Biomedical Science and Research Journals | Aerococcus Urinae: A rare cause for multi-valve endocarditis

A 42-year-old male with a history of chronic nephrolithiasis presented to the hospital after neighbors found him unconscious at home. On initial evaluation, he was febrile (38.9) with blood pressure of 120/104mmHg. He was severely hypoxic with a sinus rate of 90 beats/minute. His examination revealed multiple abrasions, and he was minimally responsive with a holosystolic murmur at the apex. His electrocardiogram showed normal sinus rhythm with no acute ST-T wave changes. Laboratory data revealed a white cell count of 17.4/nl, platelet count of 109/nl, lactate level of 4.8 mmol/l and creatinine of 1.57mg/dl. Computed tomography of the head revealed multiple regions of acute infarction involving the right inferior cerebellum, left occipital lobe with mass effect on the left occipital horn. He underwent a transthoracic echocardiogram that showed vegetations on both the mitral and aortic valve. He underwent a trans-esophageal echocardiogram, which demonstrated multiple vegetations on the mitral (Figure 1), aortic (Figure 2) and pulmonic valves (Figure 3) with severe pulmonic, mitral and aortic insufficiency (Figure 4 & 5). 

Despite negative urine cultures, serial blood cultures grew Aerococcus urinae and he was given appropriate IV antibiotics. He was evaluated for possible valvular surgery and was deemed to be a poor surgical candidate. He later developed splenic and renal infarcts followed by significant hemodynamic instability requiring vasopressors and ultimately succumbed to his illness after he developed multi organ failure and disseminated intravascular coagulation.A.urinae was first identified in 1991 as a causative organism for endocarditis [1]. Since then, a total of twenty-three cases (including our patient) of A. urinae endocarditis have been reported in the literature to date (Table 1). Aerococci are gram-positive cocci that morphologically resemble staphylococci but have biochemical and growth characteristics of streptococci and enterococci [9]. A. urinae has preponderance in patients with underlying urinary tract pathologies and are reported to be found in 0.3 to 0.8% of urine samples. The incidence of A. urinae bloodstream infection is estimated to be 3 per 1,000,000 per year, as reported by a hospital which serves a 500,000 population. The organism is considered to be of low pathogenicity and may not always need to be treated. Sometimes this organism may initially be dismissed as a contaminant in clinical cultures from non-sterile sites. However, underdiagnoses of this organism can lead to disastrous outcomes.

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