Pulmonary Embolus Caused by Suttonella indologenes Prosthetic Endocarditis in a Pulmonary Homograft

doi:10.1016/j.echo.2010.08.005

Journal of the American Society of Echocardiography

Volume 24, Issue 5, May 2011, Pages 592.e1-592.e3

https://doi.org/10.1016/j.echo.2010.08.005 Get rights and content

A 28-year-old Cambodian man with a history of congenital heart disease presented with a 6-month history of increasing fatigue, night sweats, and weight loss. His surgical history included two Blalock-Taussig shunts, ventricular septal defect closure, and placement of a pulmonary valve conduit via a Rastelli procedure. Echocardiographic and cardiac computed tomographic studies revealed a vegetation in the pulmonary homograft. Blood cultures grew gram-negative rods that were eventually identified as Suttonella indologenes. The patient underwent a prolonged course of intravenous antibiotics, which was complicated by septic pulmonary embolism that clinically resolved. Bacterial endocarditis caused by aerobic gram-negative organisms is uncommon. The authors report the first case of S. indologenes endocarditis in a patient with complex congenital heart disease.

Section snippets

Case Presentation

A 28-year-old Cambodian man with complex congenital heart disease presented with a 6-month history of increasing fatigue, night sweats, and an unintentional 30-pound weight loss. The patient reported a history of congenital heart disease, including two Blalock-Taussig shunts placed 9 years of age and a subsequent surgical ventricular septal defect closure and placement of a pulmonary valve conduit via a Rastelli procedure. He denied illicit drug use and was on no medications. The physical exam

Discussion

This is the first known case of echocardiographically documented prosthetic endocarditis caused by S. indologenes. The same bacterium under prior classification, Kingella indologenes,¹ was reported in a patient with a history of mitral and aortic valve replacements and positive blood cultures, but without vegetations seen on TTE and M-mode imaging.² Although S. indologenes is not officially part of the HACEK group (Haemophilus parainfluenzae, H. aphrophilus, H. paraphrophilus, H. influenzae,

Acknowledgment

We would like to thank Dr. Arnold Bayer for his assistance in editing the manuscript.

References (7)

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Int J Syst Bacteriol
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Endocarditis caused by Kingella indologenes
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W. Li et al.
Infective endocarditis in the grown-up congenital heart (GUCH) population
Eur Heart J
(1998)

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The microbiome of fly organs and fly-human microbial transfer during decomposition
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Citation Excerpt :
This may be simply because the surfaces of the tarsi are in contact with cadaver tissues for longer than the labellum and allows for increased transfer of bacteria. Interestingly, Suttonella has been found to be associated with human respiratory disease [82]. This may be further evidence of two things.
During decomposition, flies interact with the remains to lay eggs and acquire nutrients, and in the process, they bring their microbes with them. While it is known that flies have their own unique core microbiome, it is not known if flies associated with human cadavers have a different core microbiome. Differences in the fly microbiome may influence the types of microbes transmitted from the flies to the cadaver, therefore potentially affecting assembly of the human decomposer microbiome. The first purpose of this study was to characterize the microbiome of flies associated with human cadavers by fly organ and season. This is because fly interactions with cadavers vary by season, and because it is likely that external fly organs [i.e., the labellum and tarsi] make more direct contact and are likely involved in increased mechanical transmission with the cadaver than internal organs such as the oocyte. The second purpose of this study was to determine if the fly microbes contribute to the human decomposer microbiome. To accomplish these aims, 10 human cadavers were placed outdoors across three seasons and allowed to decompose. A total of 40 flies that landed on the cadaver were collected and dissected by the labellum, tarsi, and oocyte. In addition to fly collections, samples from the cadavers were collected using a sterile swab at sites including the cheek of the face, inner cheek, bicep, torso, and anus. Overall, it was shown that flies associated with human cadavers have a similar microbiome to flies from previous studies that were not associated with human cadavers. However, there are differences in the microbiome between seasons and fly parts. We also show evidence that flies act as a microbial source to the human decomposer microbiome, which is important for understanding the ecological mechanisms of human cadaver microbial community assembly.
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Journal of the American Society of Echocardiography

Section snippets

Case Presentation

Discussion

Acknowledgment

References (7)

Int J Syst Bacteriol

Endocarditis caused by Kingella indologenes

Rev Infect Dis

Infective endocarditis in the grown-up congenital heart (GUCH) population

Eur Heart J

Cited by (4)

The microbiome of fly organs and fly-human microbial transfer during decomposition

Microbial communities of meat and meat products: An exploratory analysis of the product quality and safety at selected enterprises in South Africa

The family cardiobacteriaceae

Right-sided infective endocarditis: Recent epidemiologic changes

Case ReportPulmonary Embolus Caused by Suttonella indologenes Prosthetic Endocarditis in a Pulmonary Homograft

Section snippets

Case Presentation

Discussion

Acknowledgment

Int J Syst Bacteriol

Endocarditis caused by Kingella indologenes

Rev Infect Dis

Infective endocarditis in the grown-up congenital heart (GUCH) population

Eur Heart J

Case Report
Pulmonary Embolus Caused by Suttonella indologenes Prosthetic Endocarditis in a Pulmonary Homograft