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Case Reports
. 2017 Apr-Jun;9(2):79-81.
doi: 10.4103/0974-777X.204693.

Infective Endocarditis Due to Abiotrophia defectiva and Its Feared Complications in an Immunocompetent Person: Rare, But Real

Mohan Rudrappa  1 , Laxmi Kokatnur  1
Affiliations
Case Reports

Infective Endocarditis Due to Abiotrophia defectiva and Its Feared Complications in an Immunocompetent Person: Rare, But Real

Mohan Rudrappa et al. J Glob Infect Dis. 2017 Apr-Jun.

Abstract

Abiotrophia defectiva is nutritional deficient streptococci that cannot be cultured on routine culture medias. Even though fastidious in growth requirement, it is a virulent bacterium preferentially affecting endovascular structures and is implicated in many culture-negative endocarditis cases. Unlike other organisms, it is known for heart valve destruction leading to heart failure and excessive embolization rates. It's inherent resistance to routinely used antibiotics also contributed to increased mortality and morbidity in affected individuals and warrants timely diagnosis and prompt treatment. Our patient, a previous healthy individual, acquired this rare bacterium from intravenous drug abuse and developed infective endocarditis with valve destruction, heart failure, and distal embolization to multiple organs. He underwent multiple surgeries including mitral valve replacement and embolectomy with clinical improvement. Our case reiterates the possibility of rare cause of common diseases and raises awareness of infective endocarditis caused by A. defectiva among medical professionals.

Keywords: Abiotrophia defectiva; acute limb ischemia; infective endocarditis; nutritional deficient streptococci.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Transthoracic echocardiogram. Long axis parasternal view (a), magnified parasternal view (b), short axis parasternal view (c), apical four chamber view (d) shows vegetation in both mitral leaflets. Apical color flow image (e) and continuous wave Doppler (f) show severe mitral regurgitation
Figure 2
Figure 2
Growth of colonies of Abiotrophia defectiva in the chocolate agar plate (right side) compared to sparse grown in blood agar (left side) due to lack of nutrients such as pyridoxal phosphate
Figure 3
Figure 3
Computed tomography angiogram of left upper extremity. The proximal part of the left brachial artery is patent, but the distal part of brachial artery shows occlusion with possible thrombus (blue arrow in panel a--e and f). The sagittal reconstruction images show infarct in the spleen (yellow arrow in panel e)
Figure 4
Figure 4
Postoperative mitral valve specimen shows large vegetation in both mitral leaflets with almost complete destruction of native valve
See this image and copyright information in PMC

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