Skip to main content
PMC home page
BMC Infectious Diseases logoLink to BMC Infectious Diseases
. 2007 Feb 6;7:4. doi: 10.1186/1471-2334-7-4

Corynebacterium endocarditis species-specific risk factors and outcomes

Jaime Belmares 1,✉,#, Stephanie Detterline 2,#, Janet B Pak 3,#, Jorge P Parada 4,#
PMCID: PMC1804271  PMID: 17284316

Abstract

Background

Corynebacterium species are recognized as uncommon agents of endocarditis, but little is known regarding species-specific risk factors and outcomes in Corynebacterium endocarditis.

Methods

Case report and Medline search of English language journals for cases of Corynebacterium endocarditis. Inclusion criteria required that cases be identified as endocarditis, having persistent Corynebacterium bacteremia, murmurs described by the authors as identifying the affected valve, or vegetations found by echocardiography or in surgical or autopsy specimens. Cases also required patient-specific information on risk factors and outcomes (age, gender, prior prosthetic valve, other prior nosocomial risk factors (infected valve, involvement of native versus prosthetic valve, need for valve replacement, and death) to be included in the analysis. Publications of Corynebacterium endocarditis which reported aggregate data were excluded. Univariate analysis was conducted with chi-square and t-tests, as appropriate, with p = 0.05 considered significant.

Results

129 cases of Corynebacterium endocarditis involving nine species met inclusion criteria. Corynebacterium endocarditis typically infects the left heart of adult males and nearly one third of patients have underlying valvular disease. One quarter of patients required valve replacement and one half of patients died. Toxigenic C. diphtheriae is associated with pediatric infections (p < 0.001). Only C. amycolatum has a predilection for women (p = 0.024), while C. pseudodiphtheriticum infections are most frequent in men (p = 0.023). C. striatum, C. jeikeium and C. hemolyticum are associated with nosocomial risk factors (p < 0.001, 0.028, and 0.024, respectively). No species was found to have a predilection for any particular heart valve. C. pseudodiphtheriticum is associated with a previous prosthetic valve replacement (p = 0.004). C. jeikeium infections are more likely to require valve replacement (p = 0.026). Infections involving toxigenic C. diphtheriae and C. pseudodiphtheriticum are associated with decreased survival (p = 0.001 and 0.032, respectively).

Conclusion

We report the first analysis of species-specific risk factors and outcomes in Corynebacterium endocarditis. In addition to species-specific associations with age, gender, prior valvular diseases, and other nosocomial risk factors, we found differences in rates of need for valve replacement and death. This review highlights the seriousness of these infections, as up to 28% of patients required valve replacement and 43.5% died.

Background

Corynebacterium species, or "diphtheroids", are aerobic, non-sporulating, pleomorphic, Gram-positive bacilli that are often considered non-pathogenic components of normal skin flora and mucosal membranes. Although frequently isolated in cultures, they are commonly and often justifiably assumed to be contaminants [1,2]. Nevertheless, the ability of these bacteria to cause life-threatening disease is well established, and over the last decade there have been increasing reports of their pathogenic potential in numerous clinical scenarios, including bacteremia and endocarditis [3-5]. Diphtheroids are now thought to cause 9% of early and 4% of late prosthetic valve endocarditis (PVE), [1,4] but only 0.2 to 0.4% of cases of native valve endocarditis (NVE) [4,6]. Recognized risk factors for Corynebacterium endocarditis include preexisting cardiac disease, a prior history of bacterial endocarditis, and the presence of prosthetic devices, including intravascular access and auriculo-ventricular cerebrospinal fluid shunts [1,6,7]. It is unknown whether certain species of Corynebacterium are more frequently associated with endocarditis, are associated with different predisposing conditions or risk factors, or if they have differences in outcomes – such as requiring valve replacement surgery or greater mortality. To date, most published reports of Corynebacterium endocarditis have been case reports and series, and no detailed species-specific analysis of risk factors and outcomes in Corynebacterium endocarditis has been conducted. Herein, we review the literature for patient-level reports of Corynebacterium endocarditis and conducted the first species-specific analysis of risk factors and outcomes in Corynebacterium endocarditis.

Methods

A Medline search of English language journals for reported cases of Corynebacterium endocarditis. In those reports with case series, every effort was made to obtain the primary reference or discuss the particulars of the case with the original authors. We standardized our definitions for inclusion/exclusion to include only cases with persistent Corynebacterium bacteremia (at least >1 positive blood culture with an identified Corynebacterium species), murmurs described by the authors of the source publication as identifying the affected valve, or vegetations found either in an echocardiographic report, or in surgical or autopsy specimens. A number of cases described Corynebacterium bacteremia in the setting of pacemaker infections and non-valvular endovascular foci of infections. While these are considered by many to be "endocarditis equivalents", they did not meet our definition of endocarditis and were dropped from the analysis. In addition, only cases whose source report included individual patient-specific information on risk factors and outcomes were included in the analysis. Patient-level characteristics and medical information of interest are detailed below. However, publications of Corynebacterium endocarditis which reported aggregate data were excluded.

Patient characteristics in the analysis included demographic data, such as gender and age. Pediatric cases were defined as those occurring in patients less than 18 years old of age and adult cases as those occurring in patients 18 years or older. Medical information recorded included the presence of comorbid illnesses, pre-existing valvular disease other than valve replacement, infected valve, and involvement of native versus prosthetic valve. Nosocomial risk factors were defined as the presence of prosthetic medical devices other than artificial heart valves, such as pacemakers, ventriculoperitoneal shunts, and the use of intravascular devices. Primary outcomes of interest were need for valve replacement and mortality. Nomenclature for Corynebacterium species was based on those approved by the International Code of Nomenclature of Bacteria and species identification was classified as reported in the original source document [8]. Statistical analysis was done using SPSS® version 13.0 (Chicago, IL). Univariate analysis was conducted with chi-square and t-tests, as appropriate, with p = 0.05 (two sided) was considered statistically significant. In three cases, Corynebacterium endocarditis was found to have only a single case for that unique species. These were excluded from the analysis because of their small numbers simultaneously added little to the analysis and because of the potential bias from the intrinsic marked skew that results from inclusion of data where a single case provides 100% of the data points for an entire species. Study received approval of the Institutional Review Board and was conducted in accordance with the Helsinki declaration.

