Abstract
Weissella confusa, a Gram positive coccobacillus, is a rare cause of human disease. They are vancomycin resistant, bile aesculin positive, lactic acid fermenters previously classified as members of the Leuconostoc and Lactobacillus genera. Among the 19 recognised species of Weissella, W. confusa is most frequently associated with human infection, however as its name suggests establishing its pathogenicity and correctly identifying it using traditional phenotypic testing platforms can be challenging. We present a case of W. confusa endocarditis in a male from Ghana where W. confusa is used in the fermenting process of commonly consumed food products. We discuss the microbiological diagnostic processes, including identification of this organism through use of matrix-assisted laser-desorption ionisation/time-of-flight (MALDI-ToF), and how the laboratory derived susceptibility tests were interpreted and applied to construct a successful therapeutic regime for infective endocarditis. We review the literature around cases of invasive W. confusa disease, contextualising this organism in terms of relevance to patients who are immunocompromised or who have indwelling vascular access devices.
Highlights
A bedside echo revealed a bicuspid aortic valve with moderate aortic stenosis and aortic regurgitation and aortic root dila tation of 3.95 cm, but with no significant change from his last screening echo. His blood tests demonstrated; C-reactive protein (CRP) 59 mg/L, troponin 13 ng/L, creatine kinase 54 U/L, creatinine 83 μmol/L, urea 3.4 mg/dL, WCC 9.3 × 109/L, neutrophils 5.3 × 109/L, lymphocytes 3.0 × 109/L, eosinophils 0.2 × 109/L, platelets 184 × 109/ L, immunoglobulins, electrolytes and liver function tests were within normal ranges and HIV test was negative
There are currently 19 recognised species of Weissella (Fusco et al, 2015) of which W. confusa is most frequently associated with human infection, as its name suggests establishing its pathogenicity and correctly identi fying it using traditional phenotypic testing platforms can be chal lenging (Fairfax et al, 2014)
While our patient was HIV negative he did have a history of diabetes and had recently been prescribed a course of steroids for presumed polymyalgia rheumatica, it is likely that his endocarditis was responsible for his early symptoms and predated the steroid course, as they fully resolved after his endocarditis was treated
Summary
A 63 year old man of Ghanaian origin presented with a four week history of chest tightness and palpitations. A bedside echo revealed a bicuspid aortic valve with moderate aortic stenosis and aortic regurgitation and aortic root dila tation of 3.95 cm, but with no significant change from his last screening echo His blood tests demonstrated; C-reactive protein (CRP) 59 mg/L, troponin 13 ng/L (repeat 11 ng/L), creatine kinase 54 U/L, creatinine 83 μmol/L, urea 3.4 mg/dL, WCC 9.3 × 109/L, neutrophils 5.3 × 109/L, lymphocytes 3.0 × 109/L, eosinophils 0.2 × 109/L, platelets 184 × 109/ L, immunoglobulins, electrolytes and liver function tests were within normal ranges and HIV test was negative. A positron emission tomography/computerised to mography scan performed on day four of admission demonstrated a metabolically active focus at the aortic root confirming the diagnosis of endocarditis (see Fig. 2) He remained apyrexial, his CRP normalised, and his gentamicin was stopped on day 17. The patient was discharged after a full recovery on day 62 of his admission, with no recurrence of symptoms to suggest a diagnosis of PMR
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