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We report a rare case of Gemella morbillorum associated pyogenic liver abscess in an immunocompetent 57-year-old female patient in this document. Gemella morbillorum is a gram-positive cocci found in the upper respiratory, genitourinary and gastrointestinal system microbiota. The bacterium is a member of the genus Gemella, and rare causative agent of endocarditis, brain abscess and bacteremia as an opportunistic pathogen. To the best of our knowledge,we present the first case of G. morbillorum associated pyogenic liver abscess in Turkey. The pathophysiology, diagnostic method and treatment of liver abscesses vary depending on the etiology. G. morbillorum is rare, but should be kept in the back of the mind while treating a patient with pyogenic liver abscess.

Background Subgingival microbiome in disease-associated subgingival sites is known to be dysbiotic and significantly altered. In patients with rheumatoid arthritis (RA), the extent of dysbiosis in disease- and health-associated subgingival sites is not clear. Methods 8 RA and 10 non-RA subjects were recruited for this pilot study. All subjects received full oral examination and underwent collection of subgingival plaque samples from both shallow (periodontal health-associated, probing depth ≤ 3mm) and deep subgingival sites (periodontal disease-associated, probing depth ≥ 4 mm). RA subjects also had rheumatological evaluation. Plaque community profiles were analyzed using 16 S rRNA sequencing. Results The phylogenetic diversity of microbial communities in both RA and non-RA controls was significantly higher in deep subgingival sites compared to shallow sites (p = 0.022), and the overall subgingival microbiome clustered primarily according to probing depth (i.e. shallow versus deep sites), and not separated by RA status. While a large number of differentially abundant taxa and gene functions was observed between deep and shallow sites as expected in non-RA controls, we found very few differentially abundant taxa and gene functions between deep and shallow sites in RA subjects. In addition, compared to non-RA controls, the UniFrac distances between deep and shallow sites in RA subjects were smaller, suggesting increased similarity between deep and shallow subgingival microbiome in RA. Streptococcus parasanguinis and Actinomyces meyeri were overabundant in RA subjects, while Gemella morbillorum, Kingella denitrificans, Prevotella melaninogenica and Leptotrichia spp. were more abundant in non-RA subjects. Conclusions The aggregate subgingival microbiome was not significantly different between individuals with and without rheumatoid arthritis. Although the differences in the overall subgingival microbiome was driven primarily by probing depth, in contrast to the substantial microbiome differences typically seen between deep and shallow sites in non-RA patients, the microbiome of deep and shallow sites in RA patients were more similar to each other. These results suggest that factors associated with RA may modulate the ecology of subgingival microbiome and its relationship to periodontal disease, the basis of which remains unknown but warrants further investigation.

A 54-year-old man was admitted to our institute with a diagnosis of infectious endocarditis with vegetation on the mitral valve and severe regurgitation due to Gemella morbillorum infection together with renal dysfunction, which was eventually diagnosed as infection-related pauci-immune necrotizing crescentic glomerulonephritis. Given the refractoriness to antibiotics, the persistent activity of nephritis, and repeated cerebral hemorrhaging, we prioritized steroid therapy over early surgical mitral valve replacement. Following steroid therapy, the glomerulonephritis completely improved. Although the administration of steroid therapy in the active phase of infectious endocarditis remains controversial, it might be indicated if comorbid glomerulonephritis is critical.

Background Vascular reconstruction is required to treat infectious intracranial aneurysms (IIAs) on arteries supplying the eloquent area. However, extracranial-intracranial bypass is sometimes impossible because IIAs are frequently located distally on arteries and the length of a donor artery is limited. We report a rare case of an unruptured Gemella morbillorum IIA, which was successfully treated by intracranial-intracranial (IC-IC) bypass using a Y-shaped superficial temporal artery (STA) interposition graft. Case Description A 52-year-old man presented with heart failure and an unruptured IIA in the right anterior parietal artery because of acute G. morbillorum endocarditis. The patient was treated with urgent replacement of cardiac valves and antibiotic therapy. However, the IIA increased in size during the following 1 month, and therefore was treated surgically to prevent the rupture. End-to-side IC-IC bypass using a Y-shaped STA graft followed by aneurysmal trapping was performed to overcome the limited length of the STA as a donor artery to prevent cerebral ischemia in the artery territory and to avoid direct injury to the sensory cortex adhering tightly to the IIA. Postoperative courses were uneventful, and he recovered from the infectious diseases. Conclusions This case suggests that end-to-side IC-IC bypass using a Y-shaped STA graft can be a good option for surgical treatment of IIAs, which are located in eloquent areas.

