Cardiobacterium

Cardiobacterium hominis is a gram-negative, rod-shaped bacterium that is a member of the HACEK group, a collection of bacteria that are a rare cause of infective endocarditis, an infection of the inner lining of the heart chambers and heart valves. It is a facultatively anaerobic organism, meaning it can grow in the presence or absence of oxygen, and is part of the normal flora of the human upper respiratory tract. This bacterium is characterized by its slow-growing nature, which can complicate diagnosis and treatment of infections it causes.

Characteristics

Cardiobacterium hominis is distinguished by its pleomorphic shape, often appearing as long rods with a tendency to form rosettes. It is oxidase and catalase positive, and produces indole. The bacterium ferments carbohydrates, producing acid but no gas. Its growth is enhanced by the presence of carbon dioxide, and it does not grow on MacConkey agar, a selective and differential medium commonly used in microbiology.

Pathogenesis

While Cardiobacterium hominis is part of the normal oral and upper respiratory tract flora, it can become pathogenic under certain conditions, particularly in individuals with pre-existing heart conditions or those who have undergone invasive procedures that breach the mucosal barrier. The bacterium can enter the bloodstream and adhere to damaged heart valves, leading to infective endocarditis. The infection is characterized by the formation of vegetations, which are masses of platelets, fibrin, microcolonies of microorganisms, and scant inflammatory cells.

Infective endocarditis caused by Cardiobacterium hominis is typically subacute, meaning it develops slowly over weeks to months. Patients may present with nonspecific symptoms such as fever, malaise, anorexia, and weight loss. Diagnosis is challenging due to the slow-growing nature of the bacterium, requiring extended blood culture periods and careful interpretation of results.

Diagnosis

The diagnosis of Cardiobacterium hominis infective endocarditis relies on blood cultures and echocardiography. Blood cultures should be incubated for at least three weeks to allow for the slow growth of the bacterium. Echocardiography, particularly transesophageal echocardiography, is used to visualize vegetations on heart valves and assess the extent of the infection.

Treatment

Treatment of infective endocarditis caused by Cardiobacterium hominis involves prolonged courses of antibiotics, typically beta-lactam antibiotics such as ceftriaxone or ampicillin, often in combination with an aminoglycoside for synergistic effect. The duration of antibiotic therapy can range from 4 to 6 weeks, depending on the severity of the infection and the patient's response to treatment. In some cases, surgical intervention may be necessary to repair or replace damaged heart valves.

Prevention

Preventive measures for Cardiobacterium hominis infective endocarditis include maintaining good oral hygiene and ensuring that individuals at high risk of endocarditis receive appropriate antibiotic prophylaxis before undergoing dental or surgical procedures that could introduce bacteria into the bloodstream.