# Rothia aeria Causing Prosthetic Valve Endocarditis in an Immunocompetent Patient

## TL;DR

A 76-year-old man developed heart infection caused by Rothia aeria, a rare bacteria typically found in the mouth, after dental cleaning, and was successfully treated with antibiotics.

## Contribution

First reported case of prosthetic valve endocarditis caused by Rothia aeria in an immunocompetent patient.

## Key findings

- Rothia aeria was identified as the causative agent of prosthetic valve endocarditis in an immunocompetent individual.
- The patient showed clinical improvement after a six-week course of intravenous penicillin and ceftriaxone.
- Advancements in MALDI-TOF MS have improved the rapid identification of R. aeria as a true bloodstream pathogen.

## Abstract

Rothia aeria is a part of the normal human oral flora and respiratory tract. This Gram-positive, pleomorphic rod has been linked to periodontal infections, typically occurring within immunocompromised hosts. To our knowledge, we present the first case of prosthetic valve endocarditis (PVE) secondary to R. aeria in an immunocompetent host. A 76-year-old man with a history of aortic valve replacement presented with generalized weakness and dyspnea on exertion eight weeks after deep dental cleaning for periodontal disease. He improved and was discharged from the hospital. Subsequently, blood cultures grew R. aeria, which was initially felt to be a contaminant. However, the patient returned a week later with similar symptoms, including night sweats and low appetite. Due to his recent normal outpatient transthoracic echocardiogram (TTE) and the concern for prosthetic valve endocarditis, we opted for a transesophageal echocardiogram (TEE). His TEE revealed a large aortic valve vegetation. Several repeat blood cultures grew again R. aeria. The patient responded to intravenous (IV) penicillin 24 million units q24 hours for six weeks and IV ceftriaxone 2 g IV q24 hours for two weeks. On a repeat TEE, there was a decrease in the size of the vegetation, and it resembled a calcified healed vegetation; the patient was able to return to his activities of daily living with significant symptomatic improvement. The rarity of severe disease due to R. aeria in immunocompetent hosts has likely been due to difficult diagnosis. With the advancement of matrix-assisted laser desorption ionization time-of-flight mass spectrometry (MALDI-TOF MS) (Bruker Microflex LT, Bruker Daltonics, Billerica, MA), R. aeria is now quickly and easily recognized. As our case suggests, R. aeria appears to be a true, non-contaminant bloodstream pathogen in both immunocompromised and immunocompetent hosts. Prompt diagnosis and aggressive treatment are imperative in order to ensure the best clinical outcomes.