A thoracic mycotic aortic aneurysm is an uncommon entity that can complicate mediastinal abscesses. Gemella morbillorum and Capnocytophaga sp. are oral bacteria that are very rarely encountered in this setting, especially when occurring together and with other organisms, posing a difficult treatment challenge per the available guidelines and sensitivities. We present in detail this interesting case of a multi-organism mediastinal abscess and thoracic mycotic aortic aneurysm after a previous esophagogastroduodenoscopic procedure in a 51-year-old female with known achalasia who presented with upper abdominal pain, including a successful surgical and antibiotic treatment regimen and a literature review of the involved topics.

El género Gemella spp corresponde a cocos gram positivos, anaerobios facultativos, catalasa negativos, no móviles y no formadores de esporas, usualmente comensales de la cavidad oral, que no suelen ser patógenos en pacientes inmunocompetentes. Sin embargo, puede comportarse como germen oportunista en pacientes inmunosuprimidos o con otros factores de riesgo como mala higiene dental, cirugía gastrointestinal, enfermedades metabólicas entre otras, y se asocia con endocarditis, meningitis y en menor medida compromiso pulmonar. La información respecto a la susceptibilidad antimicrobiana es limitada y se asemeja a la de S viridans, por lo que la penicilina y ampicilina son los medicamentos de elección, sin tener claridad en cuanto a duración del tratamiento, usualmente considerando llevar a 4 semanas o hasta el drenaje de la colección. Éste reporte de caso describe una paciente con tuberculosis en tratamiento, que desarrolla una infección invasiva con documentación de empiema y bacteriemia secundaria por Gemella morbillorum, representando la asociación poco común de ésta infección bacteriana con tuberculosis.

To evaluate and characterize cases of brain abscess in immunocompetent patients due to Gemella morbillorum, an opportunistic Gram-positive coccus. Two cases of brain abscess due to this pathogen which occurred at the authors’ native institution in 2013 and 2016 were analyzed. Moreover, a literature search regarding brain abscess surgically treated due to this pathogen was performed in PubMed database, following PRISMA statement. The final review comprised ten articles for a total of 11 patients—all immunocompetent—with a median age of 50.2 years (range 28–77); almost total were males. Neurological deficits and fever were the most common initial signs; seizures were present only in two cases. Surgical treatment was based on craniotomy and excision in six cases; the remaining five underwent stereotactic aspiration. The antibiotic initial therapy was intravenous in all cases. The average duration of therapy was of six weeks with a minimum of four and maximum of ten. One patient died, while in the other cases, a complete or partial regression of presenting symptoms and disappearing of MRI signs at intermediate follow-up were obtained. In eight patients (72%), it was possible to identify a primary infection or a predisposing factor (as cardiac diseases or septic arthritis). G. morbillorum is an emerging pathogen involved in brain abscesses. Even if it is infrequently reported, the identification of specific characteristics that may increase its neurotropism and virulence also in immunocompetent patients can help to better understand such a rare pathology.

