Gemella species endocarditis in a child

Organisms of the genus Gemella can, on occasion, cause serious systemic illness. The present paper reports a successfully treated case of endocarditis in a 12-year-old girl with congenital heart disease caused by species of Gemella. The child presented with cough, fatigue and decreased appetite without fever. Echocardiogram demonstrated marked mitral insufficiency with flail posterior mitral valve leaflet, mitral valve vegetations, and an enlarged left atrium and ventricle. While being treated with vancomycin, the child initially had persistent bacteremia, which resolved after the addition of gentamycin; the course of therapy was completed with penicillin G and gentamycin once antimicrobial susceptibilities were available. Attempts to identify the species of Gemella were unsuccessful in the local laboratory, and at reference laboratories in Canada and the United States. The isolate is undergoing further evaluation to determine its taxonomic status.Key Words: Endocarditis, Gemella species, PaediatricsThe genus Gemella has five known species: Gemella haemolysans, Gemella morbillorum, Gemella bergeri, Gemella sanguinis and Gemella palaticanis (1-4). All but the last are opportunistic human pathogens that may cause severe infections; G palaticanis has been identified only in dogs. These organisms have been implicated in serious systemic disease, including meningitis (5) and septic shock (6). In addition, several cases of endocarditis have been reported in the past 20 years, primarily in the adult population (4,7-9). The present article describes a case of endocarditis in a child caused by a species of Gemella.