Reply to Letter to the Editor: “Postpartum Infective Endocarditis with Enterococcus faecalis: Correspondence”

To the Editor,

We thank the journal readers for their interest and valuable contributions to our case report entitled “Postpartum infective endocarditis with Enterococcus faecalis after vaginal delivery,” recently published in the December 2021 issue of The Anatolian Journal of Cardiology.¹ We are pleased to see that the authors agree with the conclusion that our case is rare and that such cases require careful diagnosis and treatment.

Our case was Enterococcus faecalis endocarditis, which developed on the mitral valve after vaginal delivery. Enterococci were known as group D streptococci in the 1980s. Enterococcus faecalis was also called Streptococcus faecalis. Later, as a result of DNA genomic analysis, the idea that enterococci should be classified separately from streptococci entered the literature.¹ In our article, we did a literature review according to the new classification.

We think the claim that our case was the first enterococcal endocarditis on the normal mitral valve after vaginal delivery in the indexes we mentioned is still valid. The case of Gopaul et al.² one of the 2 E. faecalis cases seen in the postpartum period in our article, is extremely similar to the case of Hughes et al.³ That case is aortic valve endocarditis, as is the case we cited. Our discussion drew attention to this distinction and stated that our case was the first mitral valve endocarditis with the features we mentioned.

In endocarditis cases, the pathogens have features compared to mitral, tricuspid, and aortic valves.⁴ The pathogenesis of this selectivity is not fully known. We hope that our case may be a small contribution to further studies to elucidate this pathogenesis.