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Correspondence to Dr Hans Linde Nielsen; [email protected]
Background
Enterococci are Gram-positive, facultative anaerobic cocci that are members of the intestinal microbiome of nearly all land animals, including humans.1 In humans, they are associated with a variety of infections, such as urinary tract infections, intra-abdominal infections and infective endocarditis (IE).2 The Enterococcus genus currently comprises 59 validated taxa (https://lpsn.dsmz.de/), as of June 2020, of which Enterococcus faecalis and E. faecium historically represent the majority of identified species in humans, accounting for 80%–90% and 5%–10% of all enterococcal infections, respectively.1
IE is a life-threatening disease, and despite improvements in its management it remains associated with severe complications and high mortality.3 Streptococci, enterococci and staphylococci are altogether responsible for the majority of all IE cases.3 A recent Danish study identified patients from 2010 to 2017 with E. faecalis, Staphylococcus aureus, Streptococcus species and coagulase-negative staphylococci (CoNS) bacteraemia and examined the prevalence of IE. The study found that patients with E. faecalis bacteraemia had the highest prevalence of IE (16.7%), followed by S. aureus (10.1%), Streptococcus species (7.3%) and CoNS (1.6%).4
E. hirae, first described as a new species in 1985 by Farrow and Collins,5 is another member of the Enterococcus genus and is known as an opportunistic pathogen in psittacine birds and rats.6 7 E. hirae has also been associated with high mortality in broiler flocks due to septicaemia and endocarditis.8 To date, only a limited number of human cases of E. hirae infection have been described.9 Here, we present the first Danish patient with E. hirae IE and to our knowledge the sixth case detailed in the literature.
Case presentation
A 62-year-old woman presented to the hospital with a 2-week history of diarrhoea, vomiting and a 10 kg weight loss. In addition, she had been experiencing headache and dizziness over the past few weeks. The patient had a 6-year-old history of curative laparoscopic surgery for colorectal cancer without any sequelae. She was on daily use of paracetamol and non-steroidal anti-inflammatory drugs coadministered with proton-pump inhibitors for chronic hip pain. On admission, physical examination disclosed no heart murmurs or other abnormalities except for epigastric pain. The patient was afebrile, with normal vital parameters. Laboratory investigation...