Fatal mitral valve endocarditis by Erysipelothrix rhusiopathiae
Vallespi, G.V.; Pipet, D.A.; Mattoni, S.A.; Lopardo, H.A.
Revista Argentina de Microbiologia 37(2): 78-80
2005
ISSN/ISBN: 0325-7541 PMID: 16178460 Document Number: 589646
A fatal case of Erysipelothrix rhusiopathiae mitral valve endocarditis in a 45-year-old male with a history of chronic alcohol abuse and without animal contact is described (Argentina, date not given). The patient presented intermittent fever, polyarthralgia, weight loss and lower back pain. Gram-positive pleomorphic rod grew in blood cultures after 48 hours of incubation. The subculture on blood agar media showed a small, alpha-haemolytic colony that was catalase- and oxidase-negative and PYR- and LAP-positive with production of H2S in triple sugar iron agar. The isolate was initially identified as E. rhusiopathiae and was confirmed by API Coryne. On the basis of these findings and a transthoracic echocardiogram, endocarditis was confirmed. Intravenous ampicillin and gentamicin treatment was initiated. The patient became febrile and died on day 19 after admission as a consequence of acute pulmonary oedema. Susceptibility testing by E-test showed that the microorganism was resistant to vancomycin and gentamicin, and susceptible to penicillin and cefotaxime. We emphasize the importance to consider the isolates of Gram-positive pleomorphic rods, catalase- and oxidase-negative, and the addition of H2S production test in TSI medium. Vancomycin-resistance helps in the identification and establishment of correct antimicrobial therapy. Although E. rhusiopathiae is usually reported as an occupational pathogen, the contact with pigs and other farm animals may be underestimated.