Kikuchi K, Totsuka K, Shimizu K, Enari T, Shibata Y, Hasegawa H
Department of Medicine, Tokyo Women's Medical College, Kitasato Institute.
Kansenshogaku Zasshi. 1994 Jul;68(7):830-6. doi: 10.11150/kansenshogakuzasshi1970.68.830.
We report four cases of infective endocarditis due to nutritionally variant streptococci (NVS) that occurred between 1981 and 1991. Three female and one male patients had underlying heart diseases. Causative organisms showed satellitism to staphylococci. Two strains were identified as S. adjacens and the other two were identified as S. defectivus by DNA-DNA hybridization. All strains had tolerance and one strain had resistance to benzylpenicillin (MIC 4 micrograms/ml). This penicillin-resistant strain also had tolerance to gentamicin. There was no synergism of benzylpenicillin and gentamicin against this strain by a killing curve in vitro. A 11-year-old female patient with infective endocarditis due to this strain, who had a transposition of great arteries, had large vegetations in external conduits by the Rastelli's operation. Some intensive antimicrobial chemotherapies were unsuccessful and a surgical replacement of the conduits must be done in this case. Since infective endocarditis due to NVS is not rare in Japan, NVS should be considered for the causative organisms in culture negative endocarditis.
我们报告了1981年至1991年间发生的4例由营养变异型链球菌（NVS）引起的感染性心内膜炎病例。3例女性和1例男性患者有基础心脏病。致病微生物对葡萄球菌表现出卫星现象。通过DNA-DNA杂交，2株被鉴定为毗邻链球菌，另外2株被鉴定为缺陷链球菌。所有菌株均对苄青霉素耐受，1株对苄青霉素耐药（MIC为4微克/毫升）。该耐青霉素菌株对庆大霉素也耐受。体外杀菌曲线显示苄青霉素和庆大霉素对该菌株无协同作用。一名11岁因该菌株引起感染性心内膜炎的女性患者，患有大动脉转位，经Rastelli手术在体外管道中有大的赘生物。一些强化抗菌化疗未成功，该病例必须进行管道的外科置换。由于在日本由NVS引起的感染性心内膜炎并不罕见，在培养阴性的心内膜炎中应考虑NVS作为致病微生物。
