Introduction.Lactobacillus prosthetic valve endocarditis is a rare infection caused by
Lactobacillus bacteria. This bacterium is found in the normal flora of the human mouth, gastrointestinal tract and female genital tract. While there have been isolated cases of
Lactobacillus bacteraemia and endocarditis, the infections are associated with comorbidities, immune deficiency, dental manipulation procedures and other medical history. This case of bioprosthetic valve endocarditis caused by Lactobacillus paracasei is unusual, as the patient was immune-competent and treated with pre-procedural antibiotics.
Case. We present a case of a 65-year-old male who underwent a dental extraction. He presented after 3 months of fever, chills and fatigue. On initial presentation, blood cultures were positive for alpha-haemolytic streptococcus bacteraemia. He was treated with IV penicillin and underwent aortic valve replacement with a bioprosthetic valve and excision of the mitral vegetation with repair of the mitral valve. Two years later, he had a tooth extraction after being treated properly with antibiotics. Three months later he presented with difficulty speaking, left leg weakness and increased drooling. All testing was normal. Three months later he presented with left side lower extremity weakness and expressive aphasia. He was diagnosed with bioprosthetic aortic valve endocarditis and was treated with IV penicillin and gentamicin for 6 weeks and then switched to oral penicillin. He remained stable.
Conclusions.L. paracasei can potentially be a cause of complicated endocarditis in patients with prosthetic heart valves undergoing dental procedures. Timely culture-guided antibiotic therapy is critical and may obviate the need for valve surgery.
This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
FrankoB,
VaillantM,
ReculeC,
VautrinE,
BrionJP et al. Lactobacillus paracasei endocarditis in a consumer of probiotics. Med Mal Infect2013; 43:171–173 [View Article]
OakeyHJ,
HartyDW,
KnoxKW.
Enzyme production by lactobacilli and the potential link with infective endocarditis. J Appl Bacteriol1995; 78:142–148 [View Article]
SinghalN,
KumarM,
KanaujiaPK,
VirdiJS.
MALDI-TOF mass spectrometry: an emerging technology for microbial identification and diagnosis. Front Microbiol2015; 6:791 [View Article]
HoenB,
AllaF,
Selton-SutyC,
BéguinotI,
BouvetA et al. Changing profile of infective endocarditis: results of a 1-year survey in France. JAMA2002; 288:75–81
NishimuraRA,
OttoCM,
BonowRO,
CarabelloBA,
ErwinIIIJP et al. AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease. J Am Coll Cardiol2017; 7:252–289
GriffithsJK,
DalyJS,
DogeRA.
Two cases of endocarditis due to Lactobacillus species: antimicrobial susceptibility, review and discussion of therapy. Clin Infect Dis1992; 5:50–55
SalminenMK,
RautelinH,
TynkkynenS,
PoussaT,
SaxelinM et al.Lactobacillus bacteremia, clinical significance, and patient outcome, with special focus on probiotic L. rhamnosus GG. Clin Infect Dis2004; 38:62–69 [View Article]
VankerckhovenV,
MoreillonP,
PiuS,
GiddeyM,
HuysG et al. Infectivity of Lactobacillus rhamnosus and Lactobacillus paracasei isolates in a rat model of experimental endocarditis. J Med Microbiol2007; 56:1017–1024 [View Article]
HartyDW,
PatrikakisM,
HumeEB,
OakeyHJ,
KnoxKW.
The aggregation of human platelets by Lactobacillus species. J Gen Microbiol1993; 139:2945–2951 [View Article]
Soltan DallalMM,
MojarradM,
BaghbaniF,
RaoofianR,
MardanehJ et al. Effects of probiotic Lactobacillus acidophilus and Lactobacillus casei on colorectal tumor cells activity (CaCo-2). Arch Iran Med2015; 18:167–172