Case Report

A 62 year-old man with a history of hypertension, alcoholism, and mild renal insufficiency, presented to our hospital with a two-day history of fevers, lower back pain, and new onset of urinary retention. One week prior to admission, the patient had undergone diagnostic cardiac catheterization for new onset of atrial fibrillation and had been started on coumadin. Other medications prior to admission were digoxin, diltiazem, furosemide, lisinopril, metoprolol, omeprazole, simvastatin, coumadin. Vital signs on admission were: blood pressure 100/60, temperature 101.4°F, heart rate 100, respiratory rate 20, He had an irregular heart rhythm without murmurs and mild right flank pain. There was a small non-tender and non-purulent ecchymotic area in the right groin at the site of previous catheterization. His neurologic exam was nonfocal except for new 4/5 bilateral lower extremity weakness. White blood cell count was 18.4 K/mm3, with 75% neutrophils and 12% bands. Hemoglobin and platelets were normal. Sodium 128 mmol/L, blood urea nitrogen 46 mmol/L, creatinine 1.7 mmol/L. INR was 11.21. Amylase and lipase were 557 and 325. A chest x-ray, and a computed tomography (CT) scan of the lumbar spine were unremarkable. A CT scan of the abdomen showed mild early pancreatitis without dilatation of the biliary tree. Blood and urine cultures were sent and the patient was diagnosed with mild pancreatitis and coagulopathy secondary to coumadin overdose. He was was started on intravenous levofloxacin 500 mg, with resolution of the fever by the next day. He received vitamin K and his coumadin was temporarily stopped.. Over the next days, his INR decreased to 1.3 and his abdominal pain and leukocytosis improved, but the back pain and urinary retention continued. By the sixth day of admission, he complained of stool incontinence. A magnetic resonance image (MRI) study of the lumbar spine showed inflammatory diskitis with fluid in the L5/S1 disc space, along with osteomyelitis and a posterior epidural abscess with moderate-to-severe vertebral canal stenosis. The Spine Surgery Service was consulted, but they felt that the neurological findings were not explained by the lesion seen on MRI and recommended non-operative management.

Blood cultures from admission later grew Gram-positive bacilli, and repeat cultures confirmed Corynebacterium striatum bacteremia on the sixth day of admission. At this time, antibiotics were changed to vancomycin 1500 mg iv daily with subsequent improvement of the back pain, urinary retention and stool incontinence. Follow up blood cultures were negative. A transesophageal echocardiogram (TEE) revealed moderate aortic insufficiency and a 3–4 mm vegetation on the non-coronary cusp of the aortic valve, with a perforation at the same site. Cardiovascular surgery recommended that a valve replacement be deferred pending initial antibiotic treatment. A follow-up MRI of the spine reported no significant change on the fluid collection. Surgery was offered, but the patient refused stating he felt decreased weakness and wanted to pursue a conservative management. Over the next days, the patient showed progressive improvement in his lower extremity strength and was able to ambulate with the help of a physical therapist. His urinary retention and bowel dysfunction improved as well.

Three weeks later, the patient became febrile and acutely dyspneic. An emergent TEE showed an increase in the regurgitant jet through the aortic valve perforation. The patient underwent emergency coronary aortic bypass grafting and aortic valve replacement. Pathology of the aortic valve revealed a heavily calcified aortic valve, and the gram stain showed gram positive coccobacilli. Cultures of the valves were negative, however, the valve had been mistakenly placed on formalin prior to submission to the Microbiology Laboratory. The patient did well postoperatively and was discharged on intravenous vancomycin. At a two-month follow-up appointment the patient's back pain had resolved and an MRI showed resolution of the epidural abscess. Post treatment surveillance blood cultures were sterile after a total of 12 weeks of intravenous vancomycin after his discharge from the hospital. At follow up over two years later the patient remained infection free.

Results

Our search returned 172 cases of Corynebacterium endocarditis with meaningful patient-level clinical data. Of these, 43 (25.0%) were excluded (Table 1). In 21 cases (48.8%) the isolates were not identified to a species level, 14 cases (32.5%) they were identified only as "diphtheroids", and seven cases (16.3%) were single or double cases identified only by their CDC group (Table 1). C. tuscaniae, C. accolens, and C. pyogenes were excluded as they each contributed only a single case and were not amenable to analysis. Fourteen cases (32.5%) were excluded because they lacked documentation identifying which specific valve was infected or information on our primary outcomes (valve replacement and death). Five cases (11.6%) were infections of pacemakers, prosthetic devices other than heart valves, or involved non-heart valve locations.

Table 1.

Excluded cases of Corynebacterium endocarditis (N = 43)

Non speciated Corynebacterium and isolates not yet recognized as a species
 "Diphtheroids" 14 (32.5)
 Corynebacterium CDC group 1 2 (4.6)
 Corynebacterium CDC group A4 1 (2.3)
 Corynebacterium CDC group I1 1 (2.3)
 Corynebacterium CDC group D2 1 (2.3)
 Corynebacterium CDC group G1 1 (2.3)
 Corynebacterium CDC group G2 1 (2.3)
Only one case identified by species
 C. tuscaniae 1 (2.3)
 C. accolens 1 (2.3)
 C. pyogenes 1 (2.3)
Missing primary study outcomes* 13 (30.2)
Special cases† 5 (11.6)
No valve identified 1 (2.3)
TOTAL 43 (100)
Open in a new tab

* Valve replacement, death.

† Special cases: pacemaker infections (two cases), vegetation on the posterior wall of the right atrium (one case), vegetation on the proximal part of the right pulmonary artery but not on the pulmonic valve (one case), infection of an aortic allograft placed during a repair of a tetrallogy of Fallot (one case).

129 cases (75.0%) had sufficiently detailed patient-level information to be included in the final analysis. Details of the clinical and epidemiological findings of these cases are found in Table 2 [[6-96],97]. Species encountered included 60 cases (46.5%) of non-toxigenic C. diphtheriae (NTCD), 18 cases (14.0%) of C. pseudodiphtheriticum, 14 cases (10.9%) of C. striatum, 14 cases (10.9%) of toxigenic C. diphtheriae (TCD), 13 cases (10.1.%) of C. jeikeium, and four cases (3.1%) of C. xerosis. Finally, C. amycolatum, C. minutissimum, and C. hemolyticum each were responsible for two cases of endocarditis.

