Mediterraneohospital.gr

1. Aerococcus Viridans sepsis in a hemodialysis patient
Mediterraneo Hospital- March 23, 2011
Tsoutsos Elias (1), Fili Konstantina (1), Merentiti Vassiliki (1), Akrivos Theodoros (1),
Giannopoulou Sappho (2), Augustianos Charalambos(2)
(1) Mediterraneo Hospital Renal (Kidney) Clinic,(2) Mediterraneo Hospital Microbiology Lab
Aerococcus Viridans organisms are gram-positive saprophytic cocci which rarely impact on
humans (on a number of occasions they have only been accused of causing bacteraemia to
immunosuppressed patients). They are normally detected in hospitalised patients as well as
marine organisms and are known to be fatal for lobsters. In humans such air-borne cocci
may be found in the upper respiratory tract and the skin; they have only seldom been
incriminated as a cause of meningitis, endocarditis, bacteraemia and urinary tract infections.
This case of Aerococcus Viridans sepsis in a dialysis patient is a first in currently available
bibliography.
CASE STUDY: Male, age 68, end-stage polycystic kidney disease patient undergoing
hemodialysis as of November 1989, suffering from both triple vessel disease (was operated
on in 2000) and cardiac failure (EF= 30%), was admitted to our Kidney Clinic as a serious
case, in a state of confusion, with symptoms of dyspnoea, orthopnoea, tachypnoea (40-45
breaths/min), low arterial pressure (AP=70/40mmHg), tachycardia (100 beats/min), fever
with chills up and body temperature up to 39οC, the afore-stated arousing suspicions over
possible sepsis or endocarditis (cause unknown).
Lab and imaging tests which were performed right away gave: Ht=41.7%, PLT=166,
WBC=1770 (d=81%) Κ+=4.3, ESR=10, CRP=34.3.
Chest radiograph showed infiltrations in the right lower lung field and a triplex unveiled
heart chamber dilation as well as serious left ventricular systolic dysfunction with anterior,
low/mid-abdominal wall akinesia, moderate mitral valve failure, left ventricular dilation and
right cavities within normal value range.
Patient was placed blindly on vancomycin-ceftazidime & amikacin after blood cultures were
sent to the lab. Upon day two, his condition had not changed: patient was still feverish while
test results showed hepatic enzymes had risen considerably (SGOT=1591, SGPT=1216,
LDH=1005, total cholesterol=2.18, dir. chol.=1.01) and white cell count stood at 4260. Blood
cultures detected Aerococcus Viridans sensitive to penicillin, ampicillin, vancomycin and
tetracycline.
Given blood culture outcome, patient was next treated with vancomycin. On day three,
fever was gone and nine days after having been admitted he was discharged in an overall
excellent condition.
CONCLUSION: Let it be noted that Aerococcus Viridans infections, though quite rare and
found solely in immunosuppressed patients, should be considered in cases of hemodialysis
patients (who are moreover immunosuppressed). The fact that Aerococcus Viridans
resembles streptococcus viridans stands in the way of drawing a safe conclusion; it is
imperative there be further processing and incubation thereof in the lab. It is self-evident
that close collaboration between physicians and the lab is fundamental so as to properly
investigate, assess and treat patients effectively.

Source: http://www.mediterraneohospital.gr/eng/file/AerococcusViridanssepsiscasestudy.pdf