ABSTRACT:Achromobacter xylosoxidans is a Gram-negative aerobic bacterium first described by Yabuuchi and Ohyama in 1971. A. xylosoxidans is frequently found in aquatic environments. Abdominal, urinary tract, ocular, pneumonia, meningitis, and osteomyelitis are the most common infections. Infective endocarditis is rare. As far as we know, until now, only 19 cases have been described, including this current report. We report the case of community-acquired native valve endocarditis caused by A. xylosoxidans in an elderly patient without a concomitant diagnosis of a malignancy or any known immunodeficiency. The patient presented with a 2-month history of fever, weight loss, and progressive dyspnea. On physical examination, mitral and aortic murmurs were present, along with Janeway’s lesions, and a positive blood culture for A. xylosoxidans. The transesophageal echocardiogram showed vegetation in the aortic valve, which was consistent with the diagnosis of infective endocarditis.
DerberC, ElamK, ForbesBA, BearmanG. Achromobacter species endocarditis: a case report and literature review. Can J Infect Dis Med Microbiol. 2011;22(3):e17-20. [PMID:22942890] [https://doi.org/10.1155/2011/527412].
Gómez-CerezoJ, SuárezI, RíosJJ, et al. Achromobacter xylosoxidans bacteremia: a 10-year analysis of 54 cases. Eur J Clin Microbiol Infect Dis. 2003;22(6):360-3. [PMID:12750959] [https://doi.org/10.1007/s10096-003-0925-3].
DugganJM, GoldsteinSJ, ChenowethCE, KauffmanCA, BradleySF. Achromobacter xylosoxidansbacteremia: report of four cases and review of the literature. Clin Infect Dis. 1996;23(3):569-76. [PMID:8879782] [https://doi.org/10.1093/clinids/23.3.569].
KumarS, KhairaJ, PenigalapatiD. Native valve endocarditis in a dialysis patient by Achromobacter xylosoxidans: Rare pathogen. Open Forum Infect Dis. 2016;3(Suppl 1):1106. [https://doi.org/10.1093/ofid/ofw172.809].
LevoyCS, HallDJ, BermanD. Achromobacter xylosoxidans endocarditis and septic arthritis in an infant affected by generalized arterial calcification of infancy. JMM Case Rep. 2015;2(6) [https://doi.org/10.1099/jmmcr.0.005006].
RafaelAE, KeshavamurthyS, SepulvedaE, MirandaCC, OkamotoT, PetterssonGB. Intracardiac abscess with cutaneous fistula secondary to ventricular septal defect repair simulating sternal wound infection. Tex Heart Inst J. 2014;41(3):324-6. [PMID:24955054] [https://doi.org/10.14503/THIJ-13-3199].
SawantAC, SrivatsaSS, CastroLJ. Alcaligenes xylosoxidans endocarditis of a prosthetic valve and pacemaker. Tex Heart Inst J. 2013;40(1):95-8. [PMID:23466992]
TokuyasuH, FukushimaT, NakazakiH, ShimizuE. Infective endocarditis caused by Achromobacter xylosoxidans: a case report and review of the literature. Intern Med. 2012;51(9):1133-8. [PMID:22576403] [https://doi.org/10.2169/internalmedicine.51.6930].
StoreyA, WilsonA, McWilliamsE. Native valve infective endocarditis due to Achromobacter xylosoxidans in an apparently immunocompetent individual. BMJ Case Rep. 2010;2010(1):1. [PMID:22798095] [https://doi.org/10.1136/bcr.06.2010.3104].
Malek-MarínT, ArenasMD, PerdigueroM, et al. A case of endocarditis of difficult diagnosis in dialysis: could “pest” friends be involved? Clin Nephrol. 2009;72(5):405-9. [PMID:19863886] [https://doi.org/10.5414/CNP72405].
AhmedMS, NistalC, JayanR, KuduvalliM, AnijeetHK. Achromobacter xylosoxidans, an emerging pathogen in catheter-related infection in dialysis population causing prosthetic valve endocarditis: a case report and review of literature. Clin Nephrol. 2009;71(3):350-4. [PMID:19281752] [https://doi.org/10.5414/CNP71350].
Van HalS, StarkD, MarriottD, HarknessJ. Achromobacter xylosoxidans subsp. xylosoxidans prosthetic aortic valve infective endocarditis and aortic root abscesses. J Med Microbiol. 2008;57(Pt 4):525-7. [PMID:18349376] [https://doi.org/10.1099/jmm.0.47496-0].
YangCH, ShihNC, LuDCT. Infective endocarditis due to Achromobacter xylosoxidans associated with spondylodiscitis: a case report. J Int Med Taiwan. 2007;18(4):212-6.
NanuashviliA, KacharavaG, JashiashviliN. A case of native valve endocarditis caused by Alcaligenes xylosoxidans. Euro Surveill. 2007;12(5):1. [PMID:17868590]
MartinoP, MicozziA, VendittiM, et al. Catheter-related right-sided endocarditis in bone marrow transplant recipients. Rev Infect Dis. 1990;12(2):250-7. [PMID:2330480] [https://doi.org/10.1093/clinids/12.2.250].
DavisM, GrattenM, ReeGH. Infective endocarditis cause by Actinobacillus actinomycetemcomitans and Achromobacter xylosoxidans. P N G Med J. 1982;25(1):7-11. [PMID:6957084]
OlsonDA, HoeprichPD. Postoperative valve endocarditis due to Achromobacter xylosoxidans. West J Med. 1982;136(2):153-7. [PMID:7064475]
LiJS, SextonDJ, MickN, et al. Proposed modifications to the Duke criteria for the diagnosis of infective endocarditis. Clin Infect Dis. 2000;30(4):633-8. [PMID:10770721] [https://doi.org/10.1086/313753].
ErbelR, RohmannS, DrexlerM, et al. Improved diagnostic value of echocardiography in patients with infective endocarditis by transesophageal approach. A prospective study. Eur Heart J. 1988;9(1):43-53. [PMID:3345769] [https://doi.org/10.1093/ehj/9.1.43].
LuacesM, VilacostaI, FernándezC, et al. Vegetation size at diagnosis in infective endocarditis: influencing factors and prognostic implications. Int J Cardiol. 2009;137(1):76-8. [PMID:18694604] [https://doi.org/10.1016/j.ijcard.2008.05.011].
ChandrasekarPH, ArathoonE, LevineDP, ChandrasekarPH. Infections due to Achromobacter xylosoxidans. Case report and review of literature. Infection. 1986;14(6):279-82. [PMID:3818105] [https://doi.org/10.1007/BF01643962].
RaghuramanK, AhmedNH, BaruahFK, GroverRK. Achromobacter xylosoxidans: bloodstream infection in an elderly patient with hepatocellular carcinoma: case report and review of the literature. J Lab Phys. 2015;7(2):124-7. [PMID:26417165]
NgZY, FangG, LeoKW. Resolution of concomitant Achromobacter xylosoxidans burn wound infection without adjustment of antimicrobial therapy. Indian J Plast Surg. 2014;47(1):137-40. [PMID:24987220] [https://doi.org/10.4103/0970-0358.129650].