Table 2.

Corynebacterium endocarditis: risk factors and outcomes by Corynebacterium species.

Species & references Number of cases†
(% total)		 Mean age
(years)		 Male n
(%)		 Left sided Endocarditis‡
n (%)		 Previous prosthetic valve
n (%)		 Previous valvular disease§
n (%)		 Nosocomial risk factors||
n (%)		 Required valve replacement
n (%)		 Survived
n(%)
Non-toxigenic C. diphtheriae 5, 20, 22, 24–26, 27, 32, 46, 48–52, 54, 62, 63, 65, 66, 68, 78, 94 60 (46.5%) 56 ± 13.8
p = 0.012 		45 (75%) 58 (95.1%) 8 (13.3%) 17 (28.3%) 1 (1.7%)
p = 0.017 		17 (28.3%) 39 (65%)
p = 0.060
C. pseudo-diphtheriticum 18, 20, 36–38, 40, 42–45, 81, 83 18 (14.0%) 45 ± 21.32 17 (93.8%)
p = 0.023 		18 (100%) 8 (44.4%)
p = 0.004 		6 (33.3%) 0 (0%) 6 (37.5%) 6 (33.3%)
p = 0.032
Toxigenic C. diphtheriae 23, 27, 29, 49, 64, 66 14 (10.9%) 17.5 ± 16.5
p < 0.001 		8 (57.1%) 12 (85.7%) 1 (7.1%) 2 (14.3%) 0 (0%) 0 (0%)
*p = 0.014		 2 (14.3%)
p = 0.001
C. striatum 6, 7, 9–15, 53, 56, 62 14 (10.9%) 61.3 ± 13.9
p = 0.018 		7 (50%) 12 (85.7%) 3 (21.4%) 4 (28.6%) 5 (35.7%)
p < 0.001 		4 (28.6%) 11 (78.6%)
p = 0.074
C. jeikeium 6, 16, 19, 25, 34, 35, 69, 79, 93 13 (10.1%) 57.2 ± 13.6
p = 0.024 		10 (76.9%) 12 (92.3%) 5 (38.5%)
p = 0.064		 6 (42.6%) 3 (23.1%)
p = 0.028 		7 (53.8%)
p = 0.026 		10 (76.9%)
C. xerosis 59, 75, 82, 95 4 (3.1%) 51.2 ± 12.3 3 (75%) 4 (100%) 0 (0%) 2 (50%) 0 (0%) 2 (50%) 2 (50%)
C. hemolyticum 77, 80 2 (1.6%) 68.5 ± 26.1 2 (100%) 2 (100%) 0 (0%) 1 (50%) 1 (50%)
p = 0.024 		0 (0%) 0 (0%)
C. minutissimum 86, 91 2 (1.6%) 35.5 ± 6.3 1 (50%) 2 (100%) 0 (0%) 1 (50%) 0 (0%) 0 (0%) 2 (100%)
C amycolatum 6, 60 2 (1.6%) 81 ± 9.8 0 (0%)
p = 0.024 		2 (100%) 0 (0%) 1 (50%) 0 (0%) 0 (0%) 1 (50%)
Total 129 (100%) 35.7 ± 22.9 93 (72.1%) 123 (94.6%) 25 (19.3%) 40 (31.0%) 10 (7.7%) 36 (27.9%) 73 (56.6%)
Open in a new tab

*Data derived from References 2–97 (specific citations listed in by-species citations, column 1). All p values are compared to the mean.

† Percentages of the total number of cases (within column 2). Note: All other percentages represent values for each Corynebacterium species (percentage within each row).

‡ Left sided endocarditis: Aortic or mitral valve endocarditis.

§Previous valvular disease other than valve replacement.

|| Nosocomial risk factors: presence of an intravascular access device, dialysis fistula, pacemaker, or presence of a prosthetic device other than a valve

Patients' age ranged from 4 to 88 years (mean age 35.7 ± 22.9), and 93 (72.1%) were male.

Among all cases, previous valvular disease was present in 40 (31.0%) of the cases, including a previous valvular replacement in 25 cases (19.3%). Predisposing nosocomial risk factors were present in ten patients (7.7%). Left-sided endocarditis was present in 94.6% of the cases. Therapeutic valve replacement was required in 36 cases (27.9%). Mortality attributable to Corynebacterium endocarditis infection was high, with 56 patients (43.4%) succumbing to their infection.

C. amycolatum infections were more frequent in women (100%, p = 0.024), while C. pseudodiphteriticum infections were more frequently found in men (93.8%, p = 0.023). Species-specific age-related associations were also noted. In general, most Corynebacterium species were more likely to cause endocarditis in adults (attaining statistical significance for C. striatum, C. jeikeium, and NTCD, p = 0.018, p = 0.024, and p = 0.012, respectively), while TCD was the only species that infected children more frequently (p < 0.001).

All of the species showed a predilection for left-sided endocarditis (Table 2), but no species had a statistically significant predilection for any particular valve. There were no significant differences among species' associations with a history of previous valvular disease other than in cases of prior valve replacement, where C. pseudodiphtheriticum was found to more commonly infect prosthetic valves (p = 0.004). C. striatum, C. jeikeium, and C. hemolyticum were more commonly associated with a nosocomial risk factors (p < 0.001, p = 0.028, p = 0.024, respectively). C. jeikeium endocarditis was also the most likely to require valve replacement as a result of the infection (53.8%, p = 0.026). Overall, valve replacement was required in 27.9% of cases, but there were no significant differences in the likelihood of need for valve replacement among the other species.

Overall survival in Corynebacterium endocarditis across all species was 56.6%. C. striatum was associated with the highest survival rate (78.6%, p = 0.074). In contrast, TCD and C. pseudodiphtheriticum were associated with a poorer survival than other species (14.3%, p = 0.001 and 33.3%, p = 0.032, respectively).

Discussion

We conducted the largest detailed patient-level analysis of Corynebacterium endocarditis to date, and report the first species-specific associations for these infections. Foremost, we believe that our findings highlight the seriousness of Corynebacterium endocarditis, as over one quarter of patients required valve replacement and mortality was 43.4%. Overall,Corynebacterium endocarditis typically infects adult males and has a strong predilection for left sided involvement; nearly one-third of patients have underlying valvular disease.

