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Summary
Atopobium vaginae is an anaerobic gram-positive organism associated with genitourinary infections. Bacteraemia is rare, with only two cases reported in the literature. This case describes an 18-year-old type 1 diabetic, presenting with sepsis and haemoptysis, on a background of poor dental hygiene and recurrent hospital admissions. Blood cultures grew A. vaginae and echocardiogram revealed a large tricuspid valve lesion. Despite medical therapy, symptoms of pulmonary emboli continued and she therefore underwent surgical resection of the lesion. Histopathological findings were of a vegetation; culture of the lesion was negative but 16S ribosomal PCR was positive, detecting 16S rRNA of A. vaginae. The patient was treated with 4 weeks of vancomycin and made a good recovery. To our knowledge, this represents the first report of infective endocarditis due to this organism. We also provide a review of the literature, including comparing published drug susceptibility data with consensus breakpoints for antimicrobial agents.
- valvular disease
- radiology (diagnostics)
- infections
- cardiothoracic surgery
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Footnotes
Contributors All authors have contributed to this original piece of work without financial interest or competing interests. They were directly involved with the clinical management of the patient. YG and ND cared for the patient when admitted to their local hospital, including clerking, history, examination and ordering/interpretation of investigations. Empirical antimicrobial therapy and subsequent specific antibiotics following the first positive blood culture of Atopobium vaginae were implemented by these two clinicians. They also directly referred the patient to the tertiary centre for transfer, further investigations and eventual surgery. JM clerked the patient upon admission to the tertiary centre, and continued being involved in the patient’s care as part of the cardiology team. RB was part of the infectious diseases team at the tertiary centre that guided ongoing antimicrobial management, both perioperatively/postoperatively. All authors were involved in planning and reporting via this case report. This was led by JM, who is the main writer of the case report, and RB, who was the main liaison between the microbiology teams at the local and tertiary centres were the patient was cared for. YG contributed to details of the patient’s clinical course at the local hospital, being able to provide a first hand account of this. All authors were involved in final review of the case report. RB was involved in the acquisition of data and associated analysis relating the A. vaginae, as well as conducting a detailed literature review for this case report. The acquisition of intraoperative images and echocardiographic images was led by JM, via liaison with the cardiothoracic surgeons (see ‘Acknowledgements’ for details). Patient consent was obtained by YG.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient consent Obtained.
Provenance and peer review Not commissioned; externally peer reviewed.