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A case series of patients with Gemella endocarditis
Abarna Ramanathan1, Steven M Gordon1, Nabin K Shrestha1
1Department of Infectious Diseases, Cleveland Clinic, 9500 Euclid Avenue / G-21, Cleveland, OH 44195, USA.
Insights
Gemella bacteria rarely cause infective endocarditis (IE), a serious heart valve infection. Diagnosis often requires 16S rRNA polymerase chain reaction (PCR) of valve tissue, not just blood cultures, for accurate identification.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Gemella are gram-positive bacteria seldom implicated in infective endocarditis (IE).
- IE is a severe infection affecting heart valves, with diverse causative agents.
- Accurate identification of causative pathogens is crucial for effective treatment.
Purpose of the Study:
- To characterize the clinical features and outcomes of patients with Gemella infective endocarditis.
- To evaluate the diagnostic utility of different methods for Gemella IE detection.
- To highlight the importance of molecular techniques in identifying rare IE pathogens.
Main Methods:
- Retrospective review of patients diagnosed with Gemella IE at Cleveland Clinic (2007-2018).
- Inclusion criteria: patients >18 years old with confirmed Gemella IE.
- Data collection included clinical presentation, microbiological findings (blood cultures, valve cultures, 16S rRNA PCR), and treatment outcomes.
Main Results:
- Thirteen cases of Gemella IE identified, representing <1% of all IE cases.
- Most cases involved left-sided native (8) or prosthetic (5) valves.
- Positive blood cultures were found in 69% of cases; 31% required 16S rRNA PCR of explanted valves for diagnosis.
- No positive valve cultures were reported.
- All patients underwent surgical treatment and survived to discharge.
Conclusions:
- Gemella is a rare but significant cause of infective endocarditis.
- Standard blood cultures may miss Gemella IE; 16S rRNA PCR of valve tissue is essential for diagnosis in some cases.
- Prompt surgical intervention and appropriate diagnostic methods improve outcomes for Gemella IE.
Abstract:
Gemella are gram-positive bacteria that rarely cause infective endocarditis (IE). This article summarizes the characteristics of a series of patients with Gemella IE. We identified cases of Gemella IE in patients aged >18 years old hospitalized at Cleveland Clinic between July 1, 2007, and January 1, 2018, within the institutional review board-approved Cleveland Clinic IE Registry. Clinical features were obtained by manual chart review. Thirteen cases of Gemella IE were identified and accounted for <1% of all cases of IE in the registry. Eight were native and 5 were prosthetic valve IE. All were left-sided. Sixty-nine percent had positive blood cultures for Gemella, but 31% were identified solely based on 16S rRNA polymerase chain reaction (PCR) of explanted valves with sequence identification. None had positive valve cultures. All were treated surgically and survived to hospital discharge. Gemella is a rare cause of IE, albeit likely underrecognized without utilization of valve PCR.
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