Vertebral Osteomyelitis and Endocarditis of a Pacemaker Lead Due to Granulicatella ( Abiotrophia ) adiacens

Abstract

Systemic infection due to Granulicatella (formerly Abiotrophia), a species of nutrition-deficient gram-positive cocci, is rare. We present the case of a 68-year-old diabetic male who presented with back pain and a history of fever and chills. Imaging studies revealed vertebral osteomyelitis of the Th 10/11 region. Transesophageal echocardiography disclosed a vegetation adjacent to the pacemaker lead and blood cultures grew Granulicatella adiacens. A diagnosis of vertebral osteomyelitis and endocarditis due to G. adiacens was made and the patient improved with bed rest and medical treatment alone. Granulicatella ssp. should always be part of the differential diagnosis of fastidious bacteria in vertebral osteomyelitis and endocarditis.

Granulicatella adiacensBacteremia in an Elderly Trauma Patient

“…Granulicatella also has the ability to bind to fibronectin, facilitating intravascular infections, including endocarditis [17]. Infections with Granulicatella have been reported in a wide variety of settings, including the central nervous system [20,24], joints [23,26], osteomyelitis [27], tubo-ovarian abscess [22], peritonitis [18,19], and a breast implant [21]. Resistance to beta-lactam and macrolide antibiotics has been described [28,29].…”

“…Many reported infections involved immunocompromised patients, and the most common infections were sepsis and endocarditis, with more than 20 such cases reported [14][15][16][17]. The organism also has been associated with meningitis, osteomyelitis, peritonitis, various abscesses, pneumonia, and severe infections of foreign bodies such as pacemaker wires or prosthetic valves [18][19][20][21][22][23][24][25][26][27]. A common pattern of reported cases of infection with this species are high pharmacologic failure rates and a high mortality rate [14,25].…”

Granulicatella infection: diagnosis and management

“…Cases have been reported for both G. adiacens (Chang et al, 2008;Christensen et al, 1999;Jeng et al, 2005;Lin & Hsu, 2007;Perkins et al, 2003;Hernando Real et al, 2007;Rosenthal et al, 2002;Schwede et al, 2007;Vandana et al, 2010;Woo et al, 2003) and G. elegans (Al-Tawfiq et al, 2007;Casalta et al, 2002;Ohara-Nemoto et al, 2005;Roggenkamp et al, 1998). These include infections of prosthetic valves (Christensen et al, 1999;Jeng et al, 2005;Schwede et al, 2007) and of pacemaker leads (Rosenthal et al, 2002). Locally, four cases of endocarditis were identified, in two of which the patients had known cardiac abnormalities.…”

“…adiacens has been reported to cause septic arthritis (Hepburn et al, 2003;Riede et al, 2004), vertebral osteomyelitis (Rosenthal et al, 2002;Fukuda et al, 2010;Heath et al, 1998) and discitis (Heath et al, 1998). There are also reports of infections of breast implants (del Pozo et al, 2008) and of peritoneal dialysis related peritonitis (Altay et al, 2008).…”

Granulicatella spp.

“…Granulicatella adiacens es el microorganismo más frecuentemente aislado, siendo G. elegans un hallazgo infrecuente 10 . Si bien la EI es la presentación clínica no odontológica más frecuente, también se ha asociado a bacteriemias no asociadas a endocarditis 10,14-16 , sepsis neonatal por transmisión en canal del parto 17 , infección de prótesis aórtica abdominal 9 , infección de catéter tunelizado para hemodiálisis tipo Tesio 9 , absceso cerebral 18 , meningitis 19 , artritis séptica 20 , osteomielitis vertebral 21,22 , prótesis mamaria 23 y catéter de peritoneo diálisis 24 . En cuanto al estudio de susceptibilidad, la recomendación es no realizarla mediante difusión en disco, sino que por método de microdilución 25 .…”