Fever, urinary symptoms, and a heart murmur
Clinical Vignette
An 81-year-old man from Mississippi with alcohol use disorder, hypertension, and benign prostatic hyperplasia presents with fever and malaise. He reports mild urinary urgency and generalized malaise for the past 10 days. He denies focal pain, cough, abdominal symptoms, or neurologic complaints.
Three months ago, he traveled to Arizona, staying near a farm.He lives with a dog and recently adopted two kittens from a local pet store and has had multiple skin excoriations. He also underwent a molar extraction 1 month ago. He denies any known allergies to antibiotics.
Physical examination is notable for temperature of 38.9°C, heart rate 118 bpm, respiratory rate of 20 bpm. On auscultation there is a II/VI systolic murmur in cardiac apex radiating to the axilla. Labs are notable for leukocytosis (15.4 × 10⁹/L) and elevated CRP (138 mg/L). Blood cultures are reported to be growing Gram-positive cocci in pairs and short chains (Gram stain is shown below). On culture, the organism is catalase negative and produces alpha-hemolytic colonies on blood agar. A transthoracic echocardiogram demonstrates a small mitral valve vegetation.
Obtained from: "https://www.cureus.com/articles/88577-aerococcus-urinae-infective-endocarditis#!/"
Question
What is the most likely pathogen?
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Question 2
Susceptibilities show penicillin susceptibility. What is the best treatment approach?
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References
Tai DBG, Go JR, Fida M, Saleh OA. Management and treatment of Aerococcus bacteremia and endocarditis. International Journal of Infectious Diseases. 2021;102:584–589.
DOI: https://doi.org/10.1016/j.ijid.2020.10.096
Rasmussen M. Aerococcus urinae: an increasingly acknowledged human pathogen. Clinical Microbiology and Infection. 2010;16(10):1247–1252.