First Reported Case of Actinomyces oris Endocarditis and Bacteremia in the United States: A Case Report

Authors

Hajra Nosheen, Department of Internal Medicine, McLaren Health Care/Michigan State University, Flint, Michigan, USAFollow
Josephine R. Pitasari, Department of Internal Medicine, McLaren Health Care/Michigan State University, Flint, Michigan, USAFollow
Khaled Almorsy, Department of Internal Medicine, McLaren Health Care/Michigan State University, Flint, Michigan, USAFollow
Shagufta N. Ali, Department of Infectious Disease, McLaren Health Care/Michigan State University, Flint, Michigan, USAFollow

Abstract

Introduction: Actinomyces are Gram-positive bacilli found as normal flora in the oral, urogenital, and gastrointestinal tracts. Actinomyces causing endocarditis is extremely rare, with only one prior case of Actinomyces oris endocarditis reported in 2020 in Thailand. We present the first case ever reported in the United States.

Case Description: We present a 58-year-old African American woman with multiple comorbidities, including end-stage renal disease, on hemodialysis who presented with altered mentation. On investigations, she had Actinomyces oris bacteremia, with echocardiography revealing mitral valve vegetation. She was treated with IV antibiotics followed by oral amoxicillin-clavulanic acid.

Discussion: Our case highlights the diagnostic challenges posed by slow-growing organisms like Actinomyces oris in patients with comorbidities, especially on hemodialysis. Blood cultures and transesophageal echocardiography were critical in diagnosing this case. Advanced microbial diagnostic techniques are crucial in identifying the pathogen and the pathogen's susceptibility-guided treatment. This case highlights the importance of early recognition and tailored therapy for rare pathogens like Actinomyces oris.

Recommended Citation

Nosheen, Hajra; Pitasari, Josephine R.; Almorsy, Khaled; and Ali, Shagufta N. (2025) "First Reported Case of Actinomyces oris Endocarditis and Bacteremia in the United States: A Case Report," Journal of Community Hospital Internal Medicine Perspectives: Vol. 15: Iss. 2, Article 13.
DOI: 10.55729/2000-9666.1469
Available at: https://scholarlycommons.gbmc.org/jchimp/vol15/iss2/13