Case report: Infective endocarditis caused by Brevundimonas vesicularis

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There are few reports in the literature of invasive infection caused by Brevundimonas vesicularis in patients without immunosuppression or other predisposing factors. The choice of antimicrobial therapy for bacteremia caused by the pathogen requires more case experience to be determined.


Case presentation
The case of a 40-year-old previously healthy man with subacute endocarditis proposed to be contributed from an occult dental abscess is described. The infection was found to be caused by B. vesicularis on blood culture results. The patient recovered without sequelae after treatment with ceftriaxone followed by subsequent ciprofloxacin therapy owing to an allergic reaction to ceftriaxone and treatment failure with ampicillin/sulbactam.

To our knowledge, this is the first report of B. vesicularis as a cause of infective endocarditis. According to an overview of the literature and our experience, we suggest that third-generation cephalosporins, piperacillin/tazobactam, and ciprofloxacin are effective in treating invasive B. vesicularis infections, while the efficacy of ampicillin-sulbactam needs further evaluation.

Brevundimonas (formerly Pseudomonas) vesicularis is an aerobic nonsporulating and nonfermenting gram-negative bacillus [1] that has been isolated from the external environment [2-5] and human clinical specimens [6-15]. There have been only eight descriptions of infections in human beings caused by the microorganism, with only four cases of bacteremia reported in the literature [Table 1, [8-15]]. Five cases of B. vesicularis infection were attributed to community sources [10,12-15] and three to nosocomial sources [8,9,11]. Such underlying diseases as autoimmune disorders associated with long-term steroid use, end-stage renal disease treated by hemodialysis, and sickle cell anemia with functional asplenia contributed to B. vesicularis infections in 6 of the 8 reported cases due to the patients' immunocompromised state [Table 1, [8-12,15]]. B. vesicularis infection has therefore been classified as opportunistic [8-12,15]. We report here a case of infective endocarditis caused by B. vesicularis in a patient without comorbid disease. The low number of cases reported of B. vesicularis infection in humans limits the body of knowledge on the spectrum of disease caused by this pathogen as well as optimal treatment regimens. The treatment course of the current case and previous cases of B. vesicularis infection is further discussed.

Table 1. Summary of reported cases of Brevundimonas vesicularis infection in humans


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