A Rare Agent of Infective Endocarditis: Rhizobium Radiobacter

Year 2014, Volume: 67 Issue: 1, 21 - 23, 18.03.2015

Gülden Yılmaz

Abstract

Introduction: Rhizobium species are essentially plant pathogens. They are aerobic, motile, non-spore forming, oxidase positive and gram negative bacilli. Here a case of infective endocarditis due to Rhizobium radiobacter is presented.

Case: A fifty seven years old male patient who had mitral valve replacement (MVR) and coronary artery bypass greft (CABG) operation about three months ago was admitted to hospital with complaints of fever and hematuria. There wasn’t any pathological findings in transthoracic echocardiography (TTE). Ertapenem therapy was administered empirically with initial diagnosis of pyelonephritis. Enterobacter spp which was susceptible to carbapenems was grown in both urine and blood cultures. The therapy was replaced by meropenem because of ongoing fever and positive blood cultures for Enterobacter spp. Repeated TTE revealed vegetation on mitral valve. After six weeks of meropenem therapy vegetation was completely regressed. In the follow up period, meropenem was restarted because of relapse of fever and increased C-reactive protein (CRP) levels. Rhizobium radiobacter isolated from four blood cultures. TTE was repeated and vegetation on mitral valve was observed again. Five days after treatment, patient became afebrile and vegetation was resolved on the tenth day of the treatment. Four weeks of intravenous treatment with meropenem was followed by two weeks of oral therapy with ciprofloxacin. There was no need for MVR operation again and there was no vegetation on TTE at the end of the therapy.

Conclusion: Rhizobium radiobacter which is primarily a plant pathogen can rarely cause infection in humans. Particularly in immunsuppressed patients who have foreign bodies such as catheters or prosthetic valve, this rare bacteria must be kept in mind as an etiological agent.

Keywords

Rhizobium radiobacter , ınfective Endocarditis , Rhizobium radiobacte

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Nadir Bir Enfektif Endokardit Etkeni: Rhizobium Radiobacter

Abstract

Giri􀄹: Özellikle bitki patojeni olan Rhizobium türleri aerobik, hareketli, spor olu􀄹turmayan, oksidaz pozitif gram negatif basillerdir. Burada Rhizobium radiobacter ile geli􀄹en bir enfektif endokardit vakas􀃖 sunulmu􀄹tur.

Olgu: Yakla􀄹􀃖k 3 ay önce mitral kapak replasman􀃖 ve koroner arter by-pass grefti uygulamas􀃖 yap􀃖lan elli yedi ya􀄹􀃖nda erkek hasta; ate􀄹 ve hematüri 􀄹ikayeti ile hastaneye ba􀄹vurdu. Çekilen transtorasik ekokardiografide (TTE) patolojik bulgu görülmeyen hastaya piyelonefrit ön tan􀃖s􀃖 ile ampirik olarak ertapenem tedavisi ba􀄹land􀃖. 􀄝drar ve kan kültürlerinde ertapeneme duyarl􀃖 Enterobacter spp üredi. Mevcut tedavi alt􀃖nda ate􀄹 ve kan kültüründe üremenin devam etmesi üzerine tedaviye meropenem ile devam edildi. Tekrarlanan TTE’de bu kez mitral kapakta vejetasyon saptand􀃖. Alt􀃖 haftal􀃖k meropenem tedavisi sonras􀃖 vejetasyon tamamen geriledi. Antibiyotiksiz takibinde ate􀄹in tekrar ba􀄹lamas􀃖 ve C-reaktif proteinin (CRP) tekrar artmas􀃖 üzerine meropenem tedavisi yeniden ba􀄹land􀃖 ve al􀃖nan dört kan kültüründe Rhizobium radiobacter üredi. Tekrarlanan TTE’da ise mitral kapakta tekrar vejetasyon tespit edildi. Tedavinin be􀄹inci gününde ate􀄹, onuncu gününde ise vejetasyon tamamen geriledi. Dört hafta intravenöz meropenem tedavisi kesilerek tedavi oral siprofloksasin ile alt􀃖 haftaya tamamland􀃖. Tekrar mitral kapak replasman􀃖na gerek kalmayan hastada tedavi sonu TTE’de de vejetasyon saptanmad􀃖.

Sonuç: Daha çok bitki patojeni olan Rhizobium radiobacter insanlarda da nadiren enfeksiyona neden olabilmektedir. Özellikle de kateter ya da protez kapak gibi yabanc􀃖 cismi bulunan immünsuprese hastalarda nadir görülen bu bakterinin de etken olabilece􀃾i unutulmamal􀃖d􀃖r.

Keywords

Enfektif Endokardit , Rhizobium radiobacter

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