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A5301 - Septic Shock Due to Globicatella Sanguinis Bacteremia
Author Block: S. Sangli1, A. Thakkar2, S. Noronha3, V. Santibanez2, S. Chakupurakal4, G. Narayanswami5; 1Critical Care, Rochester, MN, United States, 2Mount Sinai St. Luke's Roosevelt Hospital, New York, NY, United States, 3Mayo Clinic, Rochester, MN, United States, 4Mount Sinai St. Lukes Rosevelt, New York, NY, United States, 5Critical Care, Mount Sinai St. Luke's Roosevelt Hospital, New York, NY, United States.
Introduction: Globicatella sanguinis is a gram positive catalase-negative organism that may be misdiagnosed as viridans group Streptococci. It is an uncommon human pathogen, but has been described to cause bacteremia, endocarditis, meningitis, urinary tract infections, orthopaedic and post-operative neurosurgery infections. We present a case of in a non-immunocompromised patient. Case Presentation: A 64 year old female with a past medical history of hypertension presented with seizures and encephalopathy. She was hypotensive and hypothermic, requiring emergent intubation for airway protection. She had no prior history of seizure disorder, head trauma, substance use, animal exposure or any symptoms to suggest any infectious process. On physical exam, she was unresponsive to painful stimuli with minimally responsive dilated pupils and intact brain stem reflexes. The rest of her physical exam was unremarkable. Laboratory investigations were remarkable for leukocytosis and a mixed respiratory and metabolic acidosis. Chest x-ray, urine analysis and a toxicology screen was negative. She continued to have multiple episodes of generalized tonic clonic seizures and remained in refractory shock on high doses of vasopressors. She was given broad spectrum antibiotics for septic shock and improved dramatically within 24 hours to be successfully extubated. Blood cultures obtained at the time of admission revealed Globicatella sanguinis on Vitek System. Further testing including magnetic resonance imaging of the brain and cerebrospinal fluid examination was normal. A computed tomography scan of the abdomen and pelvis revealed proctocolitis although she had no gastrointestinal symptoms. Conclusion: Globicatella Sanguinis bacteremia presenting with refractory septic shock and status epilepticus is a rare clinical presentation. Further, this case illustrates the challenges in identifying the source. It is not certain if the underlying proctocolitis contributed to the clinical presentation in our patient. Limited literature exists describing its association with the lower gastrointestinal microbiome. Often, isolates that are not identified by conventional tests and commercially available testing are accurately identified and confirmed by 16s ribosomal RNA gene sequencing. Differentiating G. sanguinis from Streptococcus viridans, which it resembles, carries important therapeutic significance, with regard to antibiotic susceptibility. Most microbiologists and laboratory technicians are yet to be acquainted with its unique phenotypic characteristics. Resistance to penicillin and cefotaxime has been noted, making prompt and accurate identification of these pathogens critical to the management of patients with G. sanguins infections. With more cases emerging, we would further be able to identify epidemiological and significant clinical patterns.