitral and tricuspid valve insufficiency. Two weeks ago, she visited a dentist for gingivitis, which was successfully controlled with antibiotics and drainage therapies.

Her primary diagnosis of admission to hospital is valvular disease. And at initial presentation, the patient had a body temperature of Upon physical examination, diastolic murmurs were heard along the left sternal border, loudest in the third or fourth left intercostal space. Serum rheumatoid factor RF was elevated Low serum albumin level Blood cultures were sampled after admission aerobic and anaerobic bottles; two sets of cultures.

The chest X-ray plain film showed cardiac image enlargement, obviously in left atrium, right ventricle and left ventricle, together with bilateral pulmonary congestion Fig. In addition, severe mitral regurgitation, and tricuspid valve prolapse, together with moderate regurgitation and pulmonary hypertension were also observed, indicating infectious endocarditis Fig.

At the same period, the computerized tomography CT scan of the brain was performed and showed mild ischemia at bilateral basal ganglia Fig. Image examination of the patient. And then, the patient received MVR, TVP and vegetation removal operation under general anesthesia on day 7 of admission. The coagulation test and the platelet aggregation function test were normal on admission.

Blood cultures kept negative since the antibiotic treatments. After aforementioned treatment, the patient did not have a fever, cough, dyspnea or chest pain, under a stable condition, except complaining about slight dizziness and headache infrequently. An urgent computerized tomography CT scan of the brain showed large high intensity areas at right frontal lobe, parietal lobe and temporal lobe that indicated spontaneous cerebral hemorrhage and broken into bilateral ventricles combined with hernia, together with subarachnoid hemorrhage Fig.

An urgent large craniectomy hematoma operation was performed on the day, and then the patient was transferred to the intensive care unit for observation.

During the surgery, a neoplasm 1. After the urgent large craniectomy hematoma operation, the patient fell into a stupor. Necessary nursing and treatment were kept, but the patient remained in a coma. During the long-term mechanical ventilation of intensive care unit, the patient obtained the lung infection of Acinetobacter baumannii. After the infection was controlled, the patient was transferred to the neurology department for continued nutrition support therapy.

Microscopy of the blood culture fluid identified small, rounded at both ends, Gram-negative, pleomorphic bacillus, often arranged in clusters Fig. Colonies were similar, being small, round, opaque, smooth, grey and weakly alpha-hemolytic on blood agar plates Fig. In order to clarify the source of pathogens, the oral cavity swab and valvular vegetations were cultured, while no target pathogens were found.

However, some small, Gram-negative bacillus in the valvular vegetations slides were found by microscopy Fig. The C. The genus Cardiobacterium is fastidious, Gram-negative bacillus, normal upper respiratory flora in humans, which encompasses two species: Cardiobacterium valvarum C.

The phenotypic profiles of the two species are very similar, so it is difficult to identify by conventional methods. In contrast to C. All the published C. As in the previous cases published, our case developed infectious endocarditis as well, and large, devastating valvular vegetations formed, which had been reported as the characteristic change in HACEK bacteria [ 1 , 2 , 4 , 19 ].

Initial presentation of previous patients was often non-specific and without fever. Notably, an abrupt cerebral hemorrhage with herniation occurred in this case, and an intravascular thrombus was found in the right temporal lobe, never reported before.

Other neurological complications were common in the previous cases including cerebral infarction [ 1 , 4 , 6 ], subarachnoid hemorrhage [ 4 , 7 , 9 ], cerebral vasculitis [ 1 ] and cerebral embolization [ 2 ]. Neurological sequelae may be another clinical feature of C. In order to clarify the source of pathogens, the oral cavity swab and valvular vegetations were cultured, while no positive findings. This may be the reason that conventional bacterial cultures are not suitable for the growth of target bacteria, as well as the experience of isolating this pathogen is lacking.

However, we found some small, Gram-negative bacillus in the valvular vegetations slides by microscopy, which further indicated that C. To understand the true clinical picture of C.

