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Abiotrophia defectiva endocarditis - Diagnostic and therapeutic challenge: Case report
Małgorzata Wilawer1, Waldemar Elikowski1, Krzysztof Greberski2
1Department of Internal Medicine, Józef Struś Hospital, Poznań, Poland.
Idcases
|October 23, 2023
Summary
Abiotrophia defectiva, a rare cause of infective endocarditis, can present atypically without fever. This case highlights the importance of specialized cultures for diagnosing this difficult-to-isolate pathogen.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Abiotrophia defectiva is a component of normal human flora, implicated in 1-2% of infective endocarditis cases.
- Infective endocarditis caused by A. defectiva may present atypically, notably without fever, posing diagnostic challenges.
- Isolation of A. defectiva requires specialized culture media due to its fastidious nature.
Observation:
- A 45-year-old female presented with anemia and significant weight loss.
- Echocardiography revealed large vegetations on the mitral valve and smaller ones on the bicuspid aortic valve.
- A. defectiva was identified using an enriched medium and VITEK-2 Compact biochemical analysis.
Findings:
- The patient required urgent mitral valve replacement due to progressive regurgitation despite antibiotic therapy.
- Vegetations on the bicuspid aortic valve resolved during treatment.
- Despite frailty and underweight, the patient recovered well post-surgery with no observed relapse of infective endocarditis during a five-month follow-up.
Implications:
- This case underscores the need for high clinical suspicion and appropriate microbiological techniques for diagnosing A. defectiva endocarditis.
- Early recognition and management, including surgical intervention when necessary, are crucial for favorable outcomes.
- The findings contribute to understanding the clinical spectrum and management of rare infective endocarditis pathogens.
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