American Journal of Medical Case Reports
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American Journal of Medical Case Reports. 2021, 9(2), 103-115
DOI: 10.12691/ajmcr-9-2-4
Open AccessArticle

Risk Factors and Patient Profile of Infective Endocarditis due to Gemella spp.

Pramod Theetha Kariyanna1, 2, Bayu Sutarjono3, Naga Pranavi Ellanti4, Apoorva Jayarangaiah5, Amog Jayarangaiah6, Harshith Priyan Chandrakumar2, Ashkan Tadayoni2, Moro O. Salifu2 and Isabel M. McFarlane2,

1Division of Interventional Cardiology Fellow, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Morningside/Beth Israel, New York City, New York-10025

2Division of Cardiovascular Disease and Department of Internal Medicine, State University of New York, Downstate Medical Center, Brooklyn, NY 11203, USA

3Saba University School of Medicine, 27 Jackson Road, Devens, MA 01434, USA

4Department of Family Medicine, Mount Sinai Hospital, Chicago, IL 60608, USA

5Department of Internal Medicine, NYC Health and Hospitals/Jacobi Medical Center, Bronx, NY 10461, USA

6Trinity School of Medicine, 925 Woodstock Road, Roswell, GA 30075, USA

Pub. Date: December 13, 2020

Cite this paper:
Pramod Theetha Kariyanna, Bayu Sutarjono, Naga Pranavi Ellanti, Apoorva Jayarangaiah, Amog Jayarangaiah, Harshith Priyan Chandrakumar, Ashkan Tadayoni, Moro O. Salifu and Isabel M. McFarlane. Risk Factors and Patient Profile of Infective Endocarditis due to Gemella spp.. American Journal of Medical Case Reports. 2021; 9(2):103-115. doi: 10.12691/ajmcr-9-2-4

Abstract

Background. The diagnosis of infective endocarditis is difficult, especially when it involves atypical organisms. Therefore, our study identified risk factors of infective endocarditis caused by rare pathogen, Gemella spp. Methods. A systematic review was conducted to investigate characteristics of endocarditis patients infected with Gemella spp. using the search term “Gemella” and “endocarditis.” Case reports were gathered by searching Medline/Pubmed, Google Scholar, CINAHL, Cochrane CENTRAL, and Web of Science databases. 83 articles were selected for review. Results. Five species of Gemella were identified. Typical patients were males between 31 and 45 years of age. On admission, patients had fever, tachycardia, and normal blood pressure. Common clinical manifestation other than fever included fatigue and weakness, chills and sweating, and nausea, vomiting, diarrhea, and weight changes. One in four reported a history of congenital heart disease, and a recent oral cavity infection. Laboratory tests reveal anemia, leukocytosis, and elevated erythrocyte sedimentation in all age groups, elevated C-reactive protein is observed among adult and geriatric populations only. Mitral and aortic valves were most commonly infected by Gemella spp.. The most common Gemella spp.-susceptible antibiotics were penicillin, vancomycin, cephalosporin, macrolide, and aminoglycosides. However, antibiotic resistance was observed against penicillin, aminoglycoside, and fluoroquinolone. Antibiotic course of at least six weeks resulted in superior clinical improvements than durations under six weeks. Finally, one in two patients underwent valve replacement or repair, with common complications affecting the cardiovascular, neurological, and renal systems. Finally, death occurred in 1 in 8 patients, half of which occurred post-surgical procedure, and the majority occurring equal to or greater than 1 week from admission. Conclusion. Our systematic review highlights the importance of considering rare pathogens, particularly in the presence of predisposing risk factors.

Keywords:
Gemella endocarditis

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