Identification of Cardiobacterium hominis by Broad-Range Bacterial Polymerase Chain Reaction Analysis in a Case of Culture-Negative Endocarditis

Nikkari, Simo; Gotoff, Robert; Bourbeau, Paul P.; Brown, Robert E.; Kamal, Nazmi; Relman, David A.

doi:10.1001/archinte.162.4.477

Cited by 26 publications

(18 citation statements)

References 9 publications

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“…In conclusion, although the detection of C. hominis in the resected heart valve materials has already been reported (8,15,16), this is the first report of direct detection of the abovementioned bacterium in the serum of a patient with endocarditis. C. hominis has historically been associated with culturenegative infective endocarditis due to its fastidious growth requirements, but recent improvements in blood culture systems and blood culture medium formulations have resulted in improved recovery of this pathogen.…”

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confidence: 65%

Direct Detection of Cardiobacterium hominis in Serum from a Patient with Infective Endocarditis by Broad-Range Bacterial PCR

Gatselis¹,

Malli

Papadamou³

et al. 2006

J Clin Microbiol

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Bacterial DNA was detected directly in the serum of a patient with endocarditis by broad-range 16S rRNA PCR followed by sequencing and analysis of the results by the BLAST search. Using these methods, Cardiobacterium hominis was identified in 2 days from the date of serum collection. The microorganism was also isolated and identified using conventional methods (bacterial culture and biochemical tests) 17 days from the date of sample collection. This is the first report showing the direct detection of C. hominis in a patient's serum using molecular-based methods, emphasizing their potential usefulness as additional and rapid diagnostic tools for the detection and identification of fastidious bacteria. CASE REPORTA 62-year-old man with a past history of arterial hypertension was admitted to our department because of a 3-week history of poor dietary intake, fatigue, weakness, diffuse abdominal discomfort, chills, and night sweats. His symptoms began after a short period of diarrhea and fever. He also reported a history of toothache and gum bleeding 4 weeks prior to admission. One week prior to his admission he was seen by his primary physician, who diagnosed viral infection. He had no previous history of cardiac murmur, heart disease, intravenous drug use, recent dental work, skin injury, or previous hospitalizations.On admission, physical examination revealed a temperature of 39°C, a heart rate of 105 beats per minute, 25 respirations per minute, and blood pressure of 160/70 mm Hg. He appeared pale and moderately ill but was not in acute distress. He had no subconjunctival, palatal, or subungual splinter hemorrhages, and his ocular fundi were normal. Dental caries was noted. There was no palpable peripheral adenopathy, but a spleen tip and a palpable liver were felt. Auscultation of the heart revealed a grade 2 of 6 at the apex of heart, without S3 sound or signs of heart failure. The remainder of the physical examination was unremarkable.A complete blood count revealed a white-blood-cell count of 14,400 cells/mm 3 , with 87% neutrophils, 5.5% lymphocytes, and 7.5% monocytes. Hemoglobin was 11.5 g/dl, and the platelet count was 262,000/mm 3 . Renal function testing revealed normal creatinine and blood urea levels. At that time, the erythrocyte sedimentation rate (ESR) was 62 mm in the first hour, C-reactive protein was 14.33 mg/dl, and fibrinogen was 597 mg/dl. Arterial blood gas analysis showed respiratory alkalosis with pH 7.503, 69 mm Hg PaO 2 , 26.2 mm Hg PaCO 2 , and 20.8 mmol/liter HCO 3 . A urine specimen was positive for hemoglobin (ϩϩϩ) and protein (ϩ); the sediment contained 4 to 6 red blood cells, 1 to 2 white cells per high-power field, and granular casts. Mild proteinuria (636 mg/24 h) was also present. His electrocardiogram showed sinus tachycardia. At entry, a two-dimensional trans-thoracic echocardiography showed normal valves without any obvious sign of valve vegetations and a left ventricular ejection fraction of 65 to 70%. Additional investigation included an abdominal ultrasonography, which con...

