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Streptococcus vestibularis bacteraemia
]ournal of Infection (1997) 34, 85-91
Letters to the Editor Streptococcus vestibularis Bacteraemia Accepted for publication 13 January 19 96 Sir,
Streptococcus vestibularis is a member of the vtridans streptococci first isolated from the vestibular mucosa of h u m a n oral cavities, and described as a new species in 1988.1 There are no reports in the literature implicating this organism as a cause of h u m a n disease. We now describe a patient with a prosthetic heart valve in whom S. vestibuIaris was isolated from multiple sets of blood cultures. A 64-year-old female was admitted for investigation of a 1 year history of lethargy and abnormal liver function tests presumed secondary to alcohol. She had undergone a Start Edwards mitral valve replacement for rheumatic valve disease 22 years previously. Clinical examination showed a low grade fever, pallor and signs of severe congestive cardiac failure. Cardiac auscultation revealed a harsh, apical pansystolic m u r m u r suggestive of mitral incompetence. Hepatobiliary ultrasound was consistent with severe biventricular failure. Haemoglobin was 69 g/1. Infective endocarditis was suspected clinically and S. vestibularis was isolated from six complete sets of blood cultures. Trans-thoracic echocardiogram showed good left ventricular function, signs of pulmonary hypertension, mildto-moderate mixed aortic valve disease and significant mitral prosthetic regurgitation. In addition there was a suggestion of vegetations on the mitral prosthesis. Subsequent trans-oesophageal echocardiogram showed moderate to severe mitral prosthetic regurgitation associated with several masses on the valve which were consistent with vegetations. Intravenous benzylpenicillin 1.8 g qds and gentamicin 8 0 m g tds was commenced and treatment was initiated for heart failure. Following three weeks of antibiotic therapy she remained ill with persistent signs of severe prosthetic mitral regurgitation and cardiac failure. Thus a triple valve procedure was performed which consisted of a re-do mitral valve replacement, aortic valve replacement and tricuspid annuloplasty. No vegetations were found at surgery and culture of the mitral valve revealed no growth, possibly expiained by the prior antibiotic therapy. The post operative course was complicated by coagulopathy, cardiac 0163-4453/97/010085 + 07 $12.00/0
arrythmias and a requirement for ever increasing inotropic support. She died 11 days following surgery and a post mortem examination was not performed. The viridans streptococci are an important cause of bacteraemia and infective endocarditis. 2 The patient described in this report clearly had a bacteraemia with S. uestibularis. Endocarditis was suspected clinically and although mitral valve vegetations were seen by echocardiography this was not confirmed at surgery. To our knowledge, this is the first published report of disease caused by this organism.
Acknowledgements The authors thank Dr N. A. Boon and Mr W. S. Walker for permission to report this case. N. A. Cunliffe 1 and A. I. I acob2
~Department of Medical Microbiology, University of Edinburgh, Medical School, Edinburgh EH8 9AG and 2Department of Cardiology, Royal Infirmary of Edinburgh NHS Trust, Lauriston Place, Edinburgh EH3 9YW, U.K.
References 1 Whiley R A, Hardie I M. Streptococcusvestibularissp. nov. from the Human Oral Cavity. Int l Syst Bacteriol1988; 38: 335-339. 2 Parker M T, Ball L C. Streptococci and aerococci associated with systemic infection in man. J Med Microbiol 1976, 9:275-302.
Analysis of Risk Factors and Evaluation of HIV Testing in Saliva and Blood Samples Accepted for publication 25 June 1996 Sir, With an increasing incidence of HIV infections in India and other developing countries, there is a need for serosurveillance as a tool to monitor the AIDS epidemic on one hand and the impact of intervention strategies on the other, x'2 With an estimated 1.5 million 3 HIV infected population in India, it has become necessary to analyse
© 1997 The British Societyfor the Study of Infection
Letters to the Editor Streptococcus vestibularis Bacteraemia Accepted for publication 13 January 19 96 Sir,
Streptococcus vestibularis is a member of the vtridans streptococci first isolated from the vestibular mucosa of h u m a n oral cavities, and described as a new species in 1988.1 There are no reports in the literature implicating this organism as a cause of h u m a n disease. We now describe a patient with a prosthetic heart valve in whom S. vestibuIaris was isolated from multiple sets of blood cultures. A 64-year-old female was admitted for investigation of a 1 year history of lethargy and abnormal liver function tests presumed secondary to alcohol. She had undergone a Start Edwards mitral valve replacement for rheumatic valve disease 22 years previously. Clinical examination showed a low grade fever, pallor and signs of severe congestive cardiac failure. Cardiac auscultation revealed a harsh, apical pansystolic m u r m u r suggestive of mitral incompetence. Hepatobiliary ultrasound was consistent with severe biventricular failure. Haemoglobin was 69 g/1. Infective endocarditis was suspected clinically and S. vestibularis was isolated from six complete sets of blood cultures. Trans-thoracic echocardiogram showed good left ventricular function, signs of pulmonary hypertension, mildto-moderate mixed aortic valve disease and significant mitral prosthetic regurgitation. In addition there was a suggestion of vegetations on the mitral prosthesis. Subsequent trans-oesophageal echocardiogram showed moderate to severe mitral prosthetic regurgitation associated with several masses on the valve which were consistent with vegetations. Intravenous benzylpenicillin 1.8 g qds and gentamicin 8 0 m g tds was commenced and treatment was initiated for heart failure. Following three weeks of antibiotic therapy she remained ill with persistent signs of severe prosthetic mitral regurgitation and cardiac failure. Thus a triple valve procedure was performed which consisted of a re-do mitral valve replacement, aortic valve replacement and tricuspid annuloplasty. No vegetations were found at surgery and culture of the mitral valve revealed no growth, possibly expiained by the prior antibiotic therapy. The post operative course was complicated by coagulopathy, cardiac 0163-4453/97/010085 + 07 $12.00/0
arrythmias and a requirement for ever increasing inotropic support. She died 11 days following surgery and a post mortem examination was not performed. The viridans streptococci are an important cause of bacteraemia and infective endocarditis. 2 The patient described in this report clearly had a bacteraemia with S. uestibularis. Endocarditis was suspected clinically and although mitral valve vegetations were seen by echocardiography this was not confirmed at surgery. To our knowledge, this is the first published report of disease caused by this organism.
Acknowledgements The authors thank Dr N. A. Boon and Mr W. S. Walker for permission to report this case. N. A. Cunliffe 1 and A. I. I acob2
~Department of Medical Microbiology, University of Edinburgh, Medical School, Edinburgh EH8 9AG and 2Department of Cardiology, Royal Infirmary of Edinburgh NHS Trust, Lauriston Place, Edinburgh EH3 9YW, U.K.
References 1 Whiley R A, Hardie I M. Streptococcusvestibularissp. nov. from the Human Oral Cavity. Int l Syst Bacteriol1988; 38: 335-339. 2 Parker M T, Ball L C. Streptococci and aerococci associated with systemic infection in man. J Med Microbiol 1976, 9:275-302.
Analysis of Risk Factors and Evaluation of HIV Testing in Saliva and Blood Samples Accepted for publication 25 June 1996 Sir, With an increasing incidence of HIV infections in India and other developing countries, there is a need for serosurveillance as a tool to monitor the AIDS epidemic on one hand and the impact of intervention strategies on the other, x'2 With an estimated 1.5 million 3 HIV infected population in India, it has become necessary to analyse
© 1997 The British Societyfor the Study of Infection