Prosthetic Valve Endocarditis Due to Neisseria skkuensis, a Novel Neisseria Species

Abstract

eWe describe the first reported case of endocarditis due to Neisseria skkuensis. The organism from the blood cultures taken on admission day was identified initially as unidentified Gram-negative cocci by Vitek2. Finally, it was identified as Neisseria skkuensis by 16 rRNA gene sequence analysis. CASE REPORTA 41-year-old man was admitted to our hospital with a 1-week history of febrile sense, chills, sweating, aggravation of dyspnea, and hypotension during hemodialysis. He had a complicated history, including liver cirrhosis caused by chronic hepatitis B infection and chronic kidney disease due to glomerulonephritis. He had received entecavir since 2009 and hemodialysis since 2000. In addition to these, he had undergone a mechanical mitral valve replacement due to infective endocarditis caused by methicillinresistant Staphylococcus aureus more than 1 year ago. He denied having had dental treatment or drug abuse since mitral valve replacement.On arrival at the emergency department, the patient's vital signs were as follows: blood pressure, 86/52 mm Hg; respiratory rate, 22 breaths per min; and temperature, 37°C. Physical examination revealed metallic heart sounds without murmur and no abdominal tenderness with positive shifting dullness. A chest radiography showed cardiomegaly and pulmonary edema. Laboratory investigations revealed a C-reactive protein concentration of 10.0 mg/dl (normal [N], Ͻ0.3 mg/dl), an erythrocyte sedimentation rate of 37 mm/h (N, Ͻ22 mm/h), and a procalcitonin concentration of 152.2 ng/ml. The white blood cell (WBC) count was 9,850/mm 3 with dominant segmented neutrophils (85%), hemoglobin (Hb) at 7.5 g/dl, platelet count of 57,000/mm 3 , blood urea nitrogen at 49.5 mg/dl, creatinine at 6.55 mg/dl (N, Ͻ1.3 mg/dl), and total bilirubin at 1.2 mg/dl (N, Ͻ1.5 mg/dl). He was coagulopathic with a prothrombin time of 23

Acute Cellulitis Caused byNeisseria skkuensis

“…In clinical point of view, previous studies showed that N. skkuensis would be an important pathogen in immunocompromised patients. Our patient had liver cirrhosis and hepatic cellular carcinoma, similar with the case of Park et al [8] which had liver cirrhosis and chronic kidney disease, other than diabetes mellitus. It is certain that this novel species is an important opportunistic pathogen in patients with underlying diseases such as diabetes mellitus and liver cirrhosis.…”

“…Previous reports described N. skkuensis infections in diabetic foot ulcer and endocarditis with underlying disorders such as diabetes and liver cirrhosis, respectively [7][8][9]. We report the first case of cellulitis due to N. skkuensis in the patient with liver cirrhosis and hepatic cellular carcinoma who was diagnosed incidentally.…”

“…skkuensis infection in liver cirrhosis, N. skkuensis was isolated from blood of the patient with liver cirrhosis due to chronic hepatitis B infection and chronic kidney disease caused by glomerulonephritis [8]. In that case, the patient received mitral valve replacement due to infective endocarditis caused by methicillin-resistant Staphylococcus aureus more than 1 year ago, but the patient was diagnosed as prosthetic valve endocarditis due to N. skkuensis which was identified by the molecular methods.…”

Non-pathogenic Neisseria: members of an abundant, multi-habitat, diverse genus

“…Notably, although Neisseria polysaccharea is the most evolutionarily related species to N. meningitidis and N. gonorrhoeae (Bennett et al, 2013;Bennett et al, 2014), there are far fewer case reports for disease caused by this species compared with N. lactamica and N. cinerea. Visceral botryomycosis: 20-year-old male with chronic granulomatous disease Washburn et al (1985) N. sicca Endocarditis: 17 cases mostly associated with mitral valve replacement Sommerstein et al (2013) Meningitis: 44-year-old female following intracranial haemorrhage and ventriculostomy tube placement Carter et al (2007) Conjunctivitis: 79-year-old female with no history of trauma or surgery Eser et al (2014) N. skkuensis Fever and foot ulcer: 50-year-old male with type 2 diabetes, suffering from complications Lee et al (2010) Prosthetic valve endocarditis: 41-year-old male with liver cirrhosis, chronic kidney disease, 1 year after a mechanical mitral valve replacement due to endocarditis caused by MRSA Park et al (2012) N. cinerea Peritonitis: 38-year-old male with type 2 diabetes, 2 years after end-stage renal disease and CAPD Taegtmeyer et al (2006) Neonatal conjunctivitis: new born, from mother during birth Bourbeau et al (1990) Bacteraemia: 47-year-old male, underlying ethanol abuse and polymicrobial sepsis Southern & Kutscher (1987) Commensal Neisseria Some Neisseria species have been reported to be bona fide animal pathogens (Table 2). In mammals, N. animaloris (EF-4a) and N. zoodegmatis (EF-4b) cause disease in animals within the Felidae family, including more than ten cases of disease in cats (Baral et al, 2007;Corboz et al, 1993;McParland et al, 1982), two Chinese leopards, a lion and a tiger cub (Fenwick et al, 1983;Lloyd & Allen, 1980;Perry & Schlingman, 1988).…”