Shuttleworthia satelles endocarditis: evidence of non-dental human disease.

lease cite this article in press as: Ne ect (2010), doi:10.1016/j.jinf.2010. A 65-year-old man with rheumatic carditis and a mitral valve mechanical prosthesis presented with weakness and expressive aphasia which prompted hospital admission at another institution. For four months prior to admission, he had nightly symptoms of muscle aches and sweats. Six months prior to admission, he recalled a ‘‘boil’’ and bleeding from the mandibular gingiva. Magnetic resonance imaging showed two small acute infarctions in the distribution of the left middle cerebral artery. An echocardiogram showed two distinct mobile thrombi on the prosthetic mitral valve. Three sets of blood cultures were obtained, but no antimicrobial therapy was administered and the patient was transferred to our institution for further management three days later. On arrival, two sets of blood cultures were collected. Therapy with ampicillin/sulbactam was started when three of the five blood culture sets grew an anaerobic Gram-positive bacillus after 72 h of incubation. Gram stain showed short Gram-positive bacilli in diphtheroidal arrangements. Small satellite colonies grew within and from the margins of the primary colony after 10e14 days of incubation. The isolate was resistant to colistin (10 mg disc) and susceptible to vancomycin (5 mg disc), bile and indole positive, and catalase negative. Esculin was hydrolyzed, but arginine and urea were not. Arabinose, glucose, lactose, maltose, melezitose, sucrose, trehalose, fructose and rhamnose were fermented, but cellobiose, melibiose, mannitol, salicin, and sorbitol were not. Gelatin was not liquefied and H2S was not produced. The organism was N-acetyl-glucosidase and a-fucosidase negative, and b-D-galactosidase, a-D-galactosidase, and a-glucosidase positive. Acetic acid, formic acid, butyric acid, and lactic acid were detected by gas liquid chromatography.