Aerococcus urinae Endocarditis: A Report of Two Cases and Review of Literature Andrew Dysangco, M.D.*, Remedios F. Coronel, M.D.**, Julie Li-Yu, M.D. ***, Francis Marie Purino M.D. ****, and Samuel Sunarso, M.D. ***** Volume 48 Number 1 January-June, 2010 49 *Resident, Department of Medicine, University of Santo Tomas Hospital **Chief, Section of Infectious and Tropical Diseases, Department of Medicine, University of Santo Tomas Hospital ***Section of Rheumatology, Clinical Immunology and Osteoporosis, Department of Medicine, University of Santo Tomas Hospital ****Section of Cardiology, Department of Medicine, University of Santo Tomas Hospital *****Resident, Department of Medicine, University of Santo Tomas Hospital Reprint request to: Andrew T. Dysangco, Department of Internal Medicine, University of Santo Tomas Hospital, Espana, Manila, Philippines 1015, E-mail: rewdy_dysangco@yahoo.com, Contact number: 0917-843- 8754; Background: Aerococcus urinae is a rare pathogen of endocarditis with high rates of embolic events, valvular damage and mortality. Case 1 A 24 y/o male, with mitral valve prolapse, presented with recurrent fever and body malaise for four months. α-hemolytic streptococci was isolated in his blood 3 months prior, antibiotics for 10 days temporarily relieved his symptoms. He denied illicit drug use, recent dental, genitourinary manipulations. On admission, he was febrile with a 4/6 holosystolic murmur at the apex. He had leukocytosis and elevated acute phase reactants. Blood cultures: Aerococcus urinae. A TEE revealed: ruptured chordae and vegetation at the posterior mitral valve leaflet. Gentamicin for 14 days and Ceftriaxone for 28 days was completed. Mitral valve replacement was done and LV dimension returned to normal. Case 2 A 51 y/o male presented with 9 days of fever, chills, and malaise. He was treated with norfloxacin with no relief of symptoms. On admission, he was febrile, with a grade 2/6 holosystolic murmur at the apex and left parasternal area. He had leukocytosis and blood culture grew Aerococcus urinae. Echocardiogram showed mitral stenosis, aortic stenosis and vegetations at the mitral valve and non coronary cusp. Pen-G plus Gentamicin for 14 days and upon discharge, amoxicillin for 2 weeks was completed. Discussion: Risk factors associated with A. urinae endocarditis are >65 years of age, male, urologic abnormalities, malignancy and diabetes. Diagnosis is usually made by culture as our cases and both were found to have vegetations by echocardiography. B-lactam and amino glycoside treatment is effective and although mortality is high, both patients improved and were discharged. Conclusion: A. urinae endocarditis does occur in a young population and to those without urologic abnormality. Keywords: Endocarditis, Aerococcus urinae A bstract I ntroduction Aerococci are gram positive cocci that resemble staphylococci by morphology but have a biochemical and growth characteristics of streptococci and enterococci. 1 They are catalase negative and form alpha-hemolytic colonies in blood agar. They are able to grow on 6.5% NaCl and form acid from glucose, sucrose, mannitol and maltose. Aerococcus urinae was initially described as a aerococcus-like organism by Colman et al and eventually was found out to differ from Aerococcus viridans by 16s rRNA sequencing. 2 A. urinae has been reported to be a rare cause of urinary tract infection [UTI], accounting for 0.3-0.4%. 3 Most infections reportedly occur in the elderly with anatomic or systemic risk factors such as diabetes mellitus, malignancy, urethal stricture or prostate hyperplasia. 4 The genito-urinary tract is said to be the port of entry for this organism. It is also a rare cause of bacteremia and endocarditis which reportedly have a high mortality rate. 7 Below are two cases of A. urinae endocarditis isolated from patients seen in the University of Santo Tomas Hospital [USTH]. Case Report Case 1. A 24 year old male, married, marine engineer, who presented for a second opinion regarding mitral valve replacement. He has mitral valve prolapse and has recurrent fever and body malaise for four months. Three months prior, he consulted a physician and blood cultures isolated α-hemolytic streptococci. He was given unrecalled antibiotics for 10 days with temporary relief of symptoms as fever then recurred intermittently. One month prior to consult, he was advised to have mitral valve replacement. On presentation at our institution a repeat 2D echocardiogram Case Report Philippine Journal of Internal Medicine