Actinomyces neuii: a case report of a rare cause of acute infective endocarditis and literature review

• Published in: BMC infectious diseases Vol. 19; no. 1; p. 511
• Main Authors: Yang, Wei-Teng, Grant, Matthew
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 10.06.2019; BioMed Central; BMC
• Subjects: Actinomyces; Actinomyces - isolation & purification; Actinomyces neuii; Actinomycetales infections; Actinomycosis; Actinomycosis - diagnosis; Actinomycosis - drug therapy; Actinomycosis - microbiology; Acute Disease; Anti-Bacterial Agents - therapeutic use; Antibiotics; Aorta; Bacilli; Bacteria; Blood culture; Blood tests; Brain; Cardiovascular system; Case Report; Case reports; Case studies; Chronic kidney failure; Contamination; Diagnostic imaging; Dialysis; Echocardiography; Endocarditis; Endocarditis - diagnosis; Endocarditis - drug therapy; Endocarditis - microbiology; Fever; Gram-positive bacilli; Heart valve diseases; Hemodialysis; Humans; Infections; Infectious diseases; Infective endocarditis; Intravenous administration; Kidney diseases; Literature reviews; Magnetic resonance imaging; Male; Metronidazole; Middle Aged; Monoclonal gammopathy; New species; Prostheses; Rare species; Risk factors; Surgery; Thoracic surgery; Ultrasonic imaging; Actinomyces neuii; Actinomyces; Infective endocarditis
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-019-4149-2

Infective endocarditis caused by Actinomyces spp. is extremely rare. However, cases by new species of Actinomyces have been increasingly reported due to advances in laboratory techniques, and many of these species do not cause classic presentations of actinomycosis. Actinomyces neuii is reported to have a tendency to cause endovascular infection. The course of infective endocarditis caused by Actinomyces spp. is usually indolent. A 61-year-old man with history of infective endocarditis, end stage renal disease, and monoclonal gammopathy was admitted for an abrupt fever, confusion, dysarthria, and facial droop after hemodialysis. Echocardiogram showed vegetations on both the aortic and mitral valves. Two sets of blood culture grew A. neuii. Brain MRI showed multiple bilateral cerebral infarcts consistent with septic emboli. The patient recovered after valvular surgery and prolonged intravenous and oral antibiotic therapy. This case illustrates an unusually acute presentation of A. neuii infective endocarditis. As with other Gram-positive bacilli, Actinomyces spp. isolates are often regarded as a result of contamination. One should keep it in mind as a cause of infective endocarditis in vulnerable patient populations.