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Table 1 Clinical characteristics of patients with endocarditis caused by Enterococcus hirae

From: Native-valve Enterococcus hirae endocarditis: a case report and review of the literature

Patient 1 2 3 4 5
Age, y 72 78 56 70 64
Sex M F M M F
Valve involvement Aortic insufficiency. Vegetation on aortic prosthetic valve present during relapse; normal TTE/TEE upon initial presentation. Aortic and mitral valve reflux. Severe aortic regurgitation with prolapse, fusion, small echodensity, and perforation of aortic cusps. Bicuspid aortic valve with stenosis, root abscess, calcifications; no evidence of vegetations or abscess on TTE.
Medical history Coronary artery disease, percutaneous transluminal coronary angioplasty. Diabetes mellitus, hypertension, prior aortic valve replacement with bioprosthetic. Hypertension, diabetes mellitus, cardiac arrhythmia with prior surgical ablation, surgical removal of gastric leiomyoma. Unknown. Hodgkin’s lymphoma, asthma, achalasia, recurrent right lower extremity DVT, fibromyalgia, cholecystectomy.
Identification sodAint gene sequencing. 16S rNA, sodAint gene sequencing. Unknown. MALDI-TOF. MALDI-TOF.
Treatment Aortic valve replacement. Ampicillin and gentamicin (4 weeks), with rifampin added (15 days); total 4 weeks. Amoxicillin and gentamicin (2 weeks), followed by amoxicillin and rifampin (4 weeks); total 6 weeks. Aortic valve replacement. Ampicillin and gentamicin (4 weeks), followed by amoxicillin and rifampin (2 weeks); total 6 weeks. Aortic valve replacement. Ampicillin and ceftriaxone, followed by IV penicillin G and ceftriaxone for 6 weeks, with indefinite chronic suppressive therapy of oral penicillin. Aortic valve replacement. Ampicillin and ceftriaxone (6 weeks).
Relapse Yes, 3 months after antibiotic discontinuation. Treated with aortic valve replacement and vancomycin/gentamicin (6 weeks) followed by amoxicillin (2 weeks) for a total of 8 weeks of antibiotic therapy. Resolved. Yes, 4 months after antibiotic discontinuation. Treated with the same regimen as before. Surgery contraindicated by poor patient condition. Resolved. No. No. No.
Notes Subacute presentation. Subacute presentation. No evidence of endocarditis on initial TTE/TEE. Multiple colonic polyps removed. Post-relapse, colonic polyp with non-neoplastic adenoma removed. The only case of the five not to require aortic valve replacement, although the infected valve was already a prosthetic valve. Presented acutely as neurological deficit with slurred speech and left hemiparesis. Subacute presentation with 3 months of bilateral lower extremity edema, exertional dyspnea, and fatigue; 1 year of fevers and mild weight loss. Lived in Vietnam for 2 years, with travel throughout Southeast Asia. Presented acutely as hypotension and atrial fibrillation with rapid ventricular response.
Year of publication, reference 2002 [8] 2011 [9] 2013 [10] 2019 [11] 2019
  1. All reported cases of E. hirae endocarditis have involved the aortic valve. Presentations of E. hirae endocarditis have been both acute and subacute. Treatment requires several weeks of bactericidal treatment, classically ampicillin and gentamicin in combination, and often necessitates aortic valve replacement
  2. TTE Transthoracic echocardiography, TEE Transesophageal echocardiography