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Gemella sanguinis is gram-positive, anaerobic, catalase and oxidase negative. Only two cases of G. sanguinis endocarditis were reported before. Predisposing factors include vascular access, poor dental hygiene, diabetes mellitus, valvular disease. A 73-year-old oriental man was admitted with fever. He had a story of non-insulin dependent diabetes mellitus, hypertension and end-stage renal disease on hemodialysis. He had extensive caries destruction. Vital signs revealed a temperature of 38.8 °C. On auscultation, a to-and-fro murmur with an intensity of a grade of Levine 3/6 was heard at the Erb’s area. White blood cell count was elevated to 21,200 /mm3. A transthoracic echocardiogram demonstrated the vegetation on the anterior mitral leaflet with moderate to severe mitral valve regurgitation. Blood cultures were obtained on admission. The samples were inoculated in SA and SN media and incubated with BacT/Alert 3D system (bioMerieux, Marci L’Efoile. France). The organism was identified as G. sanguinis. He met 2 major criteria and 1 minor modified Duke criteria. Ampicillin-sulbactam and gentamicin were started. The organism was sensitive to ampicillin, cefotaxim, erythromycin, clindamycin, vancomycin and quinupristin/dalfopristin by diffusion. Etest MIC of penicillin was 0.019 ug/mL. The following up transthoracic echocardiogram revealed that vegetation was growing up. The patient deteriorated rapidly and died. We report for the reason G. sanguinis should be examined as a cause of endocarditis.

Efficacy and Safety Profile of Voriconazole as Salvage Therapy for Invasive Aspergillosis with Hematologic Diseases in Korea