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confidence: 65%

Direct Detection of Cardiobacterium hominis in Serum from a Patient with Infective Endocarditis by Broad-Range Bacterial PCR

Gatselis¹,

Malli

Papadamou³

et al. 2006

J Clin Microbiol

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“…In addition, for Cardiobacterium hominis, a member of the HACEK group of bacteria, molecular approaches were shown to be useful. 36 Thus, there is no doubt that molecular techniques are valuable and necessary to establish a definitive IE diagnosis if fastidious and/or nonculturable microorganisms are involved. 37,38 Cases in which examination of the excised heart valve was negative despite the presence of positive blood cultures underline the importance of analyzing the appropriate section of the heart valve.…”

Section: Discussionmentioning

confidence: 99%

Impact of a Molecular Approach to Improve the Microbiological Diagnosis of Infective Heart Valve Endocarditis

et al. 2005

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Background-Even today, infective endocarditis (IE) remains a severe and potentially fatal disease demanding sophisticated diagnostic strategies for detection of the causative microorganisms. Despite the use of appropriate laboratory techniques, classic microbiological diagnostics are characterized by a high rate of negative results. Methods and Results-Broad-range polymerase chain reaction (PCR) targeting bacterial and fungal rDNA followed by direct sequencing was applied to excised heart valves (nϭ52) collected from 51 patients with suspected infectious endocarditis and from 16 patients without any signs of IE during an 18-month period. The sensitivity, specificity, and the positive and negative predictive values for the bacterial broad-range PCR were 41.2%, 100.0%, 100.0%, and 34.8%, respectively, compared with 7.8%, 93.7%, 80.0%, and 24.2% for culture and 11.8%, 100.0%, 100.0%, and 26.2% for Gram staining. Without exception, database analyses allowed identification up to the (sub)species level comprising streptococcal (nϭ13), staphylococcal (nϭ4), enterococcal (nϭ2), and other signature sequences such as Bartonella quintana and Nocardia paucivorans. Fungal ribosomal sequences were not amplified. All valve tissues of the reference group were negative for both PCR and conventional methods, except one sample that was contaminated by molds. Conclusions-Culture-independent molecular methods substantially improve the diagnostic outcome of microbiological examination of excised heart valves. Importantly, this was true not only for fastidious, slow-growing, and/or nonculturable microorganisms but also for easy-to-culture pathogens such as streptococci and staphylococci. Both patient management and empiric antibiotic therapy of IE are likely to benefit from improved knowledge of the spectrum of pathogens now causing IE.

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“…In our series, of a total of 427 cases of definite infectious endocarditis, according to the modified Duke criteria (10), 9 were caused by the HACEK group of bacteria. Of these, one case was caused by C. hominis, which was initially identified by biochemical tests and confirmed by 16S rRNA gene sequencing analysis (11), and one was caused by C. valvarum. Thus, physicians should be aware that C. valvarum is a potential agent of infectious endocarditis.…”

Section: Case Reportmentioning

confidence: 98%

“…The source of this bacterium is likely the oral flora, as is the case for C. hominis (7). In the scientific literature, 64 cases of C. hominis endocarditis have been reported (3,9,11,14,15). The lack of early recognition of C. valvarum reflects its rarity.…”

Section: Case Reportmentioning

confidence: 99%

Endocarditis Caused by Cardiobacterium valvarum

et al. 2006

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Identification of Cardiobacterium hominis by Broad-Range Bacterial Polymerase Chain Reaction Analysis in a Case of Culture-Negative Endocarditis

Cited by 26 publications

References 9 publications

Direct Detection of Cardiobacterium hominis in Serum from a Patient with Infective Endocarditis by Broad-Range Bacterial PCR

Direct Detection of Cardiobacterium hominis in Serum from a Patient with Infective Endocarditis by Broad-Range Bacterial PCR

Impact of a Molecular Approach to Improve the Microbiological Diagnosis of Infective Heart Valve Endocarditis

Endocarditis Caused by Cardiobacterium valvarum

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