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Case Reports
. 2024 Oct 25;9(3):188-195.
doi: 10.3138/jammi-2023-0040. eCollection 2024 Oct.

Rothia Aeria Bacteremia Complicated by Cerebral Mycotic Aneurysms: A Case Report

Yoko Schreiber  1   2   3 , Armelle Perez Cortes Villalobos  1   2 , James McEachern  4 , Andrew Walkty  1   2   5
Affiliations
Case Reports

Rothia Aeria Bacteremia Complicated by Cerebral Mycotic Aneurysms: A Case Report

Yoko Schreiber et al. J Assoc Med Microbiol Infect Dis Can. .

Abstract
in English, French

Background: Rothia aeria is a gram-positive bacterium that is considered a member of the normal human oral flora. Serious infections due to this organism are rare, with only eight case reports of endocarditis due to R. aeria published worldwide in the English language literature.

Methods: We report the case of a previously healthy 43-year-old man who presented with multiple acute subarachnoid hemorrhages secondary to cerebral mycotic aneurysms after several weeks of weight loss and headache, and we summarize previously published cases of endocarditis due to R. aeria.

Results: Blood cultures yielded filamentous gram-positive bacilli identified by matrix-assisted laser desorption/ionization time-of-flight (MALDI-TOF) mass spectrometry as R. aeria. The patient was treated with antimicrobial therapy (initially aqueous penicillin G, then ceftriaxone) for 12 weeks with a good clinical response. Endocarditis was suspected but not definitively proven on echocardiography. There was no clear odontogenic source of infection.

Conclusion: This report of cerebral mycotic aneurysms secondary to possible endocarditis highlights the potential pathogenic nature of R. aeria infection, and supports the use of MALDI-TOF in rapid identification of uncommon bacterial pathogens.

Introduction: Le Rothia aeria est une bactérie à Gram positif qui fait partie de la flore buccale normale des humains. Les graves infections attribuables à cet organisme sont rares, puisque seulement huit rapports de cas d'endocardite à R. aeria ont été publiés dans les publications scientifiques anglophones.

Méthodologie: Les auteurs rendent compte du cas d'un homme de 43 ans auparavant en santé qui a consulté à cause de multiples hémorragies sous-arachnoïdiennes aiguës découlant d'anévrismes mycotiques cérébraux dans le cadre d'un processus de perte de poids et de céphalées depuis plusieurs semaines, et résument des cas d'endocardite à R. aeria déjà publiés.

Résultats: Les hémocultures ont révélé des bacilles à Gram positif filamenteux identifiés comme des R. aeria par spectrométrie de masse à temps de vol à désorption-ionisation laser assistée par matrice. Le patient a reçu un traitement antimicrobien (d'abord de la pénicilline G hydrosoluble, puis de la ceftriaxone) de 12 semaines auquel il a eu une bonne réaction clinique. L'endocardite était présumée, mais n'a pas été démontrée sans équivoque à l’échocardiographie. On n'a pas établi de source odontogène claire d'infection.

Conclusion: Le présent rapport d'anévrismes mycotiques cérébraux découlant d'une éventuelle endocardite fait ressortir la nature pathogène potentielle de l'infection à R. aeria et appuie l'utilisation de la spectrométrie de masse à temps de vol à désorption-ionisation laser assistée par matrice pour identifier rapidement des agents pathogènes bactériens peu courants.

Keywords: Rothia aeria; endocarditis; mycotic aneurysm.

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Conflict of interest statement

The authors have nothing to disclose.

Figures

Figure 1:
Figure 1:. Digital subtraction angiographic (DSA) images at presentation: (a) Lateral projection late arterial phase images during a left internal carotid artery (ICA) injection and (b) Frontal projection arterial phase images during a left vertebral artery injection
The small left posterior frontal (precentral M4 branch) and distal left posterior cerebral artery (P4) mycotic aneurysms are well visualized (arrows)
Figure 2:
Figure 2:. Gram stain of Rothia aeria recovered from a blood culture bottle
Gram positive rods with some filamentous forms are seen
Figure 3:
Figure 3:. Rothia aeria growing on a blood agar plate after 48 hours of incubation in an aerobic atmosphere
Some colonies are creamy white in appearance, while others appear dry and folded
See this image and copyright information in PMC

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