pISSN 2093-2340   eISSN 2092-6448
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    Infect Chemother. 2011 Aug;43(4):372-376. Korean.
    Published online Aug 31, 2011.
    https://doi.org/10.3947/ic.2011.43.4.372
    Copyright © 2011 by The Korean Society of Infectious Diseases and Korean Society for Chemotherapy
    Case Report

    Native Valve Infective Endocarditis due to Staphylococcus lugdunensis Confirmed by 16S Ribosomal RNA Sequencing

    Young Eun Ha,1 Seong-Yeol Ryu,2 Kwan Soo Ko,3 Eun-Jeong Joo,1 So Yeon Park,1 Hyun Ah Kim,1 Min-Hee Lim,1 Cheol-In Kang,1 Doo Ryeon Chung,1 Jae-Hoon Song,1 Pyo-Won Park,4 and Kyong Ran Peck1
      • 1Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
      • 2Department of Infectious Disease, Keimyung University School of Medicine, Daegu, Korea.
      • 3Department of Molecular Cell Biology, Samsung Biomedical Research Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
      • 4Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
    • Correspondence to Kyong Ran Peck, M.D., Ph.D. Division of Infectious Diseases, Samsung Medical Center, Sungkyunkwan University School of Medicine, 50 Irwon-dong, Gangnam-gu, Seoul 135-710, Korea. Tel: +82-2-3410-0329, Fax: +82-2-3410-0064, Email: krpeck@skku.edu
    Received March 29, 2011; Revised May 18, 2011; Accepted May 18, 2011.

    This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

    Abstract

    Staphylococcus lugdunensis is a Gram-positive, coagulase-negative Staphylococcus (CNS) species that is found as a skin commensal and has been implicated in fulminant invasive diseases such as infective endocarditis. S. lugudunensis infections resemble Staphylococcus aureus infections in terms of virulence, tissue destruction and clinical course. Although correct identification and determination of the susceptibility profile are important, some commercial systems may misidentify S. lugdunensis. We report a case of native valve infective endocarditis caused by S. lugdunensis, which was misidentified by the Vitek 2 system but identified correctly by 16S ribosomal RNA (rRNA) gene sequencing in a 72-year-old male patient. The patient had multiple vegetations on his mitral valve, and the largest one was found on the posterior mitral valve leaflet. It was 2.5 cm in size and hypermobile. Diffuse valvular abscess was also observed. He had persistent bacteremia for appoximately 8 days, which was resolved after immediate surgery and antibiotic therapy. When a patient with severe sepsis syndrome grows S. aureus or CNS other than S. lugdunensis on a commercial automatic culture system, the possibility of S. lugdunensis should be considered and further confirmatory testing such as 16S rRNA sequencing may be very useful.

    Keywords
    Staphylococcus lugdunensis; Infective endocarditis; Coagulase-negative staphylococci; 16S ribosomal RNA sequencing

    Figures

    Figure 1
    Transesophageal echocardiogram finding. A 2.5 cm sized hypermobile vegetation was attached to the posterior mitral valve leaflet and two small vegetations were attached to the anterior mitral valve leaflet. Diffuse thickening of the mitral valve was also observed, which was found to be valvular abscess following surgery.

    Tables

    Table 1
    Results of 16S rRNA Gene Sequence (1,419bp) Alignment (EzTaxon Server)

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    MeSH Terms
    Abscess
    Aged
    Bacteremia
    Endocarditis
    Humans
    Male
    Mitral Valve
    RNA, Ribosomal, 16S
    Sepsis
    Skin
    Staphylococcus
    Staphylococcus aureus
    Staphylococcus lugdunensis
    Metrics
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