Posters
Presentation Type
Poster
Discipline Track
Clinical Science
Abstract Type
Case Report
Abstract
Background: Streptococcus salivarius forms part of the Viridans family which accounts for almost 40% of all endocarditis cases. However, S.salivarius is only attributed to 2% of those cases. In the most common setting, S.salivarius is a commensal bacterium of both the oral mucosa and the gut, but it has proven to have infective potential. S.salivarius accounts as an easily missed and commonly misdiagnosed Viridians strep species, but has been implicated as a rare cause of infective endocarditis.
Case presentation: We present the case of a 43-year-old male who presented with worsening fatigue, chest pain, shortness of breath, and subjective fever. Physical examination revealed a di Novo systolic murmur, splinter hemorrhages in nails, and petechial lesions on the soles. A transthoracic echocardiogram revealed a bicuspid aortic valve with mild aortic and tricuspid regurgitation, severe mitral regurgitation, mild left atrial dilation, and left ventricular concentric hypertrophy. The patient was started on vancomycin and ceftriaxone due to the concern of infective endocarditis. A transesophageal echocardiogram revealed a 1.3 cm abscess-like structure on the atrial side of the anterior mitral valve leaflet extending into the aortic root. Blood cultures grew Streptococcus Salivarius. A maxillofacial CT did not reveal any tooth abscess, and an abdominal CT to look for secondary sources of abscess and to rule out neoplasia was also negative. During the third day of hospitalization, the patient presented right eye visual disturbances. A brain MRI revealed a left occipital lobe lesion consistent with septic emboli. The patient continued with IV antibiotics and was closely monitored for systemic symptoms of infection, right eye symptoms resolved without further intervention. Blood cultures were periodically analyzed to assess bacteremia clearance, and no growth was reported since day 3 of admission. On the 12th day of hospitalization the patient underwent aortic and mitral valve replacement and after recovery he was discharged home.
Conclusion: As it is well known, the presence of bacteremia along with a di novo murmur in a patient with fever is strongly suggestive of infective endocarditis. Our patient fill two major modified Duke’s criteria and two minor. In addition, both TTE and TEE revealed a bicuspid aortic valve which could have contributed to the patient´s IE presentation. Streptococcus Salivarius is a rare organism encountered in IE cases. However, it has proven to have infective potential to the CNS, cardiovascular, musculoskeletal, and gastrointestinal system. Hence, raising awareness of this bacteria as a potential cause of IE should be brought up into the medical community in order to both, consider the diagnosis and prevent related systemic complications.
Academic/Professional Position
Resident
Mentor/PI Department
Internal Medicine
Recommended Citation
Torres Perez, Maria E.; Wong Alvarado, Ed; Salinas Domene, Cecilia; Rojas Huen, Jennifer; Mojica, Sara G.; Garza, C.; and Sheriff, Usman, "From carious to salivarius: A case of Streptococcus Salivarius Infective Endocarditis" (2024). Research Symposium. 29.
https://scholarworks.utrgv.edu/somrs/2023/posters/29
Included in
From carious to salivarius: A case of Streptococcus Salivarius Infective Endocarditis
Background: Streptococcus salivarius forms part of the Viridans family which accounts for almost 40% of all endocarditis cases. However, S.salivarius is only attributed to 2% of those cases. In the most common setting, S.salivarius is a commensal bacterium of both the oral mucosa and the gut, but it has proven to have infective potential. S.salivarius accounts as an easily missed and commonly misdiagnosed Viridians strep species, but has been implicated as a rare cause of infective endocarditis.
Case presentation: We present the case of a 43-year-old male who presented with worsening fatigue, chest pain, shortness of breath, and subjective fever. Physical examination revealed a di Novo systolic murmur, splinter hemorrhages in nails, and petechial lesions on the soles. A transthoracic echocardiogram revealed a bicuspid aortic valve with mild aortic and tricuspid regurgitation, severe mitral regurgitation, mild left atrial dilation, and left ventricular concentric hypertrophy. The patient was started on vancomycin and ceftriaxone due to the concern of infective endocarditis. A transesophageal echocardiogram revealed a 1.3 cm abscess-like structure on the atrial side of the anterior mitral valve leaflet extending into the aortic root. Blood cultures grew Streptococcus Salivarius. A maxillofacial CT did not reveal any tooth abscess, and an abdominal CT to look for secondary sources of abscess and to rule out neoplasia was also negative. During the third day of hospitalization, the patient presented right eye visual disturbances. A brain MRI revealed a left occipital lobe lesion consistent with septic emboli. The patient continued with IV antibiotics and was closely monitored for systemic symptoms of infection, right eye symptoms resolved without further intervention. Blood cultures were periodically analyzed to assess bacteremia clearance, and no growth was reported since day 3 of admission. On the 12th day of hospitalization the patient underwent aortic and mitral valve replacement and after recovery he was discharged home.
Conclusion: As it is well known, the presence of bacteremia along with a di novo murmur in a patient with fever is strongly suggestive of infective endocarditis. Our patient fill two major modified Duke’s criteria and two minor. In addition, both TTE and TEE revealed a bicuspid aortic valve which could have contributed to the patient´s IE presentation. Streptococcus Salivarius is a rare organism encountered in IE cases. However, it has proven to have infective potential to the CNS, cardiovascular, musculoskeletal, and gastrointestinal system. Hence, raising awareness of this bacteria as a potential cause of IE should be brought up into the medical community in order to both, consider the diagnosis and prevent related systemic complications.