Our study found significant differences in species-specific risk factors in Corynebacterium endocarditis, including age and gender associations, underlying clinical risk factors, predilection for prosthetic valves, as well as notable differences in clinical outcomes, such as need for valve replacement and survival.

The species-specific analysis revealed a strong gender predilection for two Corynebacterium species. C. amycolatum infections occurred exclusively in females while C. pseudodiphteriticum occurred overwhelmingly in males. Age-related species-specific findings were also noted. NTCD, C. striatum and C. jeikeium have significant predilection for adults. In contrast to NTCD, TCD is significantly more common in children, as consistent with previous literature and historic associations. In addition, adults are more likely than children to have a Corynebacterium endocarditis of nosocomial origin (p = 0.050), which is likely to reflect a greater likelihood of prosthetic medical devices, invasive procedures, and intravascular access in the adult population. While not reaching statistical significance, adults were also more likely to have endocarditis of a prosthetic valve (p = 0.073). This is likely to reflect a greater prevalence of prosthetic valves in the adult population.

Species-specific associations with a nosocomial origin were found for C. striatum, C. jeikeium, and C. hemolyticum. While these species are associated with nosocomial risk factors, they were not associated with a higher incidence of need for valve replacement or greater mortality. Of all Corynebacterium species, only C. pseudodiphtheriticum showed a predilection for prosthetic versus native valves. This species was also found to have a statistically significant increase in mortality, with two thirds of cases not surviving their infection. An unexpected finding is the greater probability of valve replacement (p = 0.014) and mortality (p = 0.001) found in TCD endocarditis. It is possible that this might be due, in part, to including older reports from time periods when antibiotic drugs and other therapeutic measures were unavailable or less effective fro managing endocarditis. However, even recent reports of TCD endocarditis have shown a high risk of complications and death even in the setting of previous immunization and modern antibiotic treatment regimens [52,64]. Of all Corynebacterium species, C. striatum endocarditis was associated with the greatest likelihood of survival, with more than three quarter of cases surviving the infection. In contrast, only one third of C. pseudodiphtheriticum cases, and one in six TCD cases survived.

There are several limitations to this study which should be considered. This search was limited to English language journals and did not include cases published in other languages. We recognize that classification of isolates and nomenclature for Corynebacterium may have changed over the time period that is encompassed by the source publications included in our analysis, and that new molecular analysis techniques have led to the reclassification of some isolates, and may impact our findings. Similarly, we recognize our acceptance of cases as endocarditis is based on source publication reports and we did not personally review the original microbiology, pathology, or imaging studies on these cases. These are well-recognized intrinsic limitations to retrospective studies and reviews of published data. While every effort was made for accuracy, we are limited to the information available in these published reports, and we can not predict how additional unpublished cases would affect our findings. This is equally true for the cases where insufficient detailed data forced exclusion from the analysis. It is possible that the associations described in this study could change as more information is available. This is especially true for those species that were least encountered but kept in our analysis (e.g., C. hemolyticum, C. minutissimum, and C. xerosis) or excluded because we could only identify a single case for this unique species (C. tuscaniae, C. accolens, and C. pyogenes).

Conclusion

Our study reveals a number of hitherto fore unknown species-specific associations between risk factors and outcomes in Corynebacterium endocarditis, including for demographic factors (gender and age), clinical factors (nosocomial risk factors, prosthetic valves), as well as outcomes (need for valve replacement and survival). Clinicians would be wise to keep these organisms in mind as rare causes of endocarditis, particularly when managing patients who present with bacteremia due to gram positive rods.

Competing interests

None of the authors have potential conflicts of interest to report, although JPP serves on the Speakers' Bureau of Pfizer and Elan Pharmaeuticals, and serves as site principal investigator for clinical trials sponsored by GlaxoSmithKline and Pfizer Pharmaceuticals

Authors' contributions

JPP conceived and oversaw the study and manuscript development. JB and JBP contributed a new case report of C. striatum endocarditis. All authors contributed to the reviews and evaluated the case series report. JB and JPP developed the database, analyzed and interpreted the data. All authors contributed to the writing of the manuscript.

Pre-publication history

The pre-publication history for this paper can be accessed here:

http://www.biomedcentral.com/1471-2334/7/4/prepub

Acknowledgments

Acknowledgements

Written consent was obtained to include the patient's medical history in this study. There was no source of funding for this study.

Contributor Information

Jaime Belmares, Email: jaimebelmares@hotmail.com.

Stephanie Detterline, Email: shassan@lumc.edu.

Janet B Pak, Email: jpak@lumc.edu.

Jorge P Parada, Email: jorge.parada@va.gov.

