RESUMO
We report a case of fulminant endocarditis on a prosthetic homograft aortic valve caused by Bordetella holmesii, which was successfully managed by surgical valve replacement and antibiotic treatment. B. holmesii, a strictly aerobic, small, Gram-negative coccobacillus, has been implicated as an infrequent cause of a pertussis-like syndrome and other respiratory illnesses. However, B. holmesii is also a rare cause of septicaemia and infective endocarditis, mostly in immunocompromised patients. To our knowledge, this is the first report of B. holmesii endocarditis on a prosthetic aortic valve. Routine laboratory testing initially misidentified the strain as Acinetobacter sp. Correct identification was achieved by 16S rRNA gene and outer-membrane protein A (ompA) gene sequencing. Interestingly, matrix-assisted laser desorption/ionization time-of-flight mass spectrometry also produced an accurate species-level identification. Subsequent susceptibility testing and review of the literature revealed ceftazidime, cefepime, carbapenems, aminoglycosides, fluoroquinolones, piperacillin/tazobactam, tigecycline and colistin as possible candidates to treat infections caused by B. holmesii.
Assuntos
Infecções por Bordetella/diagnóstico , Bordetella/isolamento & purificação , Endocardite Bacteriana/diagnóstico , Infecções Relacionadas à Prótese/diagnóstico , Adulto , Antibacterianos/farmacologia , Bordetella/classificação , Infecções por Bordetella/tratamento farmacológico , Infecções por Bordetella/microbiologia , Infecções por Bordetella/cirurgia , DNA Bacteriano/química , DNA Bacteriano/genética , DNA Ribossômico/química , DNA Ribossômico/genética , Endocardite Bacteriana/tratamento farmacológico , Endocardite Bacteriana/microbiologia , Endocardite Bacteriana/cirurgia , Humanos , Masculino , Dados de Sequência Molecular , Infecções Relacionadas à Prótese/tratamento farmacológico , Infecções Relacionadas à Prótese/microbiologia , Infecções Relacionadas à Prótese/cirurgia , RNA Ribossômico 16S/genética , Análise de Sequência de DNARESUMO
We present a rare case of endocarditis in a 33-year-old woman with a splenectomy. The patient presented with meningeal symptoms and was diagnosed with endocarditis on the medical admissions unit using a portable echocardiography machine. Bordetella holmesii was cultured from the blood on admission and the patient underwent subsequent aortic valve replacement. We discuss the importance of echo skills within the specialty of acute medicine and the benefits of swift senior review at the front door. We emphasise the guidelines on antibiotic prophylaxis for the post-splenectomy patient as well as discuss the pathogen B holmesii and its growing association of septicaemia in asplenic individuals.
