Streptobacillus moniliformis Endocarditis

A novel toxinotyp-ing scheme and correlation of toxinotypes with serogroups of Clostridium difficile isolates. ribotyping of Clostridium difficile isolates originating from human and animal sources. Streptobacillus moniliformis Endocarditis To the Editor: Streptobacillus moniliformis is a facultatively anaero-bic, pleomorphic, gram-variable bacil-lus often seen in chains and as long unbranched filaments. It is found in the nasopharynx and oropharynx of wild and laboratory rats. Human infections result either from rodent bites (rat bite fever) or contaminated milk or other foods (Haverhill fever). The most common manifestations of infection are arthralgia, fever, and rash; endocarditis occurs as a rare complication (1). We report a case of S. monili-formis endocarditis in India in a patient with congenital heart disease. An 18-year-old man was admitted to the Department of Cardiology at the Government General Hospital in Chennai, India, in November 2005, with a fever of 2 months' duration with cough, epistaxis, palpitations, and persistent joint pain. His medical history indicated congenital heart disease with a ventricular septal defect. On physical examination, his blood pressure was 100/70 mm Hg, pulse rate was 100 beats/min, and temperature was 38.5°C. Laboratory tests showed a leukocyte count of 7,600/µL, a platelet count of 127,000/µL, and an erythrocyte sedimentation rate of 70 mm/h. An electrocardiogram showed normal sinus rhythm. A transthoracic echocardiogram demonstrated a ven-tricular septal defect and vegetations on the septal leaflet of the tricuspid valve. Three blood cultures were prepared , and treatment with antimicro-bial drugs (intravenous penicillin G, 3 × 10 6 U every 6 h, and gentamicin, 50 mg every 8 h for 4 weeks) was initiated. The blood cultures were incubated at 37°C in an atmosphere of 5%–10% CO 2. Characteristic white, downy, crumblike granules were observed on the surface of the erythrocytes in all 3 cultures within 18–24 h of incubation. Characteristic puff balls were seen after 48 h of incubation. Gram-stained smears showed gram-negative bacilli in long chains. Cultures were subcul-tured onto 5% sheep blood agar plates and MacConkey agar plates. The plates were incubated at 37°C in an atmosphere of 5%–10% CO 2. After 18–24 h of incubation, growth was seen on the sheep blood agar plates. Colonies were 1–2 mm in diameter, gray, smooth, and butyrous. A Gram stain of these colonies identified gram-variable, pleomorphic coccobacilli that were negative for catalase, oxi-dase, urease, and citrate, and did not produce indole or reduce nitrate. Antimicrobial susceptibility testing was performed by using the …