Lactobacillus Jensenii Mitral Valve Endocarditis: Case Report, Literature Review and New Perspectives

11 Pages Posted: 12 Jan 2022

See all articles by Lorenzo Grazioli Gauthier

Lorenzo Grazioli Gauthier

Ospedale Regionale di Lugano - Internal Medicine Department

Elia Rigamonti

Ospedale Regionale di Lugano - Internal Medicine Department

Dr.ssa Med. Laura Anna Leo

Ospedale Regionale di Lugano - Cardiovascular Imaging Department

Dr.ssa Med. Gladys Martinetti Lucchini

Regional Hospital of Bellinzona and Valleys (ORBV) - Diagnostic Microbiology

Dr.Med. Elia Lo Priore

Ospedale Regionale di Lugano - Department of Infectious Diseases

Enos Bernasconi

Ente Ospedaliero Cantonale Lugano - Division of Infectious Diseases

Abstract

Lactobacillus is a facultative anaerobic Gram-positive rod usually found in the normal microbiota of the gastrointestinal and genitourinary tract. Frequently dismissed as a contaminant, it is implicated in several diseases. We describe a rare case of endocarditis caused by Lactobacillus jensenii in an immunocompetent 40 year-old male patient, with a history of mitral valve repair. He presented complaining of asthenia and his laboratory results showed a moderate increase in inflammatory markers. A trans-thoracic echocardiography confirmed a vegetation on the posterior leaflet of the mitral valve, with associated severe mitral insufficiency. Blood cultures revealed the significant growth of L. jensenii. The patient developed an acute abdomen with intestinal ischemia and occlusion of the superior mesenteric artery, requiring urgent surgical laparotomy. A cerebral MRI showed multiple minor emboli in the frontal and left parietal cortex. The patient consequently underwent surgery to have his mitral valve replaced with a mechanical valve. L. jensenii was isolated in culture from the mitral valve and from a mesenteric artery thrombus. After one week of combined amoxicillin and gentamicin therapy, ampicillin alone was continued for a total of six weeks and the patient could be discharged in a good general condition. Only five cases of L. jensenii are described in literature, and they mainly affect immunocompromised hosts. In our case, a long delay between the start of symptoms and the full onset of the disease was observed. tolerance of Lactobacilli to penicillin is a key determinant of therapy choice.

Note:
Funding Information: None.

Declaration of Interests: The authors certify that there is no conflict of interest with any financial organization regarding the material discussed in the manuscript.

Consent Statement: The written patient consent was obtained.

Keywords: Lactobacillus, mitral valve endocarditis, trans-oesophageal echocardiography, penicillin, differential diagnoses

Suggested Citation

Gauthier, Lorenzo Grazioli and Rigamonti, Elia and Leo, Dr.ssa Med. Laura Anna and Lucchini, Dr.ssa Med. Gladys Martinetti and Lo Priore, Dr.Med. Elia and Bernasconi, Enos, Lactobacillus Jensenii Mitral Valve Endocarditis: Case Report, Literature Review and New Perspectives. Available at SSRN: https://ssrn.com/abstract=4001252 or http://dx.doi.org/10.2139/ssrn.4001252

Lorenzo Grazioli Gauthier

Ospedale Regionale di Lugano - Internal Medicine Department ( email )

Switzerland

Elia Rigamonti (Contact Author)

Ospedale Regionale di Lugano - Internal Medicine Department ( email )

Switzerland

Dr.ssa Med. Laura Anna Leo

Ospedale Regionale di Lugano - Cardiovascular Imaging Department ( email )

Lugano
Switzerland

Dr.ssa Med. Gladys Martinetti Lucchini

Regional Hospital of Bellinzona and Valleys (ORBV) - Diagnostic Microbiology ( email )

Bellinzona
Switzerland

Dr.Med. Elia Lo Priore

Ospedale Regionale di Lugano - Department of Infectious Diseases ( email )

Lugano
Switzerland

Enos Bernasconi

Ente Ospedaliero Cantonale Lugano - Division of Infectious Diseases ( email )

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