Abstract Introduction Vagococcus lutrae (V. lutrae) is an extremely rare human pathogen. It is a gram positive, catalase negative organism. It was originally isolated in the Eurasian otter (Lutra lutra) in 1999 and is associated with various marine species, food, and soil. This pathogen was previously isolated in skin infections. Only three cases have been reported world-wide, one of which in the United States. We present the first reported case of V. lutrae sepsis secondary to aspiration pneumonia. Case Presentation An 80-year-old woman with Parkinson’s disease, Graves’ disease, prior pulmonary embolus, and recurrent urinary tract infections was found obtunded, face down in feces, with new right facial droop. Stroke was initially suspected. In the emergency room her vitals were: BP 141/74, HR 103, hypothermic (94.8 °F) and with an oxygen saturation of 80% on 10L. Her oxygen delivery was escalated to BiPAP. The patient did not respond favorably, and was intubated and mechanically ventilated. Physical examination revealed a chin abrasion. Her lung sounds were diminished bilaterally, with gurgling and coarse crackles. Labs: WBC 10.0, lactic acid 3.1, pH 7.09, pCO2 95. Head CT was negative; chest CT showed bilateral consolidation consistent with aspiration pneumonia. Broad-spectrum antibiotics were initiated, and she was admitted to the ICU. During her ICU stay, urine cultures were insignificant for any microbial growths. However, blood cultures grew Proteus vulgaris and V. lutrae, both susceptible to meropenem. Infectious disease recommended discontinuing her current antibiotic regimen and initiating a 14-day antibiotic course with meropenem. The patient’s clinical status improved and she was extubated on hospital day three, afterwhich, she was stepped down from the ICU. Discussion This is the first reported case of V. lutrae sepsis resulting from aspiration pneumonia. The unique aspect of this case lies in the patient’s discovery in a compromised state, suggesting that aspiration of fecal material was the most likely source of the infection. As seen in the three other reported cases, V. lutrae is connected to exposure to fecal material. Given that the patient’s urine culture was negative and no other respiratory pathogens were identified, clinical evidence pointed toward aspiration as the primary route of infection which improved significantly with appropriate antibiotic therapy. Additionally, the patient denied any recent travel, exposure to marine animals, or any known contaminated food. Vagococcus lutrae should be considered in the differential diagnosis of polymicrobial bloodstream infections in patients with aspiration pneumonia, particularly when conventional pathogens are not identified. This abstract is funded by: None
Abdeljaber et al. (Fri,) studied this question.