Rothia dentocariosa endocarditis with brain abscess and splenic abscess: case report and brief review.

Rothia dentocariosa is a conditionally pathogenic bacterium that may cause infective endocarditis (IE) in selected patients and give rise to a variety of clinical complications, albeit it is not a common IE pathogen. We present the case of a patient diagnosed with Rothia dentocariosa-associated IE secondary to influenza B and thrombocytopenic purpura. The blood culture revealed Rochebacterium caries, cardiac ultrasound detected vegetation, while brain and spleen abscesses manifested and progressively deteriorated. Despite a suboptimal response to anti-infective therapy, the patient ultimately underwent aortic valve replacement. Discharge from the hospital was achieved upon control of the brain abscess and spleen abscess.

qPCR assay optimisation for a clinical study comparing oral health risk in Rett syndrome.

PURPOSE: This study aimed to validate qPCR assays for specific microbiota, for use on dental plaque samples stored on Whatman FTA cards to compare relative oral health risk in Rett syndrome. METHODS: Supragingival dental plaque samples were collected, using a sterile swab, (COPAN FLOQswab™) swabbed onto Whatman FTA™ cards. DNA extraction was performed using a modified Powersoil™ protocol. Where published assays were unsuitable, species-specific qPCR assays for caries-associated, gingivitis-associated and oral-health-associated bacteria were designed using multiple sequence alignment, Primer3Plus and PrimerQuest. Assays were run using absolute quantification. Limit of detection (LOD) and limit of quantification (LOQ) were calculated, and PCR products verified by Sanger sequencing. RESULTS: Most assays allowed detection using real-time qPCR with high specificity on samples collected on FTA cards. Several assays showed low or even single gene copy numbers on the test samples. CONCLUSION: Assays were optimised for detection and evaluation of oral health risk in dental plaque samples stored on FTA cards when cold storage is not feasible, except for F. nucleatum. Several assays showed gene copy numbers less than the LOQ or outside the range of the standard curve, so there is merit in optimising these assays using digital droplet PCR.

Multimodality Imaging in Rothia dentocariosa Infective Endocarditis and Internal Iliac Artery Infectious Aneurysm.

Background: Aneurysms of the internal iliac artery in infective endocarditis are extremely rare, with few cases reported in the literature, and Rothia dentocariosa infective endocarditis are rare. Analysis: We describe the case of a previously healthy 62-year-old male who presented a Rothia dentocariosa infective endocarditis. Results: Multi-modality imaging revealed an aneurysm of the left internal iliac artery, which was clinically silent. The patient was treated with antibiotics and semi-emergent bioprosthesis aortic valve replacement. Follow-up multi-modality imaging showed the regression of the aneurysm. Conclusion: This case shows that an aneurysm of the internal iliac artery in infective endocarditis can regress under antibiotherapy alone. This case also highlights the ability of PET/CT to identify and follow such an aneurysm.

Transposon insertion in Rothia dentocariosa.

OBJECTIVES: Rothia spp. are emerging as significant bacteria associated with oral health, with Rothia dentocariosa being one of the most prevalent species. However, there is a lack of studies examining these properties at the genetic level. This study aimed to establish a genetic modification platform for R. dentocariosa. METHODS: Rothia spp. were isolated from saliva samples collected from healthy volunteers. Subsequently, R. dentocariosa strains were identified through colony morphology, species-specific polymerase chain reaction (PCR), and 16S ribosomal RNA gene sequencing. The identified strains were then transformed with plasmid pJRD215, and the most efficient strain was selected. Transposon insertion mutagenesis was performed to investigate the possibility of genetic modifications. RESULTS: A strain demonstrating high transforming ability, designated as R. dentocariosa LX16, was identified. This strain underwent transposon insertion mutagenesis and was screened for 5-fluoroorotic acid-resistant transposants. The insertion sites were confirmed using arbitrary primed PCR, gene-specific PCR, and Sanger sequencing. CONCLUSION: This study marks the first successful genetic modification of R. dentocariosa. Investigating R. dentocariosa at the genetic level can provide insights into its role within the oral microbiome.

