Endocarditis Due to<i>Neisseria elongata</i>Subspecies<i>nitroreducens</i>: Case Report and Review

Dominguez, Edward A.; Smith, Theresa L.

doi:10.1086/517671

Cited by 26 publications

(23 citation statements)

References 4 publications

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“…5,10,11 Dental procedures can be a risk factor for IE, because N. elongata is part of the normal oropharyngeal flora. Neisseria elongata is typically susceptible to a wide range of antimicrobial agents, so prophylactic antibiotics should be recommended for high-risk patients (such as those with valvular or congenital heart disease) before they undergo dental procedures.…”

Section: Discussionmentioning

confidence: 99%

Infective Endocarditis Caused by Neisseria elongata on a Native Tricuspid Valve and Confirmed by DNA Sequencing

Yoo

Kang

Yoon³

et al. 2014

Texas Heart Institute Journal

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Neisseria elongata, a common oral bacterium, has been recognized as a cause of infections such as infective endocarditis, septicemia, and osteomyelitis. Neisseria-induced infective endocarditis, although infrequently reported, typically arises after dental procedures. Without antibiotic therapy, its complications can be severe. We report the case of a 27-year-old man who presented with fever, severe dyspnea, and a leg abscess from cellulitis. An echocardiogram showed a vegetation-like echogenic structure on the septal leaflet of the patient's native tricuspid valve, and an insignificant Gerbode defect. Three blood cultures grew gram-negative, antibiotic-susceptible coccobacilli that were confirmed to be N. elongata. Subsequent DNA sequencing conclusively isolated N. elongata subsp nitroreducens as the organism responsible for the infective endocarditis. The patient recovered after 21 days of antibiotic therapy. In addition to the patient's unusual case, we discuss the nature and isolation of N. elongata and its subspecies.

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Section: Discussionmentioning

confidence: 99%

Infective Endocarditis Caused by Neisseria elongata on a Native Tricuspid Valve and Confirmed by DNA Sequencing

Yoo

Kang

Yoon³

et al. 2014

Texas Heart Institute Journal

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“…The chest X-ray film did not show pulmonary infiltrates. Laboratory studies revealed the following values: hemoglobin, 89 g/liter (normal range, 120 to 150 g/liter); platelet count, 21,000/ mm 3 (normal range 150,000 to 400,000/mm 3 ); and C-reactive protein, 209 mg/liter (normal range, Ͻ5 mg/liter). Two sets of blood cultures (Vital; bioMérieux, Marcy l'Etoile, France) were performed.…”

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confidence: 99%

“…Nine days after the beginning of the chemotherapy (cisplatin-vinocelbine), he was leukopenic (leukocyte count of 300/mm 3 ), and he presented with fever (39°C), diarrhea, and pulmonary rhonchi. The chest X-ray film did not show pulmonary infiltrates.…”

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confidence: 99%

Utilization of 16S Ribosomal DNA Sequencing for Diagnosis of Septicemia Due to Neisseria elongata subsp. glycolytica in a Neutropenic Patient

et al. 2003

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Septicemia due to Neisseria elongata subsp. glycolytica occurs infrequently. We report a case of septicemia in a patient undergoing antimitotic chemotherapy. Gram-negative coccobacilli were isolated from blood cultures. The identity of the isolate by phenotypic methods was uncertain. In contrast, identity was confirmed by 16S ribosomal DNA sequencing, which appeared to be very useful for correct identification. CASE REPORTA 66-year-old retired male was admitted to the internal medicine unit of the hospital for a second antimitotic chemotherapy treatment for a squamous cell carcinoma. Nine days after the beginning of the chemotherapy (cisplatin-vinocelbine), he was leukopenic (leukocyte count of 300/mm 3 ), and he presented with fever (39°C), diarrhea, and pulmonary rhonchi. The chest X-ray film did not show pulmonary infiltrates. Laboratory studies revealed the following values: hemoglobin, 89 g/liter (normal range, 120 to 150 g/liter); platelet count, 21,000/ mm 3 (normal range 150,000 to 400,000/mm 3 ); and C-reactive protein, 209 mg/liter (normal range, Ͻ5 mg/liter). Two sets of blood cultures (Vital; bioMérieux, Marcy l'Etoile, France) were performed. Subsequently, empirical antimicrobial therapy was started with intravenous ceftazidime (1 g/8 h) plus intravenous ciprofloxacin (200 mg/12 h) as recommended in our hospital for neutropenic fever. The fever decreased in 24 h, but the patient suddenly died 8 days after the onset of the antimicrobial therapy.Gram-negative, aerobic, nonmotile coccobacilli were detected in two blood culture bottles after 2 days of incubation. Subcultures were performed, and growth was observed after 24 h of incubation with 5% CO 2 on plates containing chocolate, blood, and Trypticase soy agar (bioMérieux). The colonies were small (0.5 to 1 mm) and nonpigmented. No hemolysis on sheep or horse blood was observed. The organism was strictly aerobic and catalase and oxidase positive. Its growth was enhanced in a 5% CO 2 atmosphere. The glucose test result was ambiguous with the API NH assay (bioMérieux), but the oxidation of glucose was negative in medium supplemented with 1% carbohydrate (MEVAG; Bio-Rad, Marnes-la-Coquette, France). All tests were negative with the API NE strip (bioMérieux). The strain was negative for the following characteristics: urease, indole production, o-nitrophenyl-␤-D-galactopyranoside, growth on Simmons citrate, hydrolysis of Tween 80, accumulation of lipids after growth on ␤-hydroxybutyrate, and ␥-glutamyl transferase. It was asaccharolytic, resistant to the vibriostatic compound O/129, and did not reduce nitrate but did reduce nitrite. The phenylalanine deaminase reaction is dependent on the culture medium used (7). Therefore, to successfully utilize this test, the isolate was grown on various media (Mueller-Hinton, blood, and chocolate agar) prior to inoculation with a heavy inoculum into the phenylalanine deaminase solution. Pseudomonas aeruginosa and Proteus mirabilis were used as negative and positive controls, respectively.

