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Identification of Cardiobacterium hominis by broad-range bacterial polymerase chain reaction analysis in a case of culture-negative endocarditis.

Culture-negative bacterial endocarditis may be attributed to fastidious microorganisms, prior institution of antibiotic treatment, or both. We describe a case of culture-negative endocarditis in which a modified Steiner stain revealed bacterial structures in the resected heart valve material. Prompted by this finding, broad-range polymerase chain reaction (PCR) amplification of small-subunit ribosomal DNA (16S rDNA) was performed, and Cardiobacterium hominis sequences were detected. This case demonstrates the usefulness of both the Steiner stain and broad-range direct molecular amplification as supplemental diagnostic tools in identification of otherwise unexplained infections.

Coloring Agents↗

Cardiobacterium hominis endocarditis with cerebral mycotic aneurysm.

Cardiobacterium hominis, a recently recognized Gram-negative pathogen, was recovered in blood cultures from a 65-year-old man with indolent endocarditis of previously normal heart valves. Despite the low virulence of the organism, major cardiac damage required valvular replacement, and there were multiple cerebral emboli with development of a mycotic aneurysm. After bacteriological cure, he died of a ruptured aneurysm.

Aneurysm, Infected↗

Cardiobacterium hominis endocarditis in a patient with a hypersensitivity reaction to penicillin. Successful treatment with partial resection of the posterior mitral valve leaflet and antibiotic therapy with cefazolin.

A 43-year-old patient with preexisting mitral valve prolapse and Cardiobacterium hominis endocarditis with partial destruction of the posterior mitral valve leaflet is described. Successful treatment was achieved with partial resection of the posterior mitral valve leaflet and antibiotic therapy. Because of a hypersensitivity reaction, initial therapy with penicillin G and gentamicin was stopped and substituted with cefazolin. No relapse of endocarditis was observed after 12 months of follow-up. Using micro broth dilution technique the isolated strain was shown to be most susceptible to penicillin G, cephalothin, and ciprofloxacin, with minimal inhibitory concentrations of 0.00025, 0.004, and 0.002 mg/l, respectively; and with minimal bactericidal concentrations (99.9% killing) of 0.25, 0.12, and 0.008 mg/l, respectively. We conclude that cephalosporins of the first generation or ciprofloxacin may be good alternatives to penicillin G in the treatment of C. hominis infection in patients known to be hypersensitive to penicillin.

Adult↗

Cardiobacterium hominis: an elusive cause of endocarditis.

Cardiobacterium hominis is a fastidious bacterium of the normal mouth flora. It has rarely been recognised in the past as a human pathogen and has been difficult to recover from the bloodstream. Mistaken diagnoses and delays in therapy have been common. We report a 29-year-old man with C. hominis endocarditis who was initially treated for a presumed collagen-vascular disorder with anti-flammatory drugs. The organism was eventually recovered in brain-heart infusion medium after prolonged incubation, and cure was accomplished with parenteral penicillin. Special blood culturing methods should be used if endocarditis caused by a fastidious organism is clinically suspected.

Adult↗

[A protracted course in Cardiobacterium hominis endocarditis].

A 69-year-old man without previous cardiac disease was found over the last 9 months to have a markedly elevated erythrocyte sedimentation rate (ESR: 120 mm/1. h), haemolytic anaemia (haemoglobin 8.2 g/dl, lactate dehydrogenase 304 U/l), markedly reduced exercise tolerance, backache and weight loss of 5 kg. Radiological, biochemical and endoscopic examinations failed to provide a diagnosis. Nine blood cultures grew, at normal body temperature, Cardiobacterium hominis, a rare Gram-negative organism which can cause endocarditis. Echocardiography revealed endocarditis of the aortic valve with regurgitation. Despite protracted and high-dosage antibiotics (4 times daily 10 million U penicillin G for 6 days, followed by four times 5 million U penicillin G for 6 days, followed by four times 5 million U daily for five weeks, and three times daily 60 mg gentamycin for 10 days), as well as treatment of extensive chronic parodontitis, anaemia, haemolysis and increased ESR have now persisted for over a year, with negative blood cultures. Immune-complex phenomena are thought to be the reason for the persistence of signs of infection.

Aged↗

Cardiobacterium homonis endocarditis. Characterization of the unusual organisms and review of the literature.

A case of subacute bacterial endocarditis in which Cardiobacterium hominis was isolated from the blood of a 55-year old woman who had rheumatic heart disease is reported. A survey of the literature revealed very few reports in which this organism has been implicated in human lesions. The colonies grew after 48 hours of incubation in a candle jar. They were small, convex, nonhemolytic, and oxidase-positive. The indole reaction was positive, the catalase and nitrate reactions were negative, and acid reaction was obtained from the following carbohydrates: glucose, maltose, mannitol, sucrose, and sorbitol. The morphologic and biochemical properties served to distinguish these organisms from similar bacteria implicated in human disease, such as Haemophilus aphrophilus, Actinobacillus actinomycetemcomitans, Streptobacillus moniliformis, and HB-1.