Apart from the conventional factors, recent evidences have suggested that lumbar disc herniation (LDH) is also associated with microbes, which is completely ignored in the management of patients with disc prolapse and disc degeneration. Therefore, the present study was carried out to identify the different microorganisms in subjects with LDH. Subjects (n = 101) who were confirmed for LDH with Magnetic Resonance Imaging and undergoing lumbar discectomy, were recruited in this study. Standard protocols for disinfection of the skin and surgical instruments were adhered. Skin scrapings, muscle biopsies and portion of the inter-vertebral disc were transferred into individually labeled Robertson’s cooked meat enrichment broth for anaerobic identification. Remaining portions of the excised disc material and muscle biopsy were taken for aerobic identification. Anaerobic isolates were identified using Gram stain and catalase test while the species identification was done by RapID ANA II ID kit. Gram stain, catalase test, DNase test and coagulase tests were used for identification of aerobic bacteria. Study confirmed 6/101 disc cultures (6%) with positive anaerobes and 12 disc cultures with coagulase negative Staphylococci spp. Among the anaerobes, two disc cultures were identified as Propionibacterium acnes and one as Gemella morbillorum. Due to slow growth, other three anaerobic cultures were not confirmed. However, they resembled the colony morphology of Gram positive bacilli. None of the control samples (skin and muscles) had any positive growth. The present study adds to the literature confirming the role of microorganisms in LDH. Present study newly identified Gemella morbillorum in the intervertebral tissue in addition to the previously reported microorganisms associated with LDH.

SARS-CoV-2, the causative agent for COVID-19, infect human mainly via respiratory tract, which is heavily inhabited by local microbiota. However, the interaction between SARS-CoV-2 and nasopharyngeal microbiota, and the association with metabolome has not been well characterized. Here, metabolomic analysis of blood, urine, and nasopharyngeal swabs from a group of COVID-19 and non-COVID-19 patients, and metagenomic analysis of pharyngeal samples were used to identify the key features of COVID-19. Results showed lactic acid, l-proline, and chlorogenic acid methyl ester (CME) were significantly reduced in the sera of COVID-19 patients compared with non-COVID-19 ones. Nasopharyngeal commensal bacteria including Gemella morbillorum, Gemella haemolysans and Leptotrichia hofstadii were notably depleted in the pharynges of COVID-19 patients, while Prevotella histicola, Streptococcus sanguinis, and Veillonella dispar were relatively increased. The abundance of G. haemolysans and L. hofstadii were significantly positively associated with serum CME, which might be an anti-SARS-CoV-2 bacterial metabolite. This study provides important information to explore the linkage between nasopharyngeal microbiota and disease susceptibility. The findings were based on a very limited number of patients enrolled in this study; a larger size of cohort will be appreciated for further investigation.

Aim To elucidate the presence of apical periodontitis in the root canal of teeth with secondary/persistent infection, including composition of microbiota, levels of endotoxins and lipoteichoic acid (LTA), and clinical implications of these findings. Method Samples were collected from root canals of 50 patients who needed endodontic retreatment and had radiographic evidence of apical periodontitis. Microorganisms were identified by using the culture technique and biochemical tests. Nested–polymerase chain reaction (nested-PCR) was used to identify 17 species of specific bacteria. Lipopolysaccharides (LPS) and LTAs were quantified by using, respectively, limulus amebocyte lysate and enzyme-linked immunosorbent assay tests. Results Bacteria were detected in all samples by culture and molecular methods. A total of 154 gram-positive strains, of 188 strains isolated, were found in the root canals by culture. Enterococcus faecalis and Gemella morbillorum were the most prevalent species identified by the biochemical tests, whereas molecular analyses (nested-PCR) showed a high frequency of P. gingivalis, E. faecalis, and Fusobacterium nucleatum. LPS and LTA were detected in all samples, with mean values being 3.52 EU/mL and 597.83 pg/mL, respectively. Significant statistical correlations were found between levels of LTA and clinical features. Conclusion Despite the prevalence of gram-positives, the microbiota present in secondary/persistent infections showed a large variety of species. Within this diversity, associations were found between specific bacteria and clinical features. In addition, higher levels of LTA were statistically associated with larger periapical radiolucent areas, but no correlation between this feature and LPS was found.

