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. 2023 Sep 4;12(9):1130.
doi: 10.3390/pathogens12091130.

A Dual-Pathogen Mitral Valve Endocarditis Caused by Coxiella burnetii and Streptococcus gordonii-Which Came First?

Ann-Sophie Kaemmerer  1 , Francesco Ciotola  2 , Walter Geißdörfer  3 , Frank Harig  1 , Jochen Mattner  3 , Timo Seitz  1 , Mathieu N Suleiman  1 , Michael Weyand  1 , Christian Heim  1
Affiliations

A Dual-Pathogen Mitral Valve Endocarditis Caused by Coxiella burnetii and Streptococcus gordonii-Which Came First?

Ann-Sophie Kaemmerer et al. Pathogens. .

Abstract

Infective endocarditis (IE) is still a life-threatening disease with high morbidity and mortality. While usually caused by a single bacterium, poly-microbial infective endocarditis (IE) is rare. Here, we report a (blood-culture-negative) dual pathogen mitral valve IE caused by Coxiella burnetii and Streptococcus gordonii: A 53-year-old woman was presented to an internal medicine department with abdominal pain for further evaluation. Within the diagnostic work up, transthoracic echocardiography (TTE) revealed an irregularly shaped echogenic mass (5 × 13 mm) adherent to the edge of the posterior mitral valve leaflet and protruding into the left atrium. As infected endocarditis was suspected, blood cultures were initially obtained, but they remained negative. Chronic Q fever infection was diagnosed using serologic testing. After the occurrence of cerebral thromboembolic events, the patient was admitted for mitral valve surgery. Intraoperatively, a massively destructed mitral valve with adhering vegetations was noted. Examination of the mitral valve by broad-range bacterial polymerase chain reaction (PCR) and amplicon sequencing confirmed Coxiella burnetii infection and yielded Streptococcus gordonii as the second pathogen. Based on the detailed diagnosis, appropriate antibiotic therapy of both pathogens was initiated, and the patient could be discharged uneventfully on the 11th postoperative day after a successful minimal-invasive mitral valve replacement.

Keywords: Coxiella burnetii; Q fever; Streptococcus gordonii; blood-culture-negative endocarditis; dual-pathogen endocarditis; endocarditis; minimally invasive mitral valve replacement; polymicrobial infective endocarditis.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Intraoperative transesophageal echocardiography demonstrating the vegetations of the mitral valve. (arrow: vegetation).
Figure 2
Figure 2
Intraoperative transesophageal echocardiography demonstrating the mitral valve insufficiency. (arrow: insufficiency).
Figure 3
Figure 3
Patient’s diagnostics during hospitalization; green indicating: signs of infective endocarditis. (echo:_echocardiography, MRI: magnetic resonance imaging).
Figure 4
Figure 4
(A,B): Intraoperative picture of the mitral valve; arrow: indicating vegetations.
Figure 5
Figure 5
Diagnostic steps of infective endocarditis in a surgical setting.
See this image and copyright information in PMC

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