Genome Mining Uncovers NRPS and PKS Clusters in Rothia dentocariosa with Inhibitory Activity against Neisseria Species.

The growing global threat of antimicrobial resistance is reaching a crisis point as common bacterial infections, including those caused by pathogenic Neisseria species, are becoming increasingly untreatable. This is compelling the scientific community to search for new antimicrobial agents, taking advantage of computational mining and using whole genome sequences to discover natural products from the human microbiome with antibiotic effects. In this study, we investigated the crude extract from a Rothia dentocariosa strain with demonstrated antimicrobial activity against pathogenic Neisseria spp. by spot-on-lawn assay. The genomic DNA of the R. dentocariosa strain was sequenced, and bioinformatic evaluation was performed using antiSMASH and PRISM to search for biosynthetic gene clusters (BGCs). The crude extract with potential antimicrobial activity was run on Tricine-SDS-PAGE, and the putative peptides were characterised using liquid chromatography-tandem mass spectrometry (LC-MS). The crude extract inhibited the growth of the pathogenic Neisseria spp. Six BGCs were identified corresponding to non-ribosomal peptide synthases (NRPSs), polyketide synthases (PKSs), and ribosomally synthesised and post-translationally modified peptides. Three peptides were also identified corresponding to Actinorhodin polyketide putative beta-ketoacyl synthase 1. These findings serve as a useful reference to facilitate the research and development of NRPS and PKS as antimicrobial products against multidrug-resistant N. gonorrhoeae.

Rothia from the Human Nose Inhibit Moraxella catarrhalis Colonization with a Secreted Peptidoglycan Endopeptidase.

Moraxella catarrhalis is found almost exclusively within the human respiratory tract. This pathobiont is associated with ear infections and the development of respiratory illnesses, including allergies and asthma. Given the limited ecological distribution of M. catarrhalis, we hypothesized that we could leverage the nasal microbiomes of healthy children without M. catarrhalis to identify bacteria that may represent potential sources of therapeutics. Rothia was more abundant in the noses of healthy children compared to children with cold symptoms and M. catarrhalis. We cultured Rothia from nasal samples and determined that most isolates of Rothia dentocariosa and "Rothia similmucilaginosa" were able to fully inhibit the growth of M. catarrhalis in vitro, whereas isolates of Rothia aeria varied in their ability to inhibit M. catarrhalis. Using comparative genomics and proteomics, we identified a putative peptidoglycan hydrolase called secreted antigen A (SagA). This protein was present at higher relative abundance in the secreted proteomes of R. dentocariosa and R. similmucilaginosa than in those from non-inhibitory R. aeria, suggesting that it may be involved in M. catarrhalis inhibition. We produced SagA from R. similmucilaginosa in Escherichia coli and confirmed its ability to degrade M. catarrhalis peptidoglycan and inhibit its growth. We then demonstrated that R. aeria and R. similmucilaginosa reduced M. catarrhalis levels in an air-liquid interface culture model of the respiratory epithelium. Together, our results suggest that Rothia restricts M. catarrhalis colonization of the human respiratory tract in vivo. IMPORTANCE Moraxella catarrhalis is a pathobiont of the respiratory tract, responsible for ear infections in children and wheezing illnesses in children and adults with chronic respiratory diseases. Detection of M. catarrhalis during wheezing episodes in early life is associated with the development of persistent asthma. There are currently no effective vaccines for M. catarrhalis, and most clinical isolates are resistant to the commonly prescribed antibiotics amoxicillin and penicillin. Given the limited niche of M. catarrhalis, we hypothesized that other nasal bacteria have evolved mechanisms to compete against M. catarrhalis. We found that Rothia are associated with the nasal microbiomes of healthy children without Moraxella. Next, we demonstrated that Rothia inhibit M. catarrhalis in vitro and on airway cells. We identified an enzyme produced by Rothia called SagA that degrades M. catarrhalis peptidoglycan and inhibits its growth. We suggest that Rothia or SagA could be developed as highly specific therapeutics against M. catarrhalis.

