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Updated: Oct 22, 2025

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Clearing the Dust-Off Abiotrophia defectiva.

Najmus Sahar1, John S Czachor1, Mohammad Shahid2

  • 1Division of Infectious Diseases, Wright State University Boonshoft School of Medicine, Dayton, OH, USA.

Journal of Medical Cases
|August 26, 2021
PubMed
Summary

Nutritional variant Streptococcus, Abiotrophia defectiva, can cause infective endocarditis. Prompt identification and treatment with ceftriaxone and gentamicin resolved a challenging case in an intravenous drug user.

Keywords:
Abiotrophia defectivaCulture negative endocarditisNutritional variant StreptococciSusceptibility of Abiotrophia

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Area of Science:

  • Infectious Diseases
  • Microbiology
  • Cardiology

Background:

  • Abiotrophia defectiva (ABI), a nutritional variant Streptococcus (NVS), is an underrecognized cause of infective endocarditis (IE).
  • Fastidious nutritional requirements of ABI can lead to underestimation of its role in IE.
  • IE typically affects heart valves, with native and prosthetic valves being susceptible.

Observation:

  • A case of native valve endocarditis caused by Abiotrophia spp. in a 40-year-old female intravenous drug user is presented.
  • Blood cultures identified ABI and Acinetobacter spp., with potential transmission from needle licking.
  • Transesophageal echocardiogram revealed mobile vegetations on the tricuspid and mitral valves.

Findings:

  • Susceptibility testing is crucial for ABI due to variable responses to penicillin and ceftriaxone compared to other NVS.
  • Recommended treatment involves empiric first-line therapies like ceftriaxone and synergistic gentamicin.
  • Successful treatment with intravenous ceftriaxone and gentamicin for 6 weeks led to clinical and echocardiographic resolution of IE.

Implications:

  • Accurate and rapid identification of challenging pathogens like ABI is vital.
  • Modern microbial techniques and equipment are essential for diagnosing rare IE causes.
  • This case underscores the importance of considering ABI in IE, particularly in at-risk populations.