First Report of Granulicatella sp. Endocarditis in a Kidney Transplant Patient

J Bras Nefrol. 2017 Jul-Sep;39(3):341-344. doi: 10.5935/0101-2800.20170059.
[Article in English, Portuguese]

Abstract

Granulicatella and Abiotrophia are genera of fastidious Gram-positive cocci commensal of the oral, genitourinary, and intestinal flora. We report the first case of infective endocarditis caused by Granulicatella sp. in a kidney transplant recipient. A 67-year-old male kidney transplant recipient was admitted to the hospital for investigation of fever, abdominal pain, and diarrhea. On physical examination, he was dehydrated. Laboratory tests identified impaired renal function (creatinine level of 15.5 mg/dl; reference, 3.0 mg/dl), metabolic acidosis, and electrolyte disturbances. Cryptosporidium sp. was identified as the cause of the diarrhea, and the infection was treated with nitazoxanide. On admission, cultures of blood, urine, and stool samples were negative. Echocardiography results were normal. Despite the antimicrobial treatment, the fever persisted. A transthoracic echocardiogram revealed infective endocarditis of the mitral valve, and Granulicatella spp. were isolated in blood cultures. Although the patient was treated with penicillin and amikacin, he evolved to septic shock of pulmonary origin and died. Infective endocarditis caused by Granulicatella sp. should be suspected in cases of culture-negative endocarditis.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Carnobacteriaceae*
  • Endocarditis, Bacterial* / diagnosis
  • Endocarditis, Bacterial* / drug therapy
  • Fatal Outcome
  • Gram-Positive Bacterial Infections* / diagnosis
  • Gram-Positive Bacterial Infections* / drug therapy
  • Humans
  • Kidney Transplantation*
  • Male
  • Postoperative Complications* / diagnosis
  • Postoperative Complications* / drug therapy