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Streptobacillus moniliformis endocarditis in an HIV-positive patient
Abstract:
Streptobacillus moniliformis is the causative agent of rat bite fever, with endocarditis being a rare but well-documented complication. We report the case of an HIV-positive man who acquired S. moniliformis endocarditis through a rat bite. No predisposing cardiac lesion was known. He was treated with ceftriaxone 2 g/day i.v. for 3 weeks, gentamicin 120 mg/day i.v. for 2 weeks and penicillin 24x10(6) units/day for 1 week. At the end of the antibiotic therapy he suffered a generalized Candida albicans infection, which was treated with fluconazole for 1 week. He was subsequently discharged in a satisfactory condition.
Insights
Rat bite fever caused by Streptobacillus moniliformis can lead to endocarditis, even in HIV-positive individuals without prior heart conditions. This case highlights successful antibiotic treatment and management of a subsequent fungal infection.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Streptobacillus moniliformis is the primary cause of rat bite fever.
- Endocarditis is a rare but recognized complication of S. moniliformis infection.
- Human immunodeficiency virus (HIV) infection can alter disease presentation and complications.
Observation:
- A case report of an HIV-positive man who developed S. moniliformis endocarditis following a rat bite.
- The patient had no known predisposing cardiac lesions.
- The patient experienced a generalized Candida albicans infection post-antibiotic therapy.
Findings:
- Successful treatment of S. moniliformis endocarditis with a multi-drug intravenous antibiotic regimen including ceftriaxone, gentamicin, and penicillin.
- Management of a secondary Candida albicans infection with fluconazole.
- Patient discharge in satisfactory clinical condition.
Implications:
- This case underscores the importance of considering S. moniliformis endocarditis in patients with relevant exposure history, particularly those who are immunocompromised.
- Effective antibiotic strategies can lead to favorable outcomes in rare infectious complications.
- Awareness of potential secondary infections, such as candidiasis, is crucial during treatment of severe bacterial infections in immunocompromised individuals.