BACTERIAL ENDOCARDITIS CAUSED BY Ochrobactrum anthropi: CASE REPORT

Abstract

Introduction: Infectious endocarditis is an inflammatory lesion of the endocardium and heart valves. It has a predilection for males and over 65 years of age. The use of intravenous drugs, surgical dental procedures and rheumatic heart disease are factors that favor its development. The clinical picture is diverse and non-specific, which makes its diagnosis difficult. Associating the clinic with imaging and microbiological data, and based on the Modified Duke Criteria, it is possible to make a definitive diagnosis. Among the rarely reported endocarditis-causing pathogens is the bacterium Ochrobactrum anthropi. This species is resistant to several antibiotics used in the clinic, such as beta-lactams. It is generally sensitive to gentamicin, polymyxins, sulfamethoxazole-trimethoprim and fluoroquinolones. Objective: Report a case of bacterial endocarditis caused by Ochrobactrum anthropi. Case report: Patient 30 years old, male, without previous comorbidities, physician. In November 2019 he started having a headache and fever. With the hypothesis of acute bacterial sinusitis, he used amoxicillin with clavulanate, with total improvement of symptoms. However, the symptoms returned, causing him to use levofloxacin, with partial improvement of the condition. He went to Hospital Santa Rita, where a systolic heart murmur was detected in the aortic area, and a transthoracic echocardiogram was requested, which showed interventricular communication and a mobile pedunculated image suggestive of vegetation. He was admitted to receive broad-spectrum antibiotic therapy, with ceftriaxone and vancomycin, for a total of six weeks. To correct the lesions, he performed ventriculoseptoplasty, atrioseptorrhaphy, aortic valve repair and removal of vegetating lesions on November 9, 2020, at Hospital Unimed de Vitória. The surgically removed cardiac tissue fragment was sent to the Tommasi laboratory for examinations, in which the presence of gram-negative rods, identified as the Ochrobactrum anthropi bacteria, was observed. He started treatment with meropenem and was discharged on November 19, 2020. He completed antibiotic therapy at home until the end of six weeks. Conclusion: Ochrobactrum anthropi is a rare etiologic agent and this information on bacterial endocarditis can favor the elucidation of infections that are difficult to diagnose, expanding the possibility of a more adequate therapeutic approach for the patient.