Gemella morbillorum is one of the rare causative microorganisms of endocarditis. We herein report a case of infective endocarditis in a patient with bicuspid aortic valve caused by G. morbillorum. Infective endocarditis diagnosis was established based on the Modified Duke’s criteria. The patient was successfully treated with medical-surgical management.

Introduction: Gemella morbillorum is a facultative anaerobic gram positive bacterium that resides as normal flora in the oral cavity and gastrointestinal system. This organism has uncommonly presented as an etiology of infective endocarditis, with varying reports of resistance and complications. Methods: Transparent Reporting of Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed for the systematic review. A medical librarian (T.R.S) versed in evidence-based medicine systematically searched databases for studies assessing Gemella morbillorum infective endocarditis in patients. Publication year included inception until December 31, 2019. Using Rayyan software, 134 abstracts were screened for eligibility after duplicates were removed. Inclusion criteria was age greater than 18 years old, infective endocarditis with positive culture for Gemella morbillorum, and publication in English. 39 full text articles were reviewed for eligibility, and 38 were included in the final analysis. Results: A total of 40 cases of infective endocarditis caused by Gemella morbillorum were identified. The average age of the patients was 54 years old, 72.5% were male patients (29), 20% female (8), 7.5% unknown sex (3). Native valve endocarditis (NVE) was present in 28 of the cases, with prosthetic valve involvement in 5 cases. Left sided endocarditis was more common than right sided with 70% of cases (28) and 12.5% (5) respectively, with 17.5% (7) of cases not listing which valve was infected on echocardiography. The most common predisposing risk factor was thought to be poor dentition in 9 cases. The most common antibiotic regimen in penicillin susceptible NVE was concordant with most recent guidelines, a beta lactam with gentamicin or vancomycin in 57.5% of the cases (23). Complications occurred in 65% of cases (26), with most common complication being need for surgical intervention occurring in 30% of the cases (12). Conclusions: Gemella morbillorum infective endocarditis cases reported in literature had a high burden of complications with nearly two thirds of cases. Most common was the need for surgery with valve replacement. Antibiotic regimens in the most recent endocarditis guidelines were effective in treatment for a majority of the cases.

A 54-year-old man was admitted to our institute with a diagnosis of infective endocarditis (IE) with vegetation on the mitral valve and severe regurgitation due to Gemella morbillorum infection together with renal dysfunction, which was eventually diagnosed as infection-related pauci-immune necrotizing crescentic glomerulonephritis. Given the refractoriness to antibiotics, the persistent activity of nephritis, and repeated cerebral hemorrhaging, we prioritized steroid therapy over early surgical mitral valve replacement. Following steroid therapy, the glomerulonephritis completely improved. Although the administration of steroid therapy in the active phase of IE remains controversial, it might be indicated if comorbid glomerulonephritis is critical.

This study was conducted for the metagenomic analysis of stool samples from CRC affected individuals to identify biomarkers for CRC in Hainan, the only tropical island province of China. The gut microbiota of CRC patients differed significantly from that of healthy and reference database cohorts based on Aitchison distance and Bray–Cutis distance but there was no significant difference in alpha diversity. Furthermore, at the species level, 68 species were significantly altered including 37 CRC-enriched, such as, Fusobacterium nucleatum, Parvimonas micra, Gemella morbillorum, Citrobacter portucalensis, Alloprevotella sp., Shigella sonnei, Coriobacteriaceae bacterium, etc. Sixty-seven different metabolic pathways were acquired, and pathways involved in the synthesis of many amino acids were significantly declined. Besides, 2 identified antibiotic resistance genes performed well (area under the receive-operation curve AUC = 0.833, 95% CI 58.51–100%) compared with virulence factor genes. The results of the present study provide region-specific bacterial and functional biomarkers of gut microbiota for CRC patients in Hainan. Microbiota is considered as a non-invasive biomarker for the detection of CRC. Gut microbiota of different geographic regions should be further studied to expand the understanding of markers, especially for the China cohort due to diverse nationalities and lifestyles.