References

  1. Meyer D, Reboli A. Other Corynebacteria and Rhodococcus. In: GLM, editor. Principles and Practice of Infectious Diseases. 5. Vol. 1. New York: Churchill Livingstone; 2000. pp. 2198–2208. [Google Scholar]
  2. Fernandez-Ayala M, Nan D, Farina M. Vertebral osteomyelitis due to Corynebacterium striatum. Am J Med. 2001;11:167. doi: 10.1016/S0002-9343(01)00739-2. [DOI] [PubMed] [Google Scholar]
  3. Berbari E, Cockerill F, Steckelberg J. Infective endocarditis due to unusual or fastidious microorganisms. Mayo Clin Proc. 1997;72:532–542. doi: 10.4065/72.6.532. [DOI] [PubMed] [Google Scholar]
  4. Murray B, Karchmer A, Moellering R. Diphtheroid prosthetic valve endocarditis: a study of clinical features and infecting organisms. Am J Med. 1980;69:838–848. doi: 10.1016/s0002-9343(80)80009-x. [DOI] [PubMed] [Google Scholar]
  5. Tiley S, Kociuba K, Heron L, Munro R. Infective endocarditis due to nontoxigenic Corynebacterium diphtheriae: Report of seven cases and review. Clin Infect Dis. 1993;16:271–275. doi: 10.1093/clind/16.2.271. [DOI] [PubMed] [Google Scholar]
  6. Knox K, Holmes A. Nosocomial endocarditis caused by Corynebacterium amycolatum and other nondiphtheriae corynebacteria. Emerg Infect Dis. 2002;1:97–99. doi: 10.3201/eid0801.010151. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Tattevin P, Cremieux A, Muller-Serieys C, Carbon C. Native valve endocarditis due to Corynebacterium striatum: first reported case of medical treatment alone. Clin Infect Dis. 1996;23:1330–1331. doi: 10.1093/clinids/23.6.1330. [DOI] [PubMed] [Google Scholar]
  8. "Bacterial nomenclature uptodate" http://www.dsmz.de/microorganisms/main.php?contentleft_id=14 Accessed on 14 September 2006.
  9. Markowitz S, Coudron P. Native valve endocarditis caused by an organism resembling Corynebacterium striatum. J Clin Microbiol. 1990;28:8–10. doi: 10.1128/jcm.28.1.8-10.1990. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Rufael DW, Cohn S. Native valve endocarditis due to Corynebacterium striatum: case report and review. Clin Infect Dis. 1994;19:1054–1061. doi: 10.1093/clinids/19.6.1054. [DOI] [PubMed] [Google Scholar]
  11. Juurlink D, Borczyk A, Simor A. Native valve endocarditis due to Corynebacterium striatum. Eur J Clin Microbiol Infect Dis. 1996;12:963–965. doi: 10.1007/BF01690520. [DOI] [PubMed] [Google Scholar]
  12. Houghton T, Kaye G, Meigh R. An unusual case of infective endocarditis. Postgrad Med J. 2002;78:290–291. doi: 10.1136/pmj.78.919.290. [DOI] [PMC free article] [PubMed] [Google Scholar]
  13. Kocazeybek B, Ozder A, Kucukoglu S, Kucukates E, Yuksel H, Olga R. Report of a case with polymicrobial endocarditis related to multiresistant strains. Chemotherapy. 2002;48:316–319. doi: 10.1159/000069710. [DOI] [PubMed] [Google Scholar]
  14. de Arriba J, Blanch J, Mateos F, Martinez-Alfaro E, Solera J. Corynebacterium striatum first reported case of prosthetic valve endocarditis. J Infect. 2002;44:193. doi: 10.1053/jinf.2001.0927. [DOI] [PubMed] [Google Scholar]
  15. Stoddart B, Sandoe J, Denton M. Corynebacterium striatum endocarditis masquerading as connective tissue disorders. Rheumatology. 2005;44:557–8. doi: 10.1093/rheumatology/keh519. [DOI] [PubMed] [Google Scholar]
  16. Ross MJ, Sakoulas G, Manning W, Cohn W, Lisbon A. Corynebacterium jeikeium native valve endocarditis following femoral access for coronary angiography. Clin Infect Dis. 2001;32:E120–121. doi: 10.1086/319592. [DOI] [PubMed] [Google Scholar]
  17. Lee P, Ferguson D, Sarubbi F. Corynebacterium striatum: An underappreciated community and nosocomial pathogen. J Infect. 2005;50:338–343. doi: 10.1016/j.jinf.2004.05.005. [DOI] [PubMed] [Google Scholar]
  18. Morris A, Guild I. Corynebacterium pseudodiphtheriticum endocarditis. Five case reports. Rev Infect Dis. 1991;13:887–892. doi: 10.1093/clinids/13.5.887. [DOI] [PubMed] [Google Scholar]
  19. Spach D, Celum C, Kirby P, Sheffield J. Palpable purpura associated with Corynebecterium jeikeium. Arch Dermatol. 1991;27:1071. doi: 10.1001/archderm.127.7.1071. [DOI] [PubMed] [Google Scholar]
  20. Wilson M, Shapiro D. Native valve endocarditis due to Corynebacterium pseudodiphtheriticum. Clin Infect Dis. 1992;15:1059–1060. doi: 10.1093/clind/15.6.1059. [DOI] [PubMed] [Google Scholar]
  21. Barritt DW, Gillespie WA. Subacute bacterial endocarditis. BMJ. 1960;5181:1235–1239. doi: 10.1136/bmj.1.5181.1235. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Gubler J, Huber-Schnieder C, Gruner E, Altwegg M. An outbreak of nontoxigenic Corynebacterium diphtheriae infection: single bacterial clone causing invasive infection among Swiss drug users. Clin Infect Dis. 1998;27:1295–1298. doi: 10.1086/514997. [DOI] [PubMed] [Google Scholar]
  23. Namnyak S, Bhat R, Al-Jama A, Fathalla S. Prosthetic valve endocarditis caused by Corynebacterium diphtheriae in a patient with pemphigus vulgaris. J Clin Microbiol. 1987;25:1330–1332. doi: 10.1128/jcm.25.7.1330-1332.1987. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Pennie R, Malik A, Wilcox L. misidentification of Corynebacterium diphtheriae as a Corynebacterium species with low virulence in a child with endocarditis. J Clin Microbiol. 1996;34:1275–1276. doi: 10.1128/jcm.34.5.1275-1276.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
