Infective endocarditis due to Atopobium vaginae: a rare association between genital infection and endocarditis of the tricuspid valve

BMJ Case Rep. 2018 Sep 1;2018:bcr2018225871. doi: 10.1136/bcr-2018-225871.

Abstract

Atopobium vaginae is an anaerobic gram-positive organism associated with genitourinary infections. Bacteraemia is rare, with only two cases reported in the literature. This case describes an 18-year-old type 1 diabetic, presenting with sepsis and haemoptysis, on a background of poor dental hygiene and recurrent hospital admissions. Blood cultures grew A. vaginae and echocardiogram revealed a large tricuspid valve lesion. Despite medical therapy, symptoms of pulmonary emboli continued and she therefore underwent surgical resection of the lesion. Histopathological findings were of a vegetation; culture of the lesion was negative but 16S ribosomal PCR was positive, detecting 16S rRNA of A. vaginae The patient was treated with 4 weeks of vancomycin and made a good recovery. To our knowledge, this represents the first report of infective endocarditis due to this organism. We also provide a review of the literature, including comparing published drug susceptibility data with consensus breakpoints for antimicrobial agents.

Keywords: cardiothoracic surgery; infections; radiology (diagnostics); valvular disease.

Publication types

  • Case Reports

MeSH terms

  • Actinobacteria*
  • Adolescent
  • Anti-Bacterial Agents / therapeutic use
  • Diabetes Mellitus, Type 1*
  • Diagnosis, Differential
  • Echocardiography, Transesophageal
  • Endocarditis, Bacterial / blood
  • Endocarditis, Bacterial / diagnosis*
  • Endocarditis, Bacterial / diagnostic imaging
  • Endocarditis, Bacterial / drug therapy
  • Female
  • Gram-Positive Bacterial Infections / blood
  • Gram-Positive Bacterial Infections / diagnosis*
  • Gram-Positive Bacterial Infections / diagnostic imaging
  • Gram-Positive Bacterial Infections / drug therapy
  • Humans
  • Pulmonary Embolism / diagnosis*
  • Pulmonary Embolism / diagnostic imaging
  • Pulmonary Embolism / surgery
  • Tomography, X-Ray Computed
  • Tricuspid Valve*
  • Urinary Tract Infections / diagnosis*
  • Urinary Tract Infections / drug therapy
  • Urinary Tract Infections / urine
  • Vancomycin / therapeutic use

Substances

  • Anti-Bacterial Agents
  • Vancomycin