Resumen El género Gemella spp corresponde a cocos gram positivos, anaerobios facultativos, catalasa negativos, no móviles y no formadores de esporas, usualmente comensales de la cavidad oral, que no suelen ser patógenos en pacientes inmunocompetentes. Sin embargo, puede comportarse como germen oportunista en pacientes inmunosuprimidos o con otros factores de riesgo como mala higiene dental, cirugía gastrointestinal, enfermedades metabólicas entre otras, y se asocia con endocarditis, meningitis y en menor medida compromiso pulmonar. La información respecto a la susceptibilidad antimicrobiana es limitada y se asemeja a la de S viridans, por lo que la penicilina y ampicilina son los medicamentos de elección, sin tener claridad en cuanto a duración del tratamiento, usualmente considerando llevar a 4 semanas o hasta el drenaje de la colección. Éste reporte de caso describe una paciente con tuberculosis en tratamiento, que desarrolla una infección invasiva con documentación de empiema y bacteriemia secundaria por Gemella morbillorum, representando la asociación poco común de ésta infección bacteriana con tuberculosis. Abstract Gemella spp. corresponds to gram positive cocci, facultative anaerobes, negative catalase, non mobile and non spore producers, part of colonizing flora of the oral cavity that are not common pathogens in immunocompetent patients. Nevertheless it may behave as an opportunistic germ in immunosuppressed patients or with other risk factors that include bad dental hygiene, bowel surgery, and metabolic diseases among others. It’s associated with infections such as endocarditis, meningitis and less frecuently can implicate the lung. The information regarding antimicrobial susceptibility is limited and resembles S viridans, so penicillin and ampicillin are the medications of choice, without being clear about the duration of treatment, usually giving 4 weeks or until collection drain. This case report describes a patient with known tuberculosis diagnosis and under treatment, that develops an invasive infection with empyema and secondary bloodstream infection by Gemella morbillorum, depicting a previously uncommon but described association of this bacterial infection with tuberculosis.

BACKGROUND Despite widespread use, the impact of minocycline hydrochloride microspheres on the shifts of oral bacterial species resistant to minocycline remains unknown. This study aimed at examining the percentage and taxonomy of minocycline-resistant isolates in saliva and subgingival plaque samples before and after minocycline microspheres application in periodontitis patients during maintenance. METHODS Patients received supra- and sub-gingival debridement with (test) or without (control) minocycline microspheres application to sites with probing depth >4 mm and were clinically monitored at baseline, 1, 3, and 6 months. Samples were collected at baseline, 1 and 6 months and analyzed via cultivation with or without 4 μg/mL minocycline. Percentage of resistant strains was determined by colony counting and taxonomy by checkerboard DNA-DNA hybridization. Significant clinical changes were sought with the Mann-Whitney test and differences in percentage of resistant isolates with the Friedman and Mann-Whitney tests. RESULTS Groups showed similar clinical improvements. Mean percentage of resistant isolates rose at 1 month and decreased at 6 months in saliva and plaque samples in test group (P

16 p.-5 fig.-1 tab., The molecular basis of the pathogenesis of the opportunistic invasive infections caused by isolates of the Gemella genus remains largely unknown. Moreover, inconsistencies in the current species assignation were detected after genome-level comparison of 16 public Gemella isolates. A literature search detected that, between the two most pathogenic species, Gemella morbillorum causes about twice the number of cases compared to Gemella haemolysans. These two species shared their mean diseases - sepsis and endocarditis - but differed in causing other syndromes. A number of well-known virulence factors were harbored by all species, such as a manganese transport/adhesin sharing 83% identity from oral endocarditis-causing streptococci. Likewise, all Gemellae carried the genes required for incorporating phosphorylcholine into their cell walls and encoded some choline-binding proteins. In contrast, other proteins were species-specific, which may justify the known epidemiological differences. G. haemolysans, but not G. morbillorum, harbor a gene cluster potentially encoding a polysaccharidic capsule. Species-specific surface determinants also included Rib and MucBP repeats, hemoglobin-binding NEAT domains, peptidases of C5a complement factor and domains that recognize extracellular matrix molecules exposed in damaged heart valves, such as collagen and fibronectin. Surface virulence determinants were associated with several taxonomically dispersed opportunistic genera of the oral microbiota, such as Granulicatella, Parvimonas, and Streptococcus, suggesting the existence of a horizontally transferrable gene reservoir in the oral environment, likely facilitated by close proximity in biofilms and ultimately linked to endocarditis. The identification of the Gemella virulence pool should be implemented in whole genome-based protocols to rationally predict the pathogenic potential in ongoing clinical infections caused by these poorly known bacterial pathogens., This research was supported by grants MPY 509/19 from the Instituto de Salud Carlos III (ISCIII) and SAF2017-88664-R from the Spanish Ministerio de Economía, Industria y Competitividad (MEICOM).