  25. Lortholary O, Buu-Hoi A, Gutmann L, Acar J. Corynebacterium diphtheriae endocarditis in France. Clin Infect Dis. 1993;17:1072–1074. doi: 10.1093/clinids/17.6.1072. [DOI] [PubMed] [Google Scholar]
  26. Trepeta R, Edberg S. Corynebacterium diphtheriae endocarditis: sustained potential of a classical pathogen. Am J Clin Path. 1984;81:679–683. doi: 10.1093/ajcp/81.5.679. [DOI] [PubMed] [Google Scholar]
  27. Belko J, Wessel D, Malley R. Endocarditis caused by Corynebacterium diphtheriae: case report and review of the literature. Pediatric Inf Dis J. 2000;19:159–163. doi: 10.1097/00006454-200002000-00015. [DOI] [PubMed] [Google Scholar]
  28. Almklov J, Hansen A. Successful treatment of C. diphtheriae with penicillin and streptomycin. Pediatrics. 1950;5:437–442. [Google Scholar]
  29. Davidson S, Rotem Y, Bogowski B, Rubeinstein E. Corynebacterium diphtheriae endocarditis. Am J Med Sci. 1976;271:351–353. doi: 10.1097/00000441-197605000-00011. [DOI] [PubMed] [Google Scholar]
  30. Sandler M. Corynebacterium diphtheriae endocarditis in an adult with congenital heart disease. S Afr Med J. 1982;61:594. [PubMed] [Google Scholar]
  31. Martino P, Micozzi A, Vendetti M, Gentile G, Girmenia C, Raccah R, Santilli S, Alessandri N, Mandelli F. Catheter related right – sided endocarditis in bone marrow transplant recipients. Rev Inf Dis. 1990;12:250–253. doi: 10.1093/clinids/12.2.250. [DOI] [PubMed] [Google Scholar]
  32. Sirinavin S, Suthas-Na-Ayutha P. Diphtheric septicemia and probable endocarditis: a case review and report of the literature. Eur J Pediatr. 1985;144:394–398. doi: 10.1007/BF00441786. [DOI] [PubMed] [Google Scholar]
  33. Sirisanthana V, Sirisanthana T. Corynebacterium diphtheriae endocarditis. Pediatr Inf Dis. 1983;2:470–471. doi: 10.1097/00006454-198311000-00015. [DOI] [PubMed] [Google Scholar]
  34. Etienne J, Barthelet M, Ninet J, Vandenesch F, Fleurette J. Corynebacterium group JK endocarditis after dental extraction under antibiotic cover. J Infect. 1988;17:188–9. doi: 10.1016/S0163-4453(88)92047-6. [DOI] [PubMed] [Google Scholar]
  35. Martinez-Vea A, Costa J, Garcia C, Bardaji A, Ridao C, Ribas M, Richart C, Oliver JA. Corynebacterium group JK endocarditis in a hemodialysis patient. Nephrol Dial Transplant. 1993;8:177–9. [PubMed] [Google Scholar]
  36. Cauda R, Tamburrini E, Ventura G, Ortona L. Effective vancomycin therapy for Corynebacterium pseudodiphtheriticum endocarditis. South Med J. 1987;80:1598. doi: 10.1097/00007611-198712000-00033. [DOI] [PubMed] [Google Scholar]
  37. Lindner PS, Hardy DJ, Murphy TF. Endocarditis due to Corynebacterium pseudodiphtheriticum. N Y State J Med. 1986;86:102–4. [PubMed] [Google Scholar]
  38. Tow A. Diphtheroid bacillus as the cause of acute endocarditis. Am J Dis Child. 1932;44:156–61. [Google Scholar]
  39. Ollinger MG. Mixed infection in subacute bacterial endocarditis: report of two cases. Arch Intern Med. 1948;81:38–41. doi: 10.1001/archinte.1948.00220210088008. [DOI] [PubMed] [Google Scholar]
  40. Johnson WD, Cobbs CG, Arditi LI, Kaye D. Diphtheroid endocarditis after insertion of a prosthetic heart valve. Report of two cases. JAMA. 1968;203:919–21. doi: 10.1001/jama.203.11.919. [DOI] [PubMed] [Google Scholar]
  41. Blount JG. Bacterial endocarditis. Am J Med. 1965;38:90–2. doi: 10.1016/0002-9343(65)90010-0. [DOI] [PubMed] [Google Scholar]
  42. Wise JR, Jr, Cleland WP, Hallidie-Smith KA, Bentall HH, Goodwin JF, Oakley CM. Urgent aortic-valve replacement for acute aortic regurgitation due to infective endocarditis. Lancet. 1971;2:115–21. doi: 10.1016/S0140-6736(71)92300-2. [DOI] [PubMed] [Google Scholar]
  43. Leonard A, Raij L, Shapiro FL. Bacterial endocarditis in regularly dialyzed patients. Kidney Int. 1973;4:407–22. doi: 10.1038/ki.1973.137. [DOI] [PubMed] [Google Scholar]
  44. Boyce JM. A case of prosthetic valve endocarditis caused by Corynebacterium hoffmannii and Candida albicans. Br Heart J. 1975;37:1195–7. doi: 10.1136/hrt.37.11.1195. [DOI] [PMC free article] [PubMed] [Google Scholar]
  45. Rubler S, Harvey L, Avitabile A, Abenavoli T. Mitral valve obstruction in a case of bacterial endocarditis due to Corynebacterium hoffmannii: echocardiographic diagnosis. N Y State J Med. 1982;11:1590–4. [PubMed] [Google Scholar]
  46. Hogg GG, Strachan JE, Huayi L, Beaton SA, Robinson PM, Taylor K. Non-toxigenic Corynebacterium diphtheriae biovar gravis: evidence for an invasive clone in a south-eastern Australian community. Med J Aust. 1996;164:72–5. doi: 10.5694/j.1326-5377.1996.tb101351.x. [DOI] [PubMed] [Google Scholar]
  47. Pike C. Corynebacterium endocarditis with report of a case due to toxigenic Corynebacterium diphtheriae. J Pathol. 1951;63:577–85. doi: 10.1002/path.1700630404. [DOI] [PubMed] [Google Scholar]
  48. Horst R, Dyer D, Hallett A. Fulminant diphtheritic mitral valve endocarditis. Arch Dis Child. 1976;51:227–8. doi: 10.1136/adc.51.3.227. [DOI] [PMC free article] [PubMed] [Google Scholar]
  49. Juffe A, Miranda AL, Rufilanchas JJ, Maronas JM, Figuero D. Prosthetic valve endocarditis by opportunistic pathogens. Arch Surg. 1977;112:151–3. doi: 10.1001/archsurg.1977.01370020045004. [DOI] [PubMed] [Google Scholar]
