eMedicine Specialties > Infectious Diseases > Bacterial Infections

Cardiobacterium

Author: Kerry O Cleveland, MD, Associate Professor of Medicine, University of Tennessee College of Medicine; Consulting Staff, Department of Internal Medicine, Division of Infectious Diseases, Methodist Healthcare of Memphis
Coauthor(s): Pierre A Dorsainvil, MD, Medical Director, HIV Specialist, Palm Beach County Main Detention Center; Consulting Staff, Department of Internal Medicine, Division of Infectious Diseases, Lake Ida Medical Center; Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital; Michael Gelfand, MD, FACP, Chief, Professor, Department of Internal Medicine, Division of Infectious Diseases, Methodist Healthcare of Memphis, University of Tennessee
Contributor Information and Disclosures

Updated: Feb 3, 2009

Introduction

Background

Cardiobacterium hominis is a member of the HACEK group (Haemophilus aphrophilus, Actinobacillus actinomycetemcomitans, C hominis, Eikenella corrodens, and Kingella kingae), which are fastidious, gram-negative, aerobic bacilli that normally reside in the respiratory tract. They have been associated with local infection in the mouth and, collectively, cause 5-10% of cases of native valve endocarditis in persons who do not abuse illicit intravenous drugs.

Pathophysiology

C hominis can be isolated from the nose or throat of approximately two thirds of healthy individuals. C hominis is a nonmotile organism that requires 5-10% carbon dioxide for growth. It does not grow on selective media such as MacConkey or eosin methylene blue agar.

In animal studies, C hominis has shown low virulence, with injection of large numbers of organisms failing to produce infection. Nearly all Cardiobacterium infections reported in humans have been in the form of bacteremia or endocarditis.

Frequency

United States

C hominis endocarditis accounts for 0.1% of all cases of endocarditis. Of these cases, 75% occur in individuals with abnormal valves. The mitral and aortic valves are affected most often.

Mortality/Morbidity

Mycotic aneurysms are an important cause of morbidity and mortality in C hominis endocarditis. Mycotic aneurysm complicates 2.5-10% of cases of C hominis endocarditis. Embolization may occur during the active stages of endocarditis.

Sex

Cardiobacterium colonization does not have a sexual predilection. C hominis is occasionally recovered from uterine, cervical, and vaginal cultures in asymptomatic women.

Age

Cardiobacterium colonization does not have an age predilection.

Clinical

History

The clinical course of C hominis endocarditis tends to be subacute. In a published series, the mean duration of symptoms was 169 days; however, this may reflect the difficulty in growing C hominis in older blood culture systems. In this same series, 44% of patients had a history of a dental procedure or oral infection.1

Physical

Common findings in Cardiobacterium infections include the following:

  • Fever (86%)
  • Splenomegaly (59%)
  • Peripheral embolic phenomenon (44%)
  • Petechiae (41%)
  • Clubbing (19%)

Causes

Bacteremia with C hominis endocarditis usually occurs in the setting of pre-existing structural heart disease or a prosthetic heart valve. Many patients have a history of a recent dental procedure or poor dentition.

More on Cardiobacterium

Overview: Cardiobacterium
Differential Diagnoses & Workup: Cardiobacterium
Treatment & Medication: Cardiobacterium
Follow-up: Cardiobacterium
References
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References

  1. Wormser GP, Bottone EJ. Cardiobacterium hominis: review of microbiologic and clinical features. Rev Infect Dis. Jul-Aug 1983;5(4):680-91. [Medline].

  2. Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, et al. Prevention of Infective Endocarditis. Guidelines From the American Heart Association. A Guideline From the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation. Apr 19 2007;[Medline].

  3. Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Bolger AF, Levison ME, et al. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation. Jun 14 2005;111(23):e394-434. [Medline].

  4. Berbari EF, Cockerill FR 3rd, Steckelberg JM. Infective endocarditis due to unusual or fastidious microorganisms. Mayo Clin Proc. Jun 1997;72(6):532-42. [Medline].

  5. Elliott TS, Foweraker J, Gould FK, Perry JD, Sandoe JA. Guidelines for the antibiotic treatment of endocarditis in adults: report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother. Dec 2004;54(6):971-81. [Medline].

  6. Horstkotte D, Follath F, Gutschik E, Lengyel M, Oto A, Pavie A, et al. Guidelines on prevention, diagnosis and treatment of infective endocarditis executive summary; the task force on infective endocarditis of the European society of cardiology. Eur Heart J. Feb 2004;25(3):267-76. [Medline].

  7. Le Quellec A, Bessis D, Perez C, Ciurana AJ. Endocarditis due to beta-lactamase-producing Cardiobacterium hominis. Clin Infect Dis. Nov 1994;19(5):994-5. [Medline].

