D109-15 Under the Radar: Emergence of the First Endocarditis Case of Streptococcus Parasanguinis Without Any Oral Risk Factors

Abstract Pneumococcus pathogens have been one of the most virulent in mankind’s history, accounting for over a million new infections every year (1). In general, pneumococcal microbes are commonly associated with pulmonary diseases. Antithetically, Streptococcus parasanguinis, even though closely related to other pneumococcal bacteria, is seldom associated with pulmonary diseases or systemic effects. This microbe is notoriously known to cause biofilm formation leading to the degradation of tooth enamel; The pathogenicity outside of the oral microbiome for this bacterium is scarcely documented, though in exceptional cases, S. parasanguinis can migrate to the bloodstream and cause comorbidity such as drowsiness and metabolic encephalopathy(2). Endocarditis caused by S. parasanguinis in the absence of dental caries or infection has not been reported. We present a groundbreaking case of S. parasanguinis inducing cardiac endocarditis and being the underlying cause for multiple transient ischemic attacks (TIAs) without typical risk factors. A 69-year-old female with a history of asthma was referred to pulmonology in anticipation of her upcoming mitral valve (MV) replacement surgery. Patient was initially admitted for neurological deficits after multiple TIAs resulting in extreme fatigue, frequently falling asleep throughout the day and dysfunction of fine motor control in her digits which persisted for several months. Multiple echocardiograms were performed and indicated 3 mobile vegetations on the MV with severe MV regurgitations and pleural effusion. Blood cultures after extubating came back positive for S. parasanguinis with no significant dental caries or oral infections. Despite promising initial recovery following the MV replacement surgery, the patient suddenly developed worsening septic and cardiogenic shock and succumbed to her sepsis. This landmark case underscores the complexities of understanding bloodborne dyscrasia and the novel presentations of bacterial infections. The pathogenicity of this bacterium outside the oral microbiome coupled with the extreme drowsiness, ataxia, and lack of typical risk factors, provides clinicians with a reminder about the unpredictability of S. Parasanguinis. The origin of the S. Parasanguinis infection remains unclear, emphasizing how clinicians need to remain vigilant when diagnosing bacterial infections. Cardiothoracic interventions, surgery, and prolonged antibiotic treatment remain the standard of care for pneumococcal endocarditis. This is the first documented case of S. parasanguinis causing MV endocarditis and multiple TIAs without the usual oral origin. Considering the vast amounts of literature surrounding the Streptococcus family of bacteria, this case highlights the unpredictability of bacteremia and serves as a reminder for clinicians to employ a multidisciplinary approach when treating bacterial infections. This abstract is funded by: None