Endocarditis caused by Kingella indologenes

The first known case of endocarditis caused by Kingella indologenes is reported. A review of the literature reveals only seven cases of endocarditis caused by the other two species of the genus Kingella (Kingella kingae, six cases; Kingella denitrificens, one case). Kingella organisms appear to be sensitive to a wide variety of antimicrobial agents. The available data suggest that endocarditis caused by Kingella species occurs rarely and is associated with a benign clinical course.     

Endocarditis due to Hemophilus influenzae

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1. Streptomycin is effective in the treatment of bacterial endocarditis due to Hemophilus influenzae. It was responsible for recovery in one of the cases presented and probably responsible in the other.     

Endocarditis due to Actinobacillus actinomycetemcomitans

A case of infective endocarditis in a 38-year-old Saudi male caused by Actinobacillus actinomycetemcomitans is reported. The patient was treated successfully with a combination of benzyl penicillin and gentamicin. Previously reported cases are reviewed.     

Endocarditis due to Citrobacter freundii

The etiologic association of acute bacterial endocarditis with the Citrobacter species has been rare, although it is one of the opportunistic organisms that afflicts the elderly, neonates, the debilitated and immunocompromised. We report a case of endocarditis due to Citrobacter freundii.     

Endocarditis due to anaerobic bacteria

This review describes the microbiology, diagnosis and management of endocarditis due to anaerobic bacteria. Anaerobic bacteria are an uncommon but important cause of endocarditis. Most cases of anaerobic endocarditis are caused by anaerobic cocci, Propionibacterium acnes and Bacteroides fragilis group. Predisposing factors and signs and symptoms of endocarditis caused by anaerobic bacteria are similar to those seen in endocarditis with facultative anaerobic bacteria with the following exceptions: the gastrointestinal tract was the most common source for B. fragilis group endocarditis, the head and neck were the most common origin for Fusobacterium and Bacteroides spp., and the head and neck and genitourinary tract were the most common source for peptostreptococci. Complications with anaerobic endocarditis include valvular destruction, multiple mycotic aneurysms, aortic-ring abscess, aortitis, cardiogenic shock, dysrhythmias and septic shock. The mortality rate for patients with anaerobes endocarditis is 21-43%. Treatment of endocarditis involving anaerobic bacteria includes the use of antibiotic therapy effective against these organisms.     

Endocarditis due to Streptococcus morbillorum

Two cases of endocarditis due to Streptococcus morbillorum are described. Neither patient had any known history of valvular disease. These are believed to be the first such reported cases in the U.K. In the first case, previous anal surgery and, in the second, drainage of a dental abscess and extraction of a tooth are the likely procedures which initiated endocarditis. The first case is of further interest in that the incriminated strain showed marked tolerance to beta-lactam antibiotics. A combination of penicillin with gentamicin was shown to be required in order to give satisfactory bactericidal activity in vitro.     

Endocarditis due to anaerobic gram-negative bacilli

A case of Bacteroides fragilis endocarditis which developed after appendicitis is discussed. Combined therapy with tetracycline and erythromycin for over 18 months, and therapy with several other agents given over a period of more than two years in all, failed to eradicate the infection. The organism in this case was markedly resistant to penicillin, intermediate in susceptibility to vancomycin, and sensitive to tetracycline, erythromycin, lincomycin, 7-chlorolincomycin, chloramphenicol, rifampin and metronidazole. Only metronidazole (Flagyl®), however, demonstrated bactericidal activity. Unfortunately, this drug was not available at the time of this patient's illness for therapeutic evaluation.A review of the 37 published cases of endocarditis due to gram-negative anaerobic bacilli revealed that these organisms appear to be more invasive and destructive than “viridans” streptococci. Major embolie phenomena were prominent complications. The over-all mortality was 46 per cent. If the penicillin-susceptible organisms alone are considered, the mortality is probably less than 20 per cent. However, because of the lack of an agent with bactericidal activity against B. fragilis (which is usually resistant to penicillin), the mortality caused by this organism is considerably greater.