Native Valve Infective Endocarditis with Osteomyelitis and Brain Abscess Caused byGranulicatella adiacenswith Literature Review

Abstract

Granulicatella adiacens is a type of NVS (nutritionally variant streptococci) rarely causing infective endocarditis (IE). NVS are fastidious and unable to sustain growth on routine culture media due to lack of specific nutrients. Endocarditis caused by NVS due to their virulence is associated with higher treatment failures and mortality rates. New antimicrobial susceptibility patterns are indicative of a significant rise in penicillin resistance and susceptibility differences between NVS subspecies. Initial empirical therapy is essential as a delay in using the appropriate agent leads to poor results. We present a case of an immunocompetent young female with recent intravenous drug abuse resulting in native mitral valve endocarditis with ruptured chordae tendineae and septic embolization, causing brain abscess and lumbar spine osteomyelitis. She was transferred to a tertiary center where she underwent mitral valve replacement successfully and treated with six weeks of intravenous vancomycin and ertapenem. To our knowledge, ours is the first case report of G. adiacens endocarditis in an adult with brain abscess and osteomyelitis with an excellent response to antibiotic therapy. Based on our case report, literature review, and new antimicrobial susceptibility patterns, updates to treatment guidelines are suggested to improve the therapeutic outcomes.

Granulicatella adiacens as an Unusual Cause of Empyema: A Case Report and Review of Literature

“…Using the inclusion and exclusion criteria, 24 literature were found relevant and included in the review. 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Clinical details of all published literature are compiled in the Table 1 . As per the review of literature of last 10 years, G. adiacens is found to be the cause of various infections such as bacteremia, endocarditis, osteomyelitis, septic arthritis, discitis, prosthetic joint infections, carbuncle, bacterascites (spontaneous bacterial peritonitis), dacryocystitis, and abscess.…”

Comparative Analyses of the Subgingival Microbiome in Chronic Periodontitis Patients with and without Gingival Erosive Oral Lichen Planus Based on 16S rRNA Gene Sequencing

“…In recent years, many cases of infection caused by Granulicatella species have been reported. In addition to the oral diseases mentioned above, a variety of infections are also involved, including bacteremia, infective endocarditis, brain abscess, central nervous system infection, and maxillary sinusitis [31][32][33]. It could give a hint that this bacterium closely relates to infection.…”

Internal jugular vein thrombosis associated withGranulicatella adiacens

“… 15 On the other hand, endovascular infection by G. adiacens is associated with its fibronectin-binding capacity, an essential process for endovascular bacterial adhesion during the formation of endocardial vegetations. 16 17 Although thromboembolism has not been reported with G. adiacens , its strong endovascular binding properties might contribute to the formation of IJV thrombophlebitis. However, further reports of thrombophlebitis associated with G. adiacens are needed to confirm its potential to cause venous thrombosis.…”