Peritonitis is a well-known complication seen with peritoneal dialysis. Peritonitis is associated with increased mortality risk and is commonly caused by gram-positive and gram-negative bacteria, but it can also be the result of fungal or viral infections. Therefore, it is imperative to obtain a peritoneal fluid sample to send for cell count with differential, gram stain, and culture prior to starting empiric antibiotic therapy. We report a case of peritoneal dialysis-related peritonitis caused by Enterococcus gallinarum, for which there has only been one other reported case in the medical literature. Our patient was initially placed on vancomycin and cefepime but continued to deteriorate until peritoneal fluid cultures revealed E. gallinarum. Based on sensitivities, the patient was treated with daptomycin and cefazolin, which resolved her peritonitis.

/pdf/a-rare-case-of-enterococcus-gallinarum-associated-1089cq2v54.pdf

A Rare Case of Enterococcus gallinarum-Associated Peritonitis and Literature Review.

Enterococcus casseliflavus is rarely isolated from human specimens. To the best of our knowledge, there are no reports on its detailed treatment course and prognosis. Here, we present the first known case of E. casseliflavus endocarditis with a detailed treatment course. An 86-year-old Japanese woman was transferred to the emergency department with dyspnoea, wheezing, and lumbago. Her medical history included hypertension, chronic kidney disease, idiopathic interstitial pneumonia, and rectal carcinoma. Physical examination revealed expiratory wheezes and a diastolic murmur (Levine 2/6) at the 4th right sternal border. Chest radiography revealed bilateral interstitial opacities and slight cardiac dilatation. Transthoracic echocardiography demonstrated the presence of mobile vegetation with perforation, prolapse, and regurgitation of the aortic valve. With a suspicion of infective endocarditis, we started administering intravenous ampicillin/sulbactam. Thereafter, blood cultures identified E. casseliflavus through matrix-assisted laser desorption/ionisation time-of-flight mass spectrometry. The antimicrobial treatment was then switched to ampicillin plus gentamicin. The patient underwent aortic valve replacement on the thirteenth hospital day. She was administered intravenous ampicillin and gentamicin for 6 weeks. The patient was discharged 8 weeks after admission. Our case demonstrated that E. casseliflavus could cause infective endocarditis, which can be successfully treated with a 6-week regimen of ampicillin and gentamicin in combination with proper surgical treatment.

/pdf/successful-treatment-of-aortic-valve-endocarditis-caused-by-2ag53pa00d.pdf

Successful treatment of aortic valve endocarditis caused by Enterococcus casseliflavus: a case report.

SUMMARYEnterococci are a diverse group of Gram-positive bacteria that are typically found as commensals in humans, animals, and the environment. Occasionally, they may cause clinically relevant diseases such as endocarditis, septicemia, urinary tract infections, and wound infections. The majority of clinical infections in humans are caused by two species: Enterococcus faecium and Enterococcus faecalis. However, there is an increasing number of clinical infections caused by non-faecium non-faecalis (NFF) enterococci. Although NFF enterococcal species are often overlooked, studies have shown that they may harbor antimicrobial resistance (AMR) genes and virulence factors that are found in E. faecium and E. faecalis. In this review, we present an overview of the NFF enterococci with a particular focus on human clinical manifestations, epidemiology, virulence genes, and AMR genes.

Non-faecium non-faecalis enterococci: a review of clinical manifestations, virulence factors, and antimicrobial resistance.