In this case, analysis using 16S rRNA gene sequences showed the strains isolated from blood had Cardiobacterium valvarum has been reported to be susceptible to many antibiotics. Oral anticoagulation is essential to prevent thromboembolic events TEs especially for the patients with mechanical heart valves. On the other hand, anticoagulation therapy is also associated with an increased risk of bleeding complications.

Studies showed that the patients treated by warfarin would stay in the safest condition with INRs between 2. In China, Zhang et al. In our case, the patient had cerebral hemorrhage in the right frontal—temporal, parietal, and an intravascular thrombus in the right temporal lobe during the oral anticoagulation treatments.

The INRs throughout anticoagulation therapy were 1. In the meantime, platelet showed sustained increase throughout anticoagulation therapy together with the high platelet aggregation function.

So we suspected that the patient stayed in a hypercoagulative state before cereal bleeding event, which lead to the thrombus.

As the secondary event, the bleeding occurred due to the extreme consumption of coagulation factors and platelets after thrombus. Above all, it is important to control the INR within the appropriate range carefully, pay close attention to the blood pressure and coagulation function state after mechanical valve replacement. In summary, our case of C. Cerebral vasculitis and Cardiobacterium valvarum endocarditis. J Med Microbiol. Cardiobacterium hominis and Cardiobacterium valvarum : two case stories with infective episodes in pacemaker treated patients.

Open Microbiol J. Endocarditis caused by Cardiobacterium valvarum. J Clin Microbiol. Aortic vascular graft infection caused by Cardiobacterium valvarum : a case report. J Infect Chemother. Fatal bioprosthetic aortic valve endocarditis due to Cardiobacterium valvarum.

Endocarditis with ruptured cerebral aneurysm caused by Cardiobacterium valvarum sp. Nonsurgical management of mitral valve endocarditis due to Cardiobacterium valvarum in a patient with a ventricular septal defect. Detection of Cardiobacterium valvarum in a patient with aortic valve infective endocarditis by broad-range PCR. Endocarditis due to a novel Cardiobacterium species. Ann Intern Med. Bicuspid aortic valve endocarditis due to Cardiobacterium valvarum : case report and review of literature.

Infect Dis Clin Pract. Ann Thorac Cardiovasc Surg. Nisbet M, Lang S. Cardiobacterium species. Antimicrobial therapy and vaccines. New York: Apple Trees Productions; Google Scholar. Ongoing revolution in bacteriology: routine identification of bacteria by matrix-assisted laser desorption ionization time-of-flight mass spectrometry. Clin Infect Dis. Jpn J Infect Dis. Ribosomal DNA sequencing: experiences from use in the Danish national reference laboratory for identification of bacteria.

Nihon Naika Gakkai Zasshi. J Jpn soc Intern Med. Han XY, Falsen E. Characterization of oral strains of Cardiobacterium valvarum and emended description of the organism. Low standard oral anticoagulation therapy for Chinese patients with St. Jude mechanical heart valves. Chin Med J. The effects of a low international normalized ratio on thromboembolic and bleeding complications in patients with mechanical mitral valve replacement.

J Cardiothorac Surg.



There are 61 reported cases of C. There is one reported case of C. Presented here are two cases of C. Patients with C.

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Haemophilus species account for the largest number of such infections in children, followed by K kingae , then A actinomycetemcomitans [ 2 , 3 ]. In children, we found no published reports of E corrodens endocarditis and only 2 reports of C hominis endocarditis; 1 in a year-old in the United Kingdom and the other in a 3-year-old in Japan [ 4 , 5 ]. To our knowledge, we describe here the first reported case of endocarditis due to C hominis in a child in the western hemisphere, and, for this infection, the unique occurrence of a large pulmonary vessel mycotic aneurysm. The patient was a 4-year-old male with DiGeorge syndrome, developmental delay and complex congenital heart disease. His heart disease consisted of tetralogy of Fallot with pulmonary atresia, small pulmonary arteries, and major aortopulmonary collaterals. He had hypoparathyroidism but had normal T-cell numbers and function.

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