Thrombocytopenic Purpura in a 40-year-old Patient with Rothia dentocariosa-associated Endocarditis.

A 40-year-old male patient with a history of dental disease was sent to the emergency room mainly for fever, unclear consciousness, and purpura. Computed tomography reveals subarachnoid hemorrhage and blood analysis reveals platelet reduction. The patient was started daily intravenous piperacillin tazobactam glucocorticoid and gamma globulin. Two weeks later, symptoms improved but still had severe complications such as fever, platelet reduction, hepatosplenic abscess, and severe myocardial injury. Subsequently, Rothia dentocariosa was cultured from the blood samples of patient's limb. The patient was started on daily injections of tigecycline and penicillin. Ten days later, symptoms improved and amikacin was tried, which was later confirmed to be ineffective in this patient. Cardiac ultrasound revealed aortic valve vegetations and magnetic resonance imaging revealed brain abscess formation. Then, antibiotics were adjusted to vancomycin and meropenem. Finally, the patient underwent valve replacement. Infectious endocarditis - after surgery, vancomycin and meropenem were utilized for a week leading to symptom resolution. The patient was transferred to rehabilitation hospital. This case will provide clinical experience for the treatment of R. dentocariosa.

A case of Fournier’s gangrene caused by Rothia dentocariosa / Un caso de gangrena de Fournier por Rothia dentocariosa

We report a case of Fournier's gangrene rescued by debridement. A 40-year-old male patient had a 2x2 cm draining ulcer and 1x2 cm necrotic area in the scrotum for about a month. The patient was diagnosed with Fournier's gangrene. Septic shock and disseminated intravascular coagulation were absent. Computed tomography scan showed soft tissue gas in the scrotum but no gas in the retroperitoneal space or abdominal wall. Debridement was performed. Gangrene of the scrotum and necrosis of the testicle was also seen. Rothia dentocariosa was isolated in extracted wound cultures. He was saved after debridement and administration of strong antibiotics. This is the first case of Fournier's gangrene caused by R. dentocariosa in the available literature. (AU)

Presentamos un caso de gangrena de Fournier rescatado mediante desbridamiento. Un paciente varón de 40 años presentó una úlcera supurante de 2x2 cm y un área necrótica de 1x2 cm en el escroto durante aproximadamente un mes. El paciente fue diagnosticado con gangrena de Fournier. El shock séptico y la coagulación intravascular diseminada estaban ausentes. La tomografía computarizada mostró gas en los tejidos blandos del escroto, pero no en el espacio retroperitoneal ni en la pared abdominal. Se realizó desbridamiento. También se observó gangrena del escroto y necrosis del testículo. Se aisló Rothia dentocariosa en cultivos extraídos de heridas. Se salvó después del desbridamiento y la administración de antibióticos fuertes. Este es el primer caso de gangrena de Fournier por R. dentocariosa en la literatura disponible. (AU)

A rare report of Rothia dentocariosa endocarditis.

Rothia species are gram positive, round to rod-shaped bacteria that are normally oral and respiratory tract flora. They were first isolated in 1967 from dental caries. We present a 69-year-old male with no risk factors for aforementioned bacteria however was found to have thickened anterior leaflet of the mitral valve with a small isoechoic lesion consistent with vegetation on Transthoracic echocardiogram. Blood cultures grew pan sensitive Rothia dentocariosa. Patient was treated with long-term antibiotics. This case adds to the limited number of cases of Rothia dentocariosa Endocarditis.

Rothia aeria and Rothia dentocariosa as biofilm builders in infective endocarditis.

