eng Science and Education Publishing American Journal of Medical Case Reports 2374-216X 2021-05-25 9 9 467 478 10.12691/ajmcr-9-9-8 AJMCR2021998 article Pramod Theetha Kariyanna 1 2 Bayu Sutarjono 3 Naga Pranavi Ellanti 4 Apoorva Jayarangaiah 5 Amog Jayarangaiah 6 Sushruth Das 6 Harshith Priyan Chandrakumar 6 Isabel M. McFarlane ISABEL.MCFARLANE@DOWNSTATE.EDU 6 Division of Interventional Cardiology Fellow, Mount Sinai Heart, Icahn School of Medicine at Mount Sinai Morningside/Beth Israel, New York City, New York-10025 Saba University School of Medicine, 27 Jackson Road, Devens, MA 01434, USA Department of Family Medicine, Mount Sinai Hospital, Chicago, IL 60608, USA Department of Internal Medicine, NYC Health and Hospitals/Jacobi Medical Center, Bronx, NY 10461, USA Trinity School of Medicine, 925 Woodstock Road, Roswell, GA 30075, USA 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 ˇ°Gemellaˇ± and ˇ°endocarditis.ˇ± 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. 5 species of Gemella were identified. Typical patient affected were male 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. 1 in 4 reported a history of congenital heart disease, and a recent oral infection. 1 in 2 patients underwent surgical procedure. Laboratory tests revealed anemia, leukocytosis, and elevated erythrocyte sedimentation in all age groups, as well as elevated C-reactive protein in 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 therapy of at least 6 weeks resulted in superior clinical improvements than durations under 6 weeks. Finally, 1 in 2 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. http://pubs.sciepub.com/ajmcr/9/9/8/ajmcr-9-9-8.pdf infective endocarditis Gemella spp heart valve vegetations clinical features mortality risk factors