  50. Guard RW. Non-toxigenic Corynebacterium diphtheriae causing subacute bacterial endocarditis: case report. Pathology. 1979;11:533–5. doi: 10.3109/00313027909059028. [DOI] [PubMed] [Google Scholar]
  51. Love JW, Medina D, Anderson S, Braniff B. Infective endocarditis due to Corynebacterium diphtheriae: report of a case and review of the literature. Johns Hopkins Med J. 1981;148:41–2. [PubMed] [Google Scholar]
  52. Marcus JC, Spector I, Chin WW, Levin SE. Infective endocarditis due to non-toxigenic Corynebacterium diphtheriae in a child. A case report. S Afr Med J. 1983;63:285–7. [PubMed] [Google Scholar]
  53. Melero-Bascones M, Munoz P, Rodriguez-Creixems M, Bouza E. Corynebacterium striatum: an undescribed agent of pacemaker-related endocarditis. Clin Infect Dis. 1996;22:576–7. doi: 10.1093/clinids/22.3.576. [DOI] [PubMed] [Google Scholar]
  54. Zasada AA, Zaleska M, Podlasin RB, Seferynska I. The first case of septicemia due to nontoxigenic Corynebacterium diphtheriae in Poland: case report. Ann Clin Microbiol Antimicrob. 2005;4:8. doi: 10.1186/1476-0711-4-8. [DOI] [PMC free article] [PubMed] [Google Scholar]
  55. Riegel P, Creti R, Mattei R, Nieri A, von Hunolstein C. Isolation of Corynebacterium tuscaniae sp. nov. from blood cultures of a patient with endocarditis. J Clin Microbiol. 2006;44:307–12. doi: 10.1128/JCM.44.2.307-312.2006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  56. Mashavi M, Soifer E, Harpaz D, Beigel Y. First report of prosthetic mitral valve endocarditis due to Corynebacterium striatum: successful medical treatment. Case report and literature review. J Infect. 2006;52:e139–41. doi: 10.1016/j.jinf.2005.08.027. Epub 2005 Oct 19. [DOI] [PubMed] [Google Scholar]
  57. Claeys G, Vanhouteghem H, Riegel P, Wauters G, Hamerlynck R, Dierick J, de Witte J, Verschraegen G, Vaneechoutte M. Endocarditis of native aortic and mitral valves due to Corynebacterium accolens: report of a case and application of phenotypic and genotypic techniques for identification. J Clin Microbiol. 1996;34:1290–2. doi: 10.1128/jcm.34.5.1290-1292.1996. [DOI] [PMC free article] [PubMed] [Google Scholar]
  58. de Mattos-Guaraldi AL, Formiga LC. Bacteriological properties of a sucrose fermenting Corynebacterium diphtheriae strain isolated from a case of endocarditis. Curr Microbiol. 1998;37:156–8. doi: 10.1007/s002849900356. [DOI] [PubMed] [Google Scholar]
  59. Pessanha B, Farb A, Lwin T, Lloyd B, Virmani R. Infectious endocarditis due to Corynebacterium xerosis. Cardiovasc Pathol. 2003;12:98–101. doi: 10.1016/S1054-8807(02)00181-3. [DOI] [PubMed] [Google Scholar]
  60. Daniels C, Schoors D, Van Camp G. Native valve endocarditis with aorta-to-left atrial fistula due to Corynebacterium amycolatum. Eur J Echocardiogr. 2003;4:68–70. doi: 10.1053/euje.2002.0176. [DOI] [PubMed] [Google Scholar]
  61. Mookadam F, Cikes M, Baddour LM, Tleyjeh IM, Mookadam M. Corynebacterium jeikeium endocarditis: a systematic overview spanning four decades. Eur J Clin Microbiol Infect Dis. 2006;25:349–53. doi: 10.1007/s10096-006-0145-8. [DOI] [PubMed] [Google Scholar]
  62. Shah M, Murillo JL. Successful treatment of Corynebacterium striatum endocarditis with daptomycin plus rifampin. Ann Pharmacother. 2005;39:1741–4. doi: 10.1345/aph.1G242. Epub 2005 Sep 6. [DOI] [PubMed] [Google Scholar]
  63. Mishra B, Dignan RJ, Hughes CF, Hendel N. Corynebacterium diphtheriae endocarditis–surgery for some but not all! Asian Cardiovasc Thorac Ann. 2005;13:119–26. doi: 10.1177/021849230501300205. [DOI] [PubMed] [Google Scholar]
  64. Lolekha R, Supradish P, Kirawittaya T, Srimaharaja S, Chotpitayasunondh T. Subacute infective endocarditis caused by Corynebacterium diphtheriae: a case report. J Med Assoc Thai. 2003;86:S696–700. [PubMed] [Google Scholar]
  65. Burnell RH, Richardson ME. Fever, cardiac failure and arteritis in a child with rheumatic carditis. Pediatr Infect Dis J. 1997;16:422–3. doi: 10.1097/00006454-199704000-00013. [DOI] [PubMed] [Google Scholar]
  66. Booth LV, Ellis C, Wale MC, Vyas S, Lowes JA. An atypical case of Corynebacterium diphtheriae endocarditis and subsequent outbreak control measures. J Infect. 1995;31:63–5. doi: 10.1016/S0163-4453(95)91519-2. [DOI] [PubMed] [Google Scholar]
  67. Malik AS, Johari MR. Pneumonia, pericarditis, and endocarditis in a child with Corynebacterium xerosis septicemia. Clin Infect Dis. 1995;20:191–2. doi: 10.1093/clinids/20.1.191-a. [DOI] [PubMed] [Google Scholar]
  68. Lin RV, Lim SC, Yew FS, Tan SY, Tey BH. Corynebacterium diphtheriae endocarditis in an adult with congenital heart disease: a case report. J Trop Med Hyg. 1994;97:189–91. [PubMed] [Google Scholar]
  69. David CA, Horowitz MD, Burke GW., 3rd Aortic valve endocarditis in a liver transplant recipient–successful management by aortic valve replacement. Transplantation. 1992;53:1366–7. [PubMed] [Google Scholar]
  70. Malanoski GJ, Parker R, Eliopoulos GM. Antimicrobial susceptibilities of a Corynebacterium CDC group I1 strain isolated from a patient with endocarditis. Antimicrob Agents Chemother. 1992;36:1329–31. doi: 10.1128/aac.36.6.1329. [DOI] [PMC free article] [PubMed] [Google Scholar]