BACKGROUND: Rothia sp. are Gram-positive bacteria in the class of Actinobacteria that are part of the physiological oral flora. In rare cases, Rothia aeria and Rothia dentocariosa can cause infective endocarditis (IE). The biofilm potential of Rothia in endocarditis is unknown. METHODS: Specimen from two cases of Rothia endocarditis were obtained during cardiac surgery. One of the patients suffered mitral valve IE from Rothia aeria. In the other case, IE of a prosthetic pulmonary valve was caused by Rothia dentocariosa. Fluorescence in situ hybridization (FISH) was used for visualization of microorganisms within heart valve tissues in combination with PCR and sequencing (FISHseq). RESULTS: The two heart valve specimens featured mature biofilms of bacteria that were identified by FISHseq as Rothia aeria and Rothia dentocariosa, respectively. FISH showed in situ biofilms of both microorganisms that feature distinct phenotypes for the first time ex vivo. Both of our reported cases were treated successfully by heart valve surgery and antibiotic therapy using beta-lactam antibiotics. CONCLUSION: The biofilm potential of Rothia sp. must be taken into account. The awareness of Rothia aeria and Rothia dentocariosa as rare but relevant pathogens for infective endocarditis must be raised. Use of biofilm-effective antibiotics in Rothia IE should be discussed.

Atypical Keratitis Caused by Rothia Dentocariosa.

Purpose: To report a case of atypical keratitis caused by Rothia dentocariosa.Methods: Retrospective case review.Results: A 49 year-old woman of South Asian descent presented with a non-discrete corneal ulcer with a small overlying epithelial defect in the right eye. Cultures were obtained, a topical fluoroquinolone was continued, and a topical steroid was added. The following day, the infiltrate was noted to have worsened and developed a branching appearance. Antifungals were initiated. The culture grew Rothia dentocariosa. A series of intrastromal cefuroxime injections, followed by topical penicillin G drops, led to complete resolution within 8 weeks. A review of the literature revealed only one previously reported case of Rothia dentocariosa keratitis.Conclusions: Rothia dentocariosa may cause an atypical keratitis requiring a prolonged treatment course for resolution. In our case, a combination of cefuroxime and penicillin was effective.

Rothia spp. infective endocarditis: A systematic literature review.

OBJECTIVE: To describe the epidemiological, clinical, microbiological, and therapeutic features and outcomes of Rothia infective endocarditis (RIE) and extracardiac infections (ECRI). METHODS: We performed a systematic literature review of published cases of RIE and ECRI. RESULTS: After inclusion of a personal case report, 51 cases of RIE and 215 cases of ECRI were reported. Compared with ECRI patients, RIE patients were significantly more often males (80% versus 59%), intravenous drug users (IVDU) (20% versus 3%), immunocompetent (76% versus 31%), and infected with R. dentocariosa (55% versus 13%) but lacked significant differences with regard to median age (45 years [6-79]), rate of orodental abnormalities (33%), and six-month mortality (14%). Following microbiological documentation, RIE was most often treated with a beta-lactam antibiotic alone (39%) for a median duration of six weeks and required surgery in 39% of cases. CONCLUSION: RIE is rare and likely secondary to a dental portal of entry or cutaneous inoculation in IVDU. Its prognosis seems to be favorable.

Cerebrovascular Accident in a 65-Year-Old Patient with Rothia dentocariosa-Associated Endocarditis.

A 65-year-old male patient with a history of heart valve replacement surgery after aortic valve stenosis and a family history of heart disease presented to the emergency room with complaints of headache, fever, back pain, and general malaise. Multiple blood samples during the patient's hospitalization cultured showed Rothia dentocariosa. The patient was started on daily intravenous ceftriaxone and vancomycin. In the following weeks, the patient's condition deteriorated with additional symptoms, persistent inflammatory markers, and elevated fever consistent with R. dentocariosa infection. The patient's clinical progression led to a cerebrovascular accident that was resolved with thrombectomy. Full symptomatic relief occurred after a valve replacement. R. dentocariosa, a common mouth flora, is not commonly pathogenic. This case is of particular importance as severe complications involving this bacterium are rare. There is an extreme paucity of cases involving deadly complications of R. dentocariosa, and there is no general consensus involving standard treatment regimen for this bacterium. We believe that this paper adds to clinical knowledge surrounding R. dentocariosa.

