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A 1.5 Hour Procedure for Identification of Enterococcus Species Directly from Blood Cultures
Published on: February 10, 2011
Finding of Anaerococcus hydrogenalis in blood using cell-free DNA technique in a patient with infective endocarditis
Tulika Chatterjee1, Moni Roy2, Yeshaswini Panathur Sreenivasa Reddy1
1University of Illinois College of Medicine at Peoria, IL, USA.
Insights
Infective endocarditis (IE) caused by Gram-positive anaerobic cocci (GPAC) is rare. Next-generation sequencing identified Anaerococcus hydrogenalis in a patient with IE, enabling successful antibiotic treatment.
Area of Science:
- Infectious Diseases
- Microbiology
- Cardiology
Background:
- Infective endocarditis (IE) affects 3-9 per 100,000 individuals in developed nations, predominantly caused by staphylococci and streptococci.
- Infections due to Gram-positive anaerobic cocci (GPAC) are exceptionally uncommon causes of IE.
Observation:
- A 38-year-old female presented with symptoms of fever, chills, and abdominal pain, later diagnosed with splenic abscesses.
- Transthoracic echocardiography revealed a mobile filamentous structure on the mitral valve, indicative of IE.
- Standard blood cultures and PCR from splenic abscess samples were negative for microbial pathogens.
Findings:
- Cell-free microbial DNA testing using the Karius test identified *Anaerococcus hydrogenalis*, a GPAC, as the causative agent.
- This diagnosis was confirmed despite negative results from conventional microbiological methods.
- The patient received successful antibiotic treatment for the infection.
Implications:
- Next-generation sequencing (NGS) technologies are crucial for identifying fastidious organisms like GPACs in complex infections.
- Accurate pathogen identification through NGS facilitates streamlined and effective treatment strategies for rare IE cases.
- This case highlights the utility of advanced molecular diagnostics in managing challenging infectious diseases.
Introduction:
The annual incidence of infective endocarditis (IE) is 3-9 cases per 100000 in developed countries and most cases are due to staphylococci and streptococci. IE due to Gram-positive anaerobic cocci (GPAC) is very rare.
Case Report:
We present a case of a 38-year-old female with Anaerococcus hydrogenalis bacteremia and infective endocarditis of the native mitral valve. She presented with fever, chills, and abdominal pain. A computed tomographic scan of the abdomen showed splenic abscesses. Blood cultures and broad-range PCR from the splenic abscess sample were negative. Transthoracic echocardiography showed a mobile filamentous structure on the atrial side of the anterior mitral leaflet which was suggestive for infective endocarditis. Karius test (cell-free microbial DNA testing) showed Gram-positive anaerobic cocci Anaerococcus hydrogenalis. She was successfully treated with antibiotics.
Conclusions:
In cases of infection with fastidious organisms like GPACs, the use of next-generation sequencing (NGS) can allow the correct identification of culprit pathogens and streamlined treatment.
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