Graft versus host disease (GVHD) is a post-transplant pathology in which donor-derived T cells present in the Peyer's patches target the cell-surface alloantigens of the recipient, causing host tissue damages. Therefore, the GVHD has long been considered only a purely immunological process whose prevention requires an immunosuppressive treatment. However, since the early 2010s, the impact of gut microbiota on GVHD has received increased attention. Both a surprising fall in gut microbiota diversity and a shift toward Enterobacteriaceae were described in this disease. Recently, unexpected results were reported that further link GVHD with changes in bacterial composition in the gut and disruption of intestinal epithelial tight junctions leading to abnormal intestinal barrier permeability. Patients receiving allogenic hematopoietic stem cell transplant (allo-HCT) as treatment of hematologic malignancies showed a decrease of the overall diversity of the gut microbiota that affects Clostridia and Blautia spp. and a predominance of lactic acid bacteria (LAB) of the Enterococcus genus, in particular the lactose auxotroph Enterococcus faecium. The reduced microbiota diversity (likely including Actinobacteria, such as Bifidobacterium adolescentis that cross feed butyrogenic bacteria) deprives the butyrogenic bacteria (such as Roseburia intestinalis or Eubacterium) of their capacity to metabolize acetate to butyrate. Indeed, administration of butyrate protects against the GVHD. Here, we review the data highlighting the possible link between GVHD and lactase defect, accumulation of lactose in the gut lumen, reduction of Reg3 antimicrobial peptides, narrower enzyme equipment of bacteria that predominate post-transplant, proliferation of En. faecium that use lactose as metabolic fuels, induction of innate and adaptive immune response against these bacteria which maintains an inflammatory process, elevated expression of myosin light chain kinase 210 (MLCK210) and subsequent disruption of intestinal barrier, and translocation of microbial products (lactate) or transmigration of LAB within the liver. The analysis of data from the literature confirms that the gut microbiota plays a major role in the GVHD. Moreover, the most recent publications uncover that the LAB, butyrogenic bacteria and bacterial cross feeding were the missing pieces in the puzzle. This opens new bacteria-based strategies in the treatment of GVHD.

/pdf/the-butyrogenic-and-lactic-bacteria-of-the-gut-microbiota-4ivqzedpbs.pdf

The Butyrogenic and Lactic Bacteria of the Gut Microbiota Determine the Outcome of Allogenic Hematopoietic Cell Transplant.

<title>Abstract</title> <bold>Background: </bold>Enterococcus gallinarum is an infrequently intestinal symbiotic pathogen associated with nosocomial infection in immunocompromised individuals. To date, rare cases of pulmonary infection attributable to Enterococcus gallinarum were reported. Herein, we presented the first case of empyema resulting from Enterococcus gallinarum infection. <bold>Case presentation: </bold>An 81-year-old male presented with fever and dyspnea upon admission. Chest CT scan and thoracic ultrasonography confirmed the presence of right pleural effusion. Thoracoscopy revealed extensive adhesion, purulent fluid, and necrotic materials within the thoracic cavity. Enterococcus gallinarum was identified through pleural effusion culture. The patient underwent an intrathoracic injection of urokinase along with thoracic drainage. Following surgery, He took oral linezolid for over 1 month. Undergoing comprehensive treatment, the patient exhibited favorable recovery. <bold>Conclusions: </bold>Enterococcus gallinarum could traverse the impaired gut barrier and cause extraintestinal infection in the immunosuppressive host. We reported the first case of empyema due to Enterococcus gallinarum infection. It should be suspected in patients with impaired immune function and invasive therapies, without responding to conventional antibiotic treatment. Prompt diagnosis and appropriate antibiotic treatment are crucial for the outcome of patients. 

A case report of empyema caused by Enterococcus gallinarum

OBJECTIVE Infective endocarditis due to Enterococus Gallinarum is a rare clinical condition. We present a case of an 85 years old male with a history of the valvular disease and permanent pace maker with past medical history of repetitive urinary tract infections in the previous months, who presented to the emergency department with fever, urinary disturbances, general malaise and positive blood cultures for Enterococcus Gallinarum. METHODS Echocardiography was a useful diagnostic method in the present case, showing the vegetation on the tricuspid valve. RESULTS This case is notable because tricuspid valve endocarditis due to Enterococcus Gallinarum is a rare clinical condition and improves knowledge of disease and management in patients with endocarditis.

A Rare Case of Tricuspid Valve Endocarditis Caused by Enterococcus Gallinarum in a Patient with Recurrent Urinary Tract Infection.

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A Rare Case of Tricuspid Valve Endocarditis Caused by Enterococcus Gallinarum in a Patient with Recurrent Urinary Tract Infection.