Bacteria↗

Cardiobacterium hominis: review of microbiologic and clinical features.

Cardiobacterium hominis, like other fastidious, opportunistic gram-negative bacilli, including Actinobacillus actinomycetemcomitans, Haemophilus aphrophilus, and Eikenella corrodens, is increasingly recognized as a cause of human disease. In this review the microbiologic and clinical features of C. hominis are discussed. The findings are based on observations of two infected patients (the case history of one was reported previously) and on reports in the literature of 32 others. Microbiologically, the chief distinguishing features of C. hominis are its characteristic colonial morphotype and its production of indole. Infection with C. hominis is clinically distinctive because of its chronic course (averaging 169 days among patients with endocarditis), the absence of documented infection outside of the bloodstream, and the high degree of responsiveness to treatment with penicillin.

Adult↗

Cardiobacterium hominis endocarditis.

A case of Cardiobacterium hominis endocarditis involving a prosthetic heart valve is reported, and 12 previously reported cases are reviewed. This gram-negative rod grows slowly in blood cultures and is readily suppressed for long periods of time by token antibiotic administration. It should be considered as a causative agent in culture-negative cases of endocarditis and also when a gram-negative rod is isolated which is sensitive to all antibiotics. The treatment of choice is penicillin.

Aged↗

Cardiobacterium hominis causing late prosthetic valve endocarditis.

We have described a patient with a prosthetic mitral valve who had endocarditis due to Cardiobacterium hominis 14 years after valve placement. She was cured with a six-week course of antibiotics, and valve replacement was not required. A four- to six-week course of ampicillin or penicillin G appears to be the therapy of choice.

Endocarditis, Bacterial↗

Septicaemia caused by Cardiobacterium hominis. A case report.

Septicaemia caused by Cardiobacterium hominis in a woman aged 67 is reported. She had been treated for metastatic adenocarcinoma for nine months with cytostatic drugs prior to the development of a fatal septicaemia. She had no known pre-existing heart disease. Isolation and identification of the strain are discussed.

Adenocarcinoma↗

Endocarditis caused by Cardiobacterium hominis. Two case reports.

Two cases of endocarditis caused by Cardiobacterium hominis are reported. There were no unusual clinical features of endocarditis in the patients except for the extensive valvular damage present at time of hospitalization. Properties with distinguish C. hominis from other fastidious, gram negative rods are oxidase and catalase reactions, indole production and carbohydrate fermentation pattern.

Adult↗

Cellular fatty acid composition of Kingella species, Cardiobacterium hominis, and Eikenella corrodens.

We determined the cellular fatty acid composition of reference strains and clinical isolates of each of the three Kingella species, Cardiobacterium hominis, and Eikenella corrodens by using capillary gas chromatography. Kingella denitrificans and Kingella kingae contained myristic (14:0) and palmitic (16:0) acids as major acids, whereas cis-vaccenic (18:1 omega 7c) and palmitic acids were the major acids in Kingella indologenes, C. hominis, and E. corrodens. C. hominis differed from the other four species by the absence of 3-hydroxylauric (3-OH-12:0) acid, from K. indologenes by the presence of 3-hydroxypalmitic (3-OH-16:0) acid, and from E. corrodens by the presence of 3-hydroxymyristic (3-OH-14:0) acid. E. corrodens contained a small amount (2%) of myristic acid, while the other four species contained moderate to large amounts (11 to 31%) of this acid.

Bacteroides↗

Infective endocarditis complicated with progressive heart failure due to beta-lactamase-producing Cardiobacterium hominis.

We describe a 66-year-old woman with infective endocarditis due to Cardiobacterium hominis whose condition, complicated by severe aortic regurgitation and congestive heart failure, necessitated aortic valve replacement despite treatment with ceftriaxone followed by ciprofloxacin. The blood isolate of C. hominis produced beta-lactamase and exhibited high-level resistance to penicillin (MIC, >==256 microgram/ml) and reduced susceptibility to vancomycin (MIC, 8 microgram/ml).

Aged↗

Cardiobacterium hominis endocarditis: description of two patients and characterization of the organism.

Two cases of endocarditis caused by Cardiobacterium hominis are reported. In both instances infection was subacute and characterized by (i) implantation on abnormal valves, (ii) chronic course lasting weeks to months before recognition, and (iii) rapid clinical and bacteriological response to penicillin, as well as other antibiotics commonly used to treat infections caused by gram-negative bacilli. Our isolates of C. hominis are compared with strains in the National Institutes of Health culture collection. Optimal growth requires yeast extract and incubation at 37 degrees C with increased humidity and supplemental CO2. The production of indole, a positive oxidase reaction, and characteristic sugar fermentation distinguish C. hominis from other slow-growing, gram-negative bacilli.

Endocarditis, Bacterial↗