  71. Zuber PL, Gruner E, Altwegg M, von Graevenitz A. Invasive infection with non-toxigenic Corynebacterium diphtheriae among drug users. Lancet. 1992;339:1359. doi: 10.1016/0140-6736(92)92004-Y. [DOI] [PubMed] [Google Scholar]
  72. Lifshitz A, Arber N, Pras E, Samra Z, Pinkhas J, Sidi Y. Corynebacterium CDC group A-4 native valve endocarditis. Eur J Clin Microbiol Infect Dis. 1991;10:1056–7. doi: 10.1007/BF01984928. [DOI] [PubMed] [Google Scholar]
  73. Adler AG, Blumberg EA, Schwartz DA, Russin SJ, Pepe R. Seven-pathogen tricuspid endocarditis in an intravenous drug abuser. Pitfalls in laboratory diagnosis. Chest. 1991;99:490–1. doi: 10.1378/chest.99.2.490. [DOI] [PubMed] [Google Scholar]
  74. Ena J, Berenguer J, Pelaez T, Bouza E. Endocarditis caused by Corynebacterium group D2. J Infect. 1991;22:95–6. doi: 10.1016/0163-4453(91)91150-V. [DOI] [PubMed] [Google Scholar]
  75. Szabo S, Lieberman JP, Lue YA. Unusual pathogens in narcotic-associated endocarditis. Rev Infect Dis. 1990;12:412–5. doi: 10.1093/clinids/12.3.412. [DOI] [PubMed] [Google Scholar]
  76. Farrer W. Four-valve endocarditis caused by Corynebacterium CDC group I1. South Med J. 1987;80:923–5. doi: 10.1097/00007611-198707000-00031. [DOI] [PubMed] [Google Scholar]
  77. Chandrasekar PH, Molinari JA. Corynebacterium hemolyticum bacteremia with fatal neurologic complication in an intravenous drug addict. Am J Med. 1987;82:638–40. doi: 10.1016/0002-9343(87)90114-8. [DOI] [PubMed] [Google Scholar]
  78. Arnold AZ. Corynebacterium endocarditis. Difficult diagnosis in an elderly woman. Postgrad Med. 1987;81:283–7. doi: 10.1080/00325481.1987.11699759. [DOI] [PubMed] [Google Scholar]
  79. Levine DP, Crane LR, Zervos MJ. Bacteremia in narcotic addicts at the Detroit Medical Center. II. Infectious endocarditis: a prospective comparative study. Rev Infect Dis. 1986;8:374–96. doi: 10.1093/clinids/8.3.374. [DOI] [PubMed] [Google Scholar]
  80. Worthington MG, Daly BD, Smith FE. Corynebacterium hemolyticum endocarditis on a native valve. South Med J. 1985;78:1261–2. doi: 10.1097/00007611-198510000-00030. [DOI] [PubMed] [Google Scholar]
  81. Herschorn BJ, Brucker AJ. Embolic retinopathy due to Corynebacterium minutissimum endocarditis. Br J Ophthalmol. 1985;69:29–31. doi: 10.1136/bjo.69.1.29. [DOI] [PMC free article] [PubMed] [Google Scholar]
  82. Eliakim R, Silkoff P, Lugassy G, Michel J. Corynebacterium xerosis endocarditis. Arch Intern Med. 1983;143:1995. doi: 10.1001/archinte.143.10.1995. [DOI] [PubMed] [Google Scholar]
  83. Ben-Chetrit E, Nashif M, Levo Y. Infective endocarditis caused by uncommon bacteria. Scand J Infect Dis. 1983;15:179–83. doi: 10.3109/inf.1983.15.issue-2.09. [DOI] [PubMed] [Google Scholar]
  84. Cookson WO, Harris AR. Diphtheroid endocarditis after electrolysis. Br Med J (Clin Res Ed) 1981;282:1513–4. doi: 10.1136/bmj.282.6275.1513. [DOI] [PMC free article] [PubMed] [Google Scholar]
  85. Leonard A, Raij L, Shapiro FL. Bacterial endocarditis in regularly dialyzed patients. Kidney Int. 1973;4:407–22. doi: 10.1038/ki.1973.137. [DOI] [PubMed] [Google Scholar]
  86. Ribush N. Probable diphtheroid endocarditis. Med J Aust. 1969;1:396–8. doi: 10.5694/j.1326-5377.1969.tb92171.x. [DOI] [PubMed] [Google Scholar]
  87. Martinak JF, Wyso EM. Corynebacterium endocarditis. N Y State J Med. 1968;68:2197–8. [PubMed] [Google Scholar]
  88. Merzbach D, Freundlich E, Metzker A, Falk W. Bacterial endocarditis due to Corynebacterium. Report of 2 cases. J Pediatr. 1965;67:792–6. doi: 10.1016/S0022-3476(65)80368-7. [DOI] [PubMed] [Google Scholar]
  89. Vaneechoutte M, De Bleser D, Claeys G, Verschraegen G, De Baere T, Hommez J, Devriese LA, Riegel P. Cardioverter-lead electrode infection due to Corynebacterium amycolatum. Clin Infect Dis. 1998;27:1553–4. doi: 10.1086/517754. [DOI] [PubMed] [Google Scholar]
  90. Gerry JL, Greenough WB., 3rd Diphtheroid endocarditis. Report of nine cases and review of the literature. Johns Hopkins Med J. 1976;139:61–8. [PubMed] [Google Scholar]
  91. Aperis G, Moyssakis I. Corynebacterium minutissimum endocarditis: A case report and review. J Infect. doi: 10.1016/j.jinf.2006.04.012. 2006 Jun 4. [DOI] [PubMed] [Google Scholar]
  92. Federmann M, Dirsch OR, Jenni R. Pacemaker endocarditis. Heart. 1996;75:446. doi: 10.1136/hrt.75.5.446. [DOI] [PMC free article] [PubMed] [Google Scholar]
  93. Vanbosterhaut B, Surmont I, Vandeven J, Wauters G, Vandepitte J. Corynebacterium jeikeium (group JK diphtheroids) endocarditis. A report of five cases. Diagn Microbiol Infect Dis. 1989;12:265–8. doi: 10.1016/0732-8893(89)90025-4. [DOI] [PubMed] [Google Scholar]
  94. Holthouse DJ, Power B, Kermode A, Golledge C. Non-toxigenic Corynebacterium diphtheriae: two cases and review of the literature. J Infect. 1998;37:62–6. doi: 10.1016/S0163-4453(98)90690-9. [DOI] [PubMed] [Google Scholar]
  95. Roder BL, Frimodt-Moller N. Corynebacterium xerosis as a cause of community acquired endocarditis. Eur J Clin Microbiol Infect Dis. 1990;9:233–4. doi: 10.1007/BF01963847. [DOI] [PubMed] [Google Scholar]
  96. Jootar P, Gherunpong V, Saitanu K. Corynebacterium pyogenes endocarditis. Report of a case with necropsy and review of the literature. J Med Assoc Thai. 1978;61:596–601. [PubMed] [Google Scholar]

Articles from BMC Infectious Diseases are provided here courtesy of BMC

RESOURCES