Phytocompounds vs. Dental Plaque Bacteria: In vitro Effects of Myrtle and Pomegranate Polyphenolic Extracts Against Single-Species and Multispecies Oral Biofilms.

In the last decades, resistant microbial infection rate has dramatically increased, especially infections due to biofilm-producing strains that require increasingly complex treatments and are responsible for the increased mortality percentages compared with other infectious diseases. Considering that biofilms represent a key factor for a wide range of chronic infections with high drug tolerance, the treatment of biofilm-causing bacterial infections represents a great challenge for the future. Among new alternative strategies to conventional antimicrobial agents, the scientific interest has shifted to the study of biologically active compounds from plant-related extracts with known antimicrobial properties, in order to also evaluate their antibiofilm activity. In this regard, the aim of this study has been to assess the antibiofilm activity of polyphenolic extracts from myrtle leaf and pomegranate peel against oral pathogens of dental plaque, an excellent polymicrobial biofilm model. In particular, the in vitro antibiofilm properties of myrtle and pomegranate extracts, also in binary combination, were highlighted. In addition to inhibiting the biofilm formation, the tested polyphenolic extracts have been proven to destroy both preformed single-species and multispecies biofilms formed by Streptococcus mutans, Streptococcus oralis, Streptococcus mitis, and Rothia dentocariosa oral isolates, suggesting that the new natural sources are rich in promising compounds able to counteract biofilm-related infections.

In vitro Synergy of Polyphenolic Extracts From Honey, Myrtle and Pomegranate Against Oral Pathogens, S. mutans and R. dentocariosa.

The increasing incidence rate of oral diseases, the wide spread of antimicrobial resistance, and the adverse effects of conventional antibiotics mean alternative prevention and treatment options are needed to counteract oral pathogens. In this regard, our study aims to evaluate the antibacterial activity of polyphenolic extracts prepared from acacia honey, myrtle leaves, and pomegranate peel against cariogenic bacteria, such as Streptococcus mutans and Rothia dentocariosa. The chemical-physical parameters of acacia honey and the RP-HPLC polyphenolic profile of pomegranate peel extract have been previously described in our studies, while the characterization of myrtle extract, performed by HPLC analysis, is reported here. All the extracts were used singly and in binary combinations to highlight any synergistic effects. Moreover, the extracts were tested in association with amoxicillin to evaluate their ability to reduce the effective dose of this drug in vitro. The values of minimal inhibitory concentrations and minimal bactericidal concentrations have been used to quantitatively measure the antibacterial activity of the single extracts, while the fractional inhibitory concentration index has been considered as predictor of in vitro anticariogenic synergistic effects. Finally, a time-kill curve method allowed for the evaluation of the bactericidal efficacy of the combined extracts. The microbiological tests suggest that acacia honey, myrtle, and pomegranate extracts are able to inhibit the cariogenic bacteria, also with synergistic effects. This study provides useful and encouraging results for the use of natural extract combinations alone or in association with antibiotics (adjuvant therapy) as a valid alternative for the prevention and treatment of oral infectious diseases.

Melody Valve Endocarditis Due to Rothia dentocariosa: A Diagnostic Challenge.

Recently, there have been several advances in the field of adult congenital heart disease, such as the percutaneous pulmonic valve implantation (PPVI) to treat right ventricular outflow obstruction. Complications from this technique are seldom but essential to understand. We present a case of a 37-year-old Caucasian male with complicated congenital heart disease, including prior Melody valve implantation, who presented to our hospital with recurrent episodes of pneumonia of two months duration. He was diagnosed with prosthetic valve endocarditis (PVE) from an unusual organism, Rothia dentocariosa. He eventually underwent surgical replacement of the infected valve. Our report is the first case of Melody valve endocarditis due to Rothia dentocariosa reported from the United States.