  8. Nerard JL, Snydman DR. Miscellaneous gram-negative bacilli: Acinetobacter, Cardiobacterium, Actinobacillus, Chromobacterium, Capnocytophaga, and others. In: Gorbach SL, Bartlett JG, Blacklow NR. Infectious Diseases. Philadelphia, Pa: WB Saunders; 1992:1543-55.

  9. Nurnberger M, Treadwell T, Lin B, Weintraub A. Pacemaker lead infection and vertebral osteomyelitis presumed due to Cardiobacterium hominis. Clin Infect Dis. Oct 1998;27(4):890-1. [Medline].

  10. Silver SE. Ruptured mycotic aneurysm of the superior mesenteric artery that was due to cardiobacterium endocarditis. Clin Infect Dis. Dec 1999;29(6):1573-4. [Medline].

  11. Wilson WR, Karchmer AW, Dajani AS, Taubert KA, Bayer A, Kaye D, et al. Antibiotic treatment of adults with infective endocarditis due to streptococci, enterococci, staphylococci, and HACEK microorganisms. American Heart Association. JAMA. Dec 6 1995;274(21):1706-13. [Medline].

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Further Reading

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Keywords

Cardiobacterium hominis, C hominis, HACEK group, Haemophilus aphrophilus, H aphrophilus, Actinobacillus actinomycetemcomitans, A actinomycetemcomitans, Eikenella corrodens, E corrodens, Kingella kingae, K kingae, endocarditis, Cardiobacterium hominis endocarditis, C hominis endocarditis, native valve endocarditis, prosthetic valve endocarditis, heart infection, bacterial infection, bacteremia, mycotic aneurysm, structural heart disease, prosthetic heart valve, dental procedures, poor dentition, HACEK endocarditis

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Contributor Information and Disclosures

Author

Kerry O Cleveland, MD, Associate Professor of Medicine, University of Tennessee College of Medicine; Consulting Staff, Department of Internal Medicine, Division of Infectious Diseases, Methodist Healthcare of Memphis
Kerry O Cleveland, MD is a member of the following medical societies: American College of Physicians, American Medical Association, Infectious Diseases Society of America, and Society for Healthcare Epidemiology of America
Disclosure: Nothing to disclose.

Coauthor(s)

Pierre A Dorsainvil, MD, Medical Director, HIV Specialist, Palm Beach County Main Detention Center; Consulting Staff, Department of Internal Medicine, Division of Infectious Diseases, Lake Ida Medical Center
Disclosure: Nothing to disclose.

Burke A Cunha, MD, Professor of Medicine, State University of New York School of Medicine at Stony Brook; Chief, Infectious Disease Division, Winthrop-University Hospital
Burke A Cunha, MD is a member of the following medical societies: American College of Chest Physicians, American College of Physicians, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Michael Gelfand, MD, FACP, Chief, Professor, Department of Internal Medicine, Division of Infectious Diseases, Methodist Healthcare of Memphis, University of Tennessee
Michael Gelfand, MD, FACP is a member of the following medical societies: American College of Physicians, American Medical Association, American Society for Microbiology, Infectious Diseases Society of America, and Southern Medical Association
Disclosure: Nothing to disclose.

Medical Editor

Thomas Herchline, MD, Professor of Medicine, Wright State University Boonshoft School of Medicine; Medical Director, Public Health, Dayton and Montgomery County, Ohio
Thomas Herchline, MD is a member of the following medical societies: American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Joseph F John Jr, MD, FACP, FIDSA, FSHEA, Clinical Professor of Medicine, Molecular Genetics and Microbiology, Medical University of South Carolina; Associate Chief of Staff for Education, Ralph H Johnson Veterans Affairs Medical Center
Disclosure: BioMerieux Honoraria Review panel membership; Cubist Honoraria Review panel membership; Pfizer Honoraria Speaking and teaching; Merck Stock dividends stock holdings

CME Editor

Eleftherios Mylonakis, MD, Clinical and Research Fellow, Department of Internal Medicine, Division of Infectious Diseases, Massachusetts General Hospital
Eleftherios Mylonakis, MD is a member of the following medical societies: American Association for the Advancement of Science, American College of Physicians, American Society for Microbiology, and Infectious Diseases Society of America
Disclosure: Nothing to disclose.

Chief Editor

Michael Stuart Bronze, MD, Professor, Stewart G Wolf Chair in Internal Medicine, Department of Medicine, University of Oklahoma Health Science Center
Michael Stuart Bronze, MD is a member of the following medical societies: Alpha Omega Alpha, American College of Physician Executives, American College of Physicians, American College of Physicians-American Society of Internal Medicine, American Federation for Clinical Research, American Medical Association, American Society for Microbiology, Association of Professors of Medicine, Association of Program Directors in Internal Medicine, Infectious Diseases Society of America, Oklahoma State Medical Association, and Southern Society for Clinical Investigation
Disclosure: Nothing to disclose.

 
 
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