Infective endocarditis caused by Brevundimonas vesicularis

Background: There are few reports in the literature of invasive infection caused by Brevundimonas vesicularis in patients without immunosuppression or other predisposing factors. The choice of antimicrobial therapy for bacteremia caused by the pathogen requires more case experience to be determined. Case presentation: The case of a 40-year-old previously healthy man with subacute endocarditis proposed to be contributed from an occult dental abscess is described. The infection was found to be caused by B. vesicularis on blood culture results. The patient recovered without sequelae after treatment with ceftriaxone followed by subsequent ciprofloxacin therapy owing to an allergic reaction to ceftriaxone and treatment failure with ampicillin/sulbactam. Conclusion: To our knowledge, this is the first report of B. vesicularis as a cause of infective endocarditis. According to an overview of the literature and our experience, we suggest that thirdgeneration cephalosporins, piperacillin/tazobactam, and ciprofloxacin are effective in treating invasive B. vesicularis infections, while the efficacy of ampicillin-sulbactam needs further evaluation. Background Brevundimonas (formerly Pseudomonas) vesicularis is an aerobic nonsporulating and nonfermenting gram-negative bacillus [1] that has been isolated from the external environment [2-5] and human clinical specimens [6-15]. There have been only eight descriptions of infections in human beings caused by the microorganism, with only four cases of bacteremia reported in the literature [Table 1, [8-15]]. Five cases of B. vesicularis infection were attributed to community sources [10,12-15] and three to nosocomial sources [8,9,11]. Such underlying diseases as autoimmune disorders associated with long-term steroid use, end-stage renal disease treated by hemodialysis, and sickle cell anemia with functional asplenia contributed to B. vesicularis infections in 6 of the 8 reported cases due to the patients' immunocompromised state [Table 1, [8-12,15]]. B. vesicularis infection has therefore been classified as opportunistic [8-12,15]. We report here a case of infective endocarditis caused by B. vesicularis in a patient without comorbid disease. The low number of cases reported of B. vesicularis infection in humans limits the body of knowledge on the spectrum of disease caused by this pathogen Published: 29 December 2006 BMC Infectious Diseases 2006, 6:179 doi:10.1186/1471-2334-6-179 Received: 07 September 2006 Accepted: 29 December 2006 This article is available from: http://www.biomedcentral.com/1471-2334/6/179 © 2006 Yang et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.