First reported case of Rothia dentocariosa spondylodiscitis in an immunocompetent patient.

Rothia dentocariosa is part of the normal human oropharyngeal microflora and is frequently associated with dental caries and periodontal disease. Invasive disease has been described essentially in immunocompromised hosts and/or patients with underlying conditions as predisposing factors. We present a case of an otherwise healthy 46-years old male with spondylodiscitis caused by this pathogen. Treatment with ceftriaxone and rifampin was successful. To our knowledge, this is the first R. dentocariosa spondylodiscitis reported in an immunocompetent patient, and the second one in the literature overall.

Rothia dentocariosa endophthalmitis following intravitreal injection-a case report.

PURPOSE: This report describes the first recognised case of Rothia dentocariosa endophthalmitis following intravitreal injection. CASE REPORT: A 57-year-old indigenous Australian diabetic female developed pain, redness and decreased vision 3 days after intravitreal aflibercept injection to the right eye-administered for diabetic vitreous haemorrhage with suspected macular oedema and proliferative diabetic retinopathy. Examination revealed best corrected visual acuity (BCVA) of hand movements, ocular hypertension and marked anterior chamber inflammation. The left eye was unaffected but had a BCVA of 6/24 due to pre-existing diabetic retinopathy. Vitreous culture isolated Rothia dentocariosa as the organism responsible for the endophthalmitis. The following treatment with intraocular cephazolin, vancomycin and ceftazidime, topical ciprofloxacin and gentamicin and systemic ciprofloxacin, the patient underwent vitrectomy. Nine weeks after onset, the patient's BCVA had improved to 6/36, and fundal examination revealed extensive retinal necrosis. CONCLUSION: Rothia dentocariosa is presented as a rare cause of endophthalmitis following intravitreal injection and reports the appearance of 'pink hypopyon' previously observed with other organisms. Its identification also demonstrates the risk of oral bacterial contamination during intraocular injections. Vigilance with strategies to minimise bacterial contamination in the peri-injection period are important. Further research to identify additional techniques to prevent contamination with oral bacteria would be beneficial, including whether a role exists for patients wearing surgical masks during intravitreal injections.

Transcriptional Profiling of C. albicans in a Two Species Biofilm with Rothia dentocariosa.

Biofilms on silicone rubber voice prostheses are the major cause for frequent failure and replacement of these devices. The presence of both bacterial and yeast strains has been suggested to be crucial for the development of voice prosthetic biofilms. Polymicrobial biofilms that include Candida albicans and Rothia dentocariosa are the leading cause of voice prosthesis failure. An in vitro biofilm comprising these two organisms was developed on silicone rubber, a material used for Groningen button voice prosthesis. We found that this biofilm environment was not conducive for C. albicans growth or differentiation. Global transcriptional analyses of C. albicans biofilm cells grown with R. dentocariosa revealed that genes with functions related to cell cycle progression and hyphal development were repressed >2-fold. The mixed species biofilms were more compact and less robust compared to C. albicans mono-species biofilms, even when developed under conditions of continuous nutrient flow. Under these conditions R. dentocariosa also significantly inhibited C. albicans biofilm dispersal. Preferential adherence of R. dentocariosa to candidal hyphae was mediated by the adhesin Als3.

Mitral endocarditis due to Rothia aeria with cerebral haemorrhage and femoral mycotic aneurysms, first French description.

Rothia aeria is a Rothia species from the Micrococcaceae family. We report here the first French R. aeria endocarditis complicated by brain haemorrhage and femoral mycotic aneurysms. Altogether, severity and antimicrobial susceptibility should make us consider the management of R. aeria endocarditis as Staphylococcus aureus methicillin-susceptible endocarditis.