Aggregatibacter aphrophilus infective endocarditis confirmed by broad-range PCR diagnosis: A case report. (2017)

• Record Type: Journal Article
• Authors: Hirano, Koji; Tokui, Toshiya; Inagaki, Masahiro; Fujii, Taro; Maze, Yasumi; Toyoshima, Hirokazu
• Is Part Of: International journal of surgery case reports. Volume 31(2017)
• Page Start: 150
• Page End: 153
• Publication Date: 2017
• Subjects: IE infective endocarditis -- br-PCR broad-range polymerase chain reaction -- PR3-ANCA serum proteinase 3 anti-neutrophil cytoplasmic antibody; Case report -- Aggregatibacter aphrophilus -- Infective endocarditis -- Culture-negative endocarditis -- Broad-range polymerase chain reaction -- Proteinase 3 anti-neutrophil cytoplasmic antibody; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; Surgery; Electronic journals; Periodicals; 617.005
• DOI: 10.1016/j.ijscr.2017.01.041
• Languages: English
• ISSNs: 2210-2612

Abstract

Highlights: Case of infective endocarditis caused by a rare pathogen, Aggregatibacter aphrophilus is presented. Aggregatibacter aphrophilu s can't be detected by common culture methods. Br-PCR testing is a useful tool to identify pathogens of culture negative endocarditis. Serum PR3-ANCA can be positive in Aggregatibacter aphrophilus endocarditis. Abstract: Introduction: Aggregatibacter aphrophilus is a rare cause of infective endocarditis. This pathogen is difficult to identify with common culture methods, which can lead to incorrect diagnosis and treatment. Presentation of case: A 72-year-old woman was admitted to a community hospital with a persistent high fever and deteriorating renal function. Based on negative blood culture and positive serum proteinase 3 anti-neutrophil cytoplasmic antibody (PR3-ANCA), acute renal failure associated with ANCA-rerated vasculitis was initially suspected. However, the patient developed heart failure soon afterward; echocardiography showed mitral insufficiency with mobile vegetation attached to the mitral valve, indicating infective endocarditis. After transfer to our hospital, the patient underwent mitral valve repair. Broad-range polymerase chain reaction (br-PCR) and sequencing identified Aggregatibacter aphrophilus in the excised vegetation. The patient had a good postoperative course, with recovery of renal function. Conclusion: A rare disease, Aggregatibacter aphrophilus infective endocarditis was successfully treated with surgical repair and appropriate antibiotic therapy. To avoid misdiagnosis, br-PCR testing should be performed in patients with blood culture-negative endocarditis.