A Cryptic Septic Endocarditis and Systemic Thromboembolism Triggered by Oral Microflora

Authors

  • Sriharsha Kanuri Merit Health Wesley Health Center 5001 Hardy St, Hattiesburg, MS 39402, USA
  • Samprith Ala Merit Health Wesley Health Center 5001 Hardy St, Hattiesburg, MS 39402, USA
  • Stephen Fletcher Merit Health Wesley Health Center 5001 Hardy St, Hattiesburg, MS 39402, USA
  • Gagandeep Grewal Merit Health Wesley Health Center 5001 Hardy St, Hattiesburg, MS 39402, USA

DOI:

https://doi.org/10.59667/sjoranm.v23i1.16

Keywords:

Streptococcus Anginosis, Gram-positive-cocci, Sepsis, Vegetations, Thromboembolism and Splenic Infarction, Aortic Regurgitation

Abstract

Streptococcus Anginosus group is normal commensal flora of oral and gastrointestinal cavity. Being a commensal, it can provoke endocarditis only in the presence of defective, injured or congenital abnormal heart valve and predisposing factors like cancer, immunosuppression, and surgery. We present a rare of clinical case of aortic valve endocarditis with Streptococcus Anginosus in the 30-yr-young male with no recognizable risk factors and pre-existing cardiovascular disease. His clinical presentation was very vague with nausea, vomiting, memory impairment and upper respiratory symptoms. His aortic valve endocarditis gave rise to systemic embolism in the spleen, which spawned multiple splenic infarctions. Blood culture was positive for gram-positive rods and chains, most likely Streptococcus Anginosus, due to which he was treated with Pencillin G. Ultimately, he needed an aortic valve replacement with a prosthetic valve. This case highlights the rare case of bacterial endocarditis triggered by commensal microbial flora in absence pertinent risk factors.

Author Biographies

  • Sriharsha Kanuri, Merit Health Wesley Health Center 5001 Hardy St, Hattiesburg, MS 39402, USA

    Resident Internal Medicine, Merit Health Wesley Health Center 5001 Hardy St, Hattiesburg, MS 39402, USA

  • Samprith Ala, Merit Health Wesley Health Center 5001 Hardy St, Hattiesburg, MS 39402, USA

    Resident Internal Medicine, Merit Health Wesley Health Center 5001 Hardy St, Hattiesburg, MS 39402, USA

  • Stephen Fletcher, Merit Health Wesley Health Center 5001 Hardy St, Hattiesburg, MS 39402, USA

    Faculty Hospitalist Internal Medicine, Merit Health Wesley Health Center 5001 Hardy St, Hattiesburg, MS 39402, USA

  • Gagandeep Grewal, Merit Health Wesley Health Center 5001 Hardy St, Hattiesburg, MS 39402, USA

    Faculty Hospitalist Internal Medicine, Merit Health Wesley Health Center 5001 Hardy St, Hattiesburg, MS 39402, USA

References

Pilarczyk-Zurek, M., et al. (2022). "The Clinical View on Streptococcus anginosus Group - Opportunistic Pathogens Coming Out of Hiding." Front Microbiol 13: 956677. https://doi.org/10.3389/fmicb.2022.956677

2. Yallowitz AW, D. L. (2025). "Infectious Endocarditis. "In: StatPearls [Internet]. https://www.ncbi.nlm.nih.gov/books/NBK557641/

3. Nappi, F. (2024). "Native Infective Endocarditis: A State-of-the-Art-Review." Microorganisms 12(7). https://doi.org/10.3390/microorganisms12071481

4. Bezak, B., et al. (2020). "Valve-related factors and incidence of prosthetic valve endocarditis." Kardiochir Torakochirurgia Pol 17(4): 178-182. https://doi.org/10.5114/kitp.2020.102341

5. Cheung, A. L., et al. (1991). "Fibrinogen acts as a bridging molecule in the adherence of Staphylococcus aureus to cultured human endothelial cells." J Clin Invest 87(6): 2236-2245. https://doi.org/10.1172/JCI115259

6. Sullam, P. M., et al. (1985). "Pathogenesis of endocarditis." Am J Med 78(6b): 110-115. https://doi.org/10.1016/0002-9343(85)90373-0

7. Lerche, C. J., et al. (2021). "Anti-biofilm Approach in Infective Endocarditis Exposes New Treatment Strategies for Improved Outcome." Frontiers in Cell and Developmental Biology Volume 9 - 2021. https://doi.org/10.3389/fcell.2021.643335

8. McCormick, J. K., et al. (2002). "Formation of Vegetations during Infective Endocarditis Excludes Binding of Bacterial-Specific Host Antibodies to Enterococcus faecalis." The Journal of Infectious Diseases 185(7): 994-997. https://doi.org/10.1086/339604

9. Kjerulf, A., et al. (1993). "Crossed immunoelectrophoresis used for bacteriological diagnosis in patients with endocarditis." Apmis 101(10): 746-752. https://doi.org/10.1111/j.1699-0463.1993.tb00175.x

10. Laxdal, T., et al. (1968). "Opsonic, agglutinating, and complement-fixing antibodies in patients with subacute bacterial endocarditis." The Journal of Laboratory and Clinical Medicine 71(4): 638-653. https://pubmed.ncbi.nlm.nih.gov/5651364/

11. Okan, T., et al. (2025). "Bilateral Multivalvular Infective Endocarditis Presenting as a Splenic Infarction and Acute Ischemic Stroke in a Young Immunocompetent Woman." Cureus 17(1): e77942. https://doi.org/10.7759/cureus.77942

12. Bayer, A. S., et al. (1998). "Diagnosis and management of infective endocarditis and its complications." Circulation 98(25): 2936-2948. https://doi.org/10.1161/01.CIR.98.25.2936

13. Alnasser, S. A., et al. (2019). "Successful Conservative Management of a Large Splenic Abscess Secondary to Infective Endocarditis." Ann Thorac Surg 107(4): e235-e237. https://doi.org/10.1016/j.athoracsur.2018.08.065

14. Baroudi, M. M., et al. (2023). "Subacute infective endocarditis presenting with an isolated splenic infarction." IDCases 32: e01752. https://doi.org/10.1016/j.idcr.2023.e01752

15. De Castro, S., et al. (2000). "Diagnostic Accuracy of Transthoracic and Multiplane Transesophageal Echocardiography for Valvular Perforation in Acute Infective Endocarditis: Correlation with Anatomic Findings." Clinical Infectious Diseases 30(5): 825-826. https://doi.org/10.1086/313762

16. Nishimura, R. A., et al. (2017). "2017 AHA/ACC Focused Update of the 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines." Circulation 135(25): e1159-e1195. https://doi.org/10.1161/CIR.0000000000000503

Cryptic_septic_endocarditis_and_systemic_thromboembolism_triggered_by_oral_microflora

Published

2025-09-26

Data Availability Statement

NA

How to Cite

A Cryptic Septic Endocarditis and Systemic Thromboembolism Triggered by Oral Microflora. (2025). Swiss Journal of Radiology and Nuclear Medicine, 23(1), 14-21. https://doi.org/10.59667/sjoranm.v23i1.16

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