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“…Among these, only seven opportunistic Neisseria species have been occasionally involved in infective endocarditis: Neisseria elongata subsp. nitroreducens (9,13,22), Neisseria elongata subsp. elongata (4,20), N. mucosa (7,17,26), N. cinerea (5), N. sicca (12,14,24), N. flavescens (25), and N. subflava (2,23).…”

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confidence: 99%

“…Those most frequently encountered are N. elongata subsp. nitroreducens (at least 27 cases) (9,13,22), N. mucosa (20 cases) (7,17,26), N. sicca (14 cases) (12,14,24), and N. subflava (12 cases) (2,23). Other species, such as N. elongata subsp.…”

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confidence: 99%

Endocarditis Due to a New Rod-Shaped Neisseria sp

et al. 2005

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We report the first case of pacemaker endocarditis due to a new rod-shaped Neisseria sp. isolated from blood culture. On the basis of rrs sequencing, the isolate was found to be most closely related to an uncultured organism from human subgingival plaque and was identified as Neisseria sp. group AK105. A cure was achieved after a combination of surgical and antibiotic treatment. Oral flora-induced pacemaker endocarditis is a rare condition that reinforces the need for good oral hygiene as an important preventive measure.Apart from Neisseria meningitidis and N. gonorrhoeae, which are primary pathogens, all other Neisseria species are considered commensal inhabitants of the oro-or nasopharynx of humans or animals. These Neisseria spp. have only sporadically been associated with human illness, such as meningitis, bacteremia, endocarditis, pericarditis, empyema, or pneumonia, as opportunistic pathogens (19). Among these, only seven opportunistic Neisseria species have been occasionally involved in infective endocarditis: Neisseria elongata subsp. nitroreducens (9,13,22), Neisseria elongata subsp. elongata (4,20), N. mucosa (7,17,26), N. cinerea (5), N. sicca (12,14,24), N. flavescens (25), and N. subflava (2, 23). While Neisseria species are typically gram-negative diplococci, there are some rod-shaped species such as N. elongata (6) and N. weaveri (3). We report the first case of pacemaker endocarditis with secondary arthritis localization due to a new rod-shaped Neisseria sp. It was identified by sequencing the rrs gene coding for the 16S rRNA gene.A 38-year-old man presented with acute pain in the left shoulder associated with local inflammatory signs. During the preceding 3 weeks, he had developed dizziness, myalgia, and intense shivers. The patient had had a grade I atrioventricular block detected in 1993 and had then been equipped with a permanent pacemaker system. On admission, physical examination revealed left sternoclavicular stiffness and pain with localized heat and erythema around the affected joint. The patient presented neither fever nor respiratory, cardiovascular, gastrointestinal, or neurological signs. He complained also about dental pain which had started a few weeks before, although teeth and gums seemed healthy. Laboratory investigations revealed an erythrocyte sedimentation rate (ESR) of 92 mm/h, a C-reactive protein (CRP) concentration of 149 mg/ liter, and a leukocyte count of 9.8 ϫ 10 9 /liter with 75% polymorphonuclear (PMN) cells. Urine culture was negative. Plain dental and maxillary sinus X rays were normal. Plain X rays and a computed tomography scan of the sternoclavicular joints showed left joint space widening due to a localized edema, joint effusion, soft tissue swelling, and left clavicle erosion.Forty-eight hours after admission, the patient developed an acute-onset fever up to 39°C, chills, and shivers. Initial transesophageal echocardiography visualized a small heterogeneous mass suggesting vegetation on the intracardiac portion of the pacing wire on the atrial septum. Three se...

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Endocarditis Due toNeisseria elongataSubspeciesnitroreducens: Case Report and Review

Cited by 26 publications

References 4 publications

Infective Endocarditis Caused by Neisseria elongata on a Native Tricuspid Valve and Confirmed by DNA Sequencing

Infective Endocarditis Caused by Neisseria elongata on a Native Tricuspid Valve and Confirmed by DNA Sequencing

Utilization of 16S Ribosomal DNA Sequencing for Diagnosis of Septicemia Due to Neisseria elongata subsp. glycolytica in a Neutropenic Patient

Endocarditis Due to a New Rod-Shaped Neisseria sp

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