Moore Curtiss, Addison Daniel, Wilson James M, Zeluff Barry
Department of Cardiology, Baylor College of Medicine, Houston, Texas 77030.
Tex Heart Inst J. 2013;40(4):449-52.
Fusobacterium necrophorum, an obligate, anaerobic, filamentous, gram-negative rod, is thought to be a normal inhabitant of the mucous membranes in human beings. Fusobacterium species have been implicated in cases of Lemierre syndrome and other pathologic conditions. Their reported association with infective endocarditis is extremely rare. We describe the case of a previously healthy 34-year-old man who emergently presented with flu-like symptoms and dyspnea on exertion. He had recently undergone a dental procedure. Empiric antibiotic therapy was initiated. Blood cultures were positive for metronidazole-resistant F. necrophorum. A transesophageal echocardiogram revealed 2 mobile vegetations on the mitral valve. Despite the antibiotic therapy, the patient's respiratory status worsened and, after 3 weeks, he died. On the basis of the organism's pathophysiology and the patient's recent dental procedure, the oral cavity was the likely source of the bacteremia. Our patient's case underscores the importance of recognizing Fusobacterium bacteremia as a possible cause of endocarditis. To our knowledge, this is the first reported case of monomicrobial F. necrophorum endocarditis to have presented in a patient after the 2nd decade of life. In addition, it is apparently only the 4th report of F. necrophorum mitral valve endocarditis with case results derived from modern culture techniques.
坏死梭杆菌是一种专性厌氧、丝状、革兰氏阴性杆菌，被认为是人类黏膜的正常寄居菌。梭杆菌属与 Lemierre 综合征及其他病理状况有关。据报道，它们与感染性心内膜炎的关联极为罕见。我们描述了一例先前健康的 34 岁男性病例，该患者因出现类似流感症状和劳力性呼吸困难而紧急就诊。他近期接受了牙科手术。开始进行经验性抗生素治疗。血培养结果显示对甲硝唑耐药的坏死梭杆菌呈阳性。经食管超声心动图显示二尖瓣有 2 个活动的赘生物。尽管进行了抗生素治疗，患者的呼吸状况仍恶化，3 周后死亡。基于该病原体的病理生理学以及患者近期的牙科手术，口腔很可能是菌血症的来源。我们患者的病例强调了认识到坏死梭杆菌菌血症可能是心内膜炎病因的重要性。据我们所知，这是首例报道的 20 岁以后发病的坏死梭杆菌单微生物性心内膜炎病例。此外，这显然是第 4 例源自现代培养技术的坏死梭杆菌二尖瓣心内膜炎病例报告。
