American Journal of Medical Case Reports
ISSN (Print): 2374-2151 ISSN (Online): 2374-216X Website: Editor-in-chief: Apply for this position
Open Access
Journal Browser
American Journal of Medical Case Reports. 2017, 5(11), 279-281
DOI: 10.12691/ajmcr-5-11-4
Open AccessCase Report

Infective Endocarditis due to Abiotrophia defectiva presenting as Ankle Cellulitis

Mahmoud Al Subhi1, Fatima Al Yaqubi1 and Hilal Al Hashami2,

1Microbiology department, Royal Hospital, Muscat, Oman

2Pediatrics Infectious Diseases Department, Royal Hospital, Muscat, Oman

Pub. Date: December 20, 2017

Cite this paper:
Mahmoud Al Subhi, Fatima Al Yaqubi and Hilal Al Hashami. Infective Endocarditis due to Abiotrophia defectiva presenting as Ankle Cellulitis. American Journal of Medical Case Reports. 2017; 5(11):279-281. doi: 10.12691/ajmcr-5-11-4


We report a case of infective endocarditis (IE) caused by Abiotrophia defectiva in an 8 year-old boy presented initially with left ankle cellulitis and fever. Blood culture showed Gram variable cocci which confirmed by Matrix-Assisted Laser Desorption Ionization Time Of Flight Mass Spectrophotometer (MALDI-TOF MS) as Abiotrophia defectiva. Vegetation seen at Mitral valve by transthoracic echocardiogram (TTE). He was diagnosed as Infective Endocarditis caused by Abiotrophia defectiva and was treated with intravenous gentamicin (6mg/kg/day) and ceftriaxone (100mg/kg/day) for six weeks. The patient had excellent outcome, vegetation was absent on repeated Echocardiography (ECHO), and the result showed no relapse after follow up. Abiotrophia defectiva should be considered as a cause of IE in patients with positive blood culture especially those caused by gram variable cocci.

Abiotrophia defectiva endocarditis child streptococci

Creative CommonsThis work is licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit


[1]  Bouvet A. Human endocarditis due to nutritionally variant streptococci: Streptococcus adjacens and Streptococcus defectiva. Eur Heart J 1995; 16(Suppl B): 24-7.
[2]  Lainscak M, Lejko–Zupanc T, Strumbelj I, Gasparac I, Meuller-Premru M, Pirs M. Infective endocarditis due to Abiotrophia defectiva: a report of two cases. J Heart Valve Dis 2005; 14: 33-36.
[3]  Yang YS, Shang ST, Lin JC, Chiu CH, Chang FY. A ruptured cerebral mycotic aneurysm caused by Abiotrophia defectiva endocarditis. Am J Med Sci. 2010; 339(2): 190-1.
[4]  Ruoff K. Nutritionally variant streptococci. Clin Microbiol Rev 1991; 4: 184-90.
[5]  Collins MD, Lawson PA. The genus Abiotrophia (Kawamura et al.) is not monophyletic: proposal of Granulicatella gen. nov. Granulicatella adiacens comb. nov. Granulicatella elegans comb. nov. And Granulicatella balaenopterae comb. nov. Int J Syst Evol Microbiol 2000; 50(Pt 1): 365-9.
[6]  Brouqui P, Raoult D. Endocarditis due to rare and fastidious bacteria. Clin Microbiol Rev 2001; 177-207.
[7]  Okada Y, Kitada K, Takagaki M, Ito HO, Inoue M (2000) Endocardiac infectivity and binding to extracellular matrix proteins of oral Abiotrophia species. FEMS Immunol Med Microbiol 27: 257-261.
[8]  K. Giannakopoulos, C. Zompolou, M. Bennes, E. Elmas, M. Borggrefe, I. Akin. Infective endocarditis –A word of caution on non-typical bacteria. Eur Rev Med Pharmacol Sci 2016 Nov; 20(22): 4782-4785.
[9]  Woo PC, Fung AM, Lau SK, Chan BY, Chiu S, Teng JL, Que T, Yung RW and Yuen Y. Granulicatella adiacens and Abiotrophia defective bacteremia characterized by 16S rRNA gene sequencing. J Med Microbiol 2003; 52: 137-140.
[10]  Chang HH, Lu CY, Hsueh PR, Wu MW, Wang JK, Huang L M. Endocarditis caused by Abiotrophia defectiva in children. Pediatr Infect Dis J. 2002; 21: 697-700.
[11]  Cerceo E, Christie JD, Nachamkin I, Lautenbach E. Central nervous system infections due to Abiotrophia and Granulicatella species: an emerging challenge? Diagn Microbiol Infect Dis 2004; 48(3): 161-165.
[12]  Ince A, Tiemer B, Gille J, Boos C, Russlies M. Total Knee arthroplasty infection due to Abiotrophia defectiva. J Med Microbiol 2002; 51: 899-902.
[13]  Christensen JJ, Cruhn N, Facklam RR. Endocarditis caused by Abiotrophia species. Scand J Infect Dis 1999; 31: 210-212.
[14]  Jodian Amor Pinkney, Rajeev Peeyush Nagassar, Karen Judith Roye-Green, Trevor Ferguson. CASE REPORT, Abiotrophia defectiva endocarditis.BMJ Case Rep 2014.
[15]  Asma M Al-Jasser1, Mushira A Enani and Mohammed R Al-Fagih, Endocarditis caused by Abiotrophia defective, Libyan J Med, AOP: 061223.
[16]  Bajaj A, Rathor P, Sethi A, Sehgal V, Ramos JA (2013) Aortic Valve Endocarditis by a Rare Organism: Abiotrophia defectiva. J Clin Exp Cardiolog 4: 276.
[17]  Y. Kadri, M. Hassine, C. Echahed, C. Chaouch, M.Boussaada, H. Ben Abdallah, N. Boujaafer, H. Gamra, and M. Mastouri, “Infective Endocarditis Caused by Abiotrophia Defectiva: A Case Report.” American Journal of Medical Case Reports, vol. 3, no. 7 (2015): 187190.
[18]  Holler JG, Pedersen LK, Calum H, Nielsen JB, Tvede M, et al. (2011) Using MALDI-TOF mass spectrometry as a rapid and accurate diagnostic tool in infective endocarditis: a case report of a patient with mitral valve infective endocarditis caused by Abiotrophia defectiva. Scand J Infect Dis 43: 234-237.
[19]  Maria Aurora Carleo, Annalisa Del Giudice, Rosaria Viglietti, Pietro Rosario and Vincenzo Esposito. Aortic Valve Endocarditis Caused by Abiotrophia defectiva: Case Report and Literature Overview. In vivo29: 515-518 (2015).
[20]  Stein DS, Nelson KE (1987) Endocarditis due to nutritionally deficient streptococci: therapeutic dilemma. Rev Infect Dis 9: 908-916.
[21]  Yemisen M, Koksal F, Mete B, Yarimcam F, Okcun B, et al. (2006) Abiotrophiadefectiva: a rare cause of infective endocarditis. Scand J Infect Dis 38: 939-941.
[22]  Wilson WR, Karchmer AW, Dajani AS, Taubert KA, Bayer A, et al. (1995) Antibiotic treatment of adults with infective endocarditis due to streptococci, enterococci, staphylococci, and HACEK microorganisms. American Heart Association. JAMA 274: 1706-1713.