Endocarditis Due to Neisseria mucosa: Two Case Reports and Review

Ingram, R. J. H.; Cornere, B.; Rb, Ellis-Pegler

doi:10.1093/clinids/15.2.321

Cited by 25 publications

(16 citation statements)

References 13 publications

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“…Neisseria mucosa, originally described as Diplococcus mucosus by von Lingelsheim [7] in 1906, is a saprophytic organism that frequently colonizes the nasopharynx and rarely causes human infections [1,[3][4][5][6]. Neisseria species other than Neisseria meningitidis and Neisseria gonorrhoeae, such as Neisseria sicca, Neisseria subflava, Neisseria lactamica, Neisseria cinerea, and N. mucosa, are unusual pathogens in humans [1,2].…”

Section: Discussionmentioning

confidence: 99%

“…are generally susceptible to penicillin or ampicillin [1]. However, N. mucosa isolates vary in their penicillin sensitivity, and MICs range from 0.125 to 4.0 mg/l [3]. In addition, penicillin-resistant -lactamase producing N. mucosa strains with MICs for penicillin greater than 4 mg/l have been reported [2].…”

Section: Discussionmentioning

confidence: 99%

“…However, it may occasionally cause serious invasive disease, including endocarditis, meningitis, septic arthritis, ocular and urinary tract infection [1][2][3][4]. Peritonitis associated with N. mucosa is extremely rare: we have identified only two case reports of adults who developed peritonitis associated with this organism while receiving continuous ambulatory peritoneal dialysis (CAPD) [5,6].…”

Section: Introductionmentioning

confidence: 99%

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Peritonitis Due to Neisseria mucosa in an Adolescent Receiving Peritoneal Dialysis

et al. 2005

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Neisseria mucosa is part of the normal nasopharyngeal flora and rarely pathogenic in humans. Reports of serious infections associated with this pathogen are very unusual. A 17-year-old boy with end-stage renal disease due to IgA nephropathy presented with acute, spontaneous, symptomatic peritoneal dialysis-associated peritonitis without reported break in sterility or PD catheter exit site infection. beta-lactamase-negative N. mucosa was isolated from the dialysate effluent. Intraperitoneal antibiotic treatment with cephalothin/gentamicin for 5 days and subsequent ceftriaxone led to complete resolution of the infection. This case demonstrates that "non-pathogenic" Neisseria species can cause clinically severe peritonitis with high intraperitoneal neutrophil counts, elevated C-reactive protein levels in the peritoneal effluent (in the presented case, 27,600/mul and 3.6 mg/l, respectively) and impaired peritoneal membrane transport function. To our knowledge, this is the first case of N. mucosa peritonitis complicating chronic peritoneal dialysis in an adolescent patient.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Peritonitis Due to Neisseria mucosa in an Adolescent Receiving Peritoneal Dialysis

et al. 2005

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“…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).…”

mentioning

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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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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