A 66-year-old man presented with upper back cellulitis and imaging findings consistent with a necrotising soft tissue infection. He was started on broad-spectrum intravenous antibiotics and was taken to the operating room for immediate surgical debridement. On postoperative day 5, the culture was noted to be growing Gemella morbillorum, an exceedingly rare cause of necrotising soft tissue infections in immunocompetent hosts. His condition improved, and he was transitioned to oral antibiotics and discharged home.

Gemella morbillorum is increasingly implicated in infectious endocarditis. Our patient presented with anaemia and renal failure with evidence of infarcts and embolic disease. He was found to have endocarditis with an organism that could not speciate with standard culture methods requiring matrix assisted laser desorption ionization-time of flight mass spectrometry (MALDI-TOF) for identification and susceptibilities. While involvement of mitral and aortic valves can be expected with Gemella, he had rare involvement of the pulmonic valve in a structurally normal heart. Although bacteriological cure was achieved, due to the locally destructive nature of Gemella, he ultimately required valve replacements for heart failure resolution. Workup for commonly implicated pathologies associated with G. morbillorum led to suspicion of gastrointestinal malignancy with findings of occult bleeding prompting an ongoing evaluation. With improved access to advanced diagnostics, G. morbillorum has been increasingly identified in infectious endocarditis. Given its destructive nature, it is important for clinicians to consider this organism is difficult to identify isolates.

Rare bacteria can lead to infective endocarditis, which may lead to renal involvement as severe glomerulonephritis. We report our experience of a 12-year-old child who presented with infective endocarditis and blood culture-grown Gemella morbillorum – a rarely reported bacteria. The clinical picture was further complicated with severe glomerulonephritis. Renal biopsy was suggestive of crescentic glomerulonephritis. The child was managed with antibiotics, steroids, and plasmapheresis and responded well to the treatment. To our knowledge, this is the first report of G. morbillorum endocarditis with immune complex deposition and necrotizing glomerulonephritis in a child.

Back pain associated with lumbar disc herniation is a common musculoskeletal disorder that leads to absence at work place worldwide. Studies have proven in addition to the traditional factors, microbes play a role in disc herniation causing chronic back pain. A 34-year-old male who has not involved in any traumatic work but has a family history of disc herniation presented with lower back pain and numbness in his right leg. He had previously undergone lumbar discectomy at L4/L5 ten years back. Magnetic Resonance Imaging (MRI) showed L5/S1 right para central disc herniation impinging on the right S1 and S2 nerve roots. Standard protocols for disinfection of instruments, external skin and all transport media were adhered. Skin scrapings, muscle biopsy and excised disc tissue were obtained for anaerobic and aerobic bacterial cultures. Anaerobic microbial cultures of excised disc tissue following lumbar discectomy showed Gram positive growth. Further anaerobic isolation carried out using RapID ANA ID kit confirmed the growth as Gemella morbillorum. In addition, neither of the control samples (muscle nor skin) had any anaerobic growth indicating the absence of contamination. Aerobic bacterial growth was not present in the skin, muscles and disc cultures. The study findings add to the available literature, on the role of microorganisms in lumbar disc herniation and future treatment regimens with antibiotics.