Fusobacterium species cardiac device infective endocarditis diagnosed via molecular methods

• Published in: Clinical infection in practice Vol. 15; p. 100155
• Main Authors: Galgut, Oliver, Mitchell, Andrew R.J., Le Page, Pierre
• Format: Journal Article
• Language: English
• Published: Elsevier 01.07.2022
• Subjects: Diagnosis; Fusobacterium; Infective endocarditis; Pacemaker; PCR
• ISSN: 2590-1702; 2590-1702
• DOI: 10.1016/j.clinpr.2022.100155

Background: Endocarditis of an implanted cardiac device is difficult to diagnose but has a high morbidity and mortality if left untreated. We present a case of culture negative endocarditis due to Fusobacterium species detected using molecular methods. Case report: An 81-year-old female presents with chest pain and breathlessness two months after aortic valve replacement and permanent pacemaker implantation. Fevers, hypoxia, and a single splinter haemorrhage were noted. Transoesophageal echocardiography demonstrated a single vegetation. Blood cultures were negative, but 16S ribosomal RNA matching Fusobacterium species was detected in serum. Antimicrobials were rationalised and the patient made a complete recovery. Conclusion: Infective endocarditis is a life-threatening condition which patients with cardiac devices in-situ are particularly susceptible to. There should be a low threshold for transoesophageal echocardiography when cardiac device endocarditis is suspected. Molecular methods such as polymerase chain reaction and serology are valuable when assessing culture negative endocarditis.