A rare cause of infective endocarditis and stroke: Filamentous vegetation due to Granulicatella adiacens
Bibliographic record
Abstract
•Granulicatella adiacens is a cause of filamentous cardiac vegetation and aneurysm.•Infective endocarditis due to Granulicatella adiacens is rare.•Nutrition variant streptococci require media supplementation for culturing. A 29-year-old healthy female presented with a left-sided stoke and mitral valve (MV) regurgitation. Computer tomography and a subtraction angiogram of the brain revealed a right frontal and parietal branch middle cerebral artery mycotic aneurysm with right frontal lobe hemorrhage. Endovascular intracranial embolization was done. A transthoracic echocardiogram showed a 0.8–0.9 cm mass on the MV valve leaflet, with filamentous vegetation in the atrium adjacent to the pulmonary vein opening (Figure 1). No vegetation was observed after empirically treating for 4 weeks with intravenous Penicillin, initially combined with Gentamycin for 2 weeks. She is awaiting MV replacement. The nutrition variant streptococci (NVS), Granulicatella adiacens, was cultured from blood. NVS are etiological agents in 4–6% (Patel et al., 2017Patel S.N. Austin A.M. Siebert H. Siddiqi F. Soares D. Kus J.V. Susceptibility profiles of nutritionally variant streptococci (NVS) recovered from invasive cases in Ontario, Canada.JAMMI. 2017; 2: 11-15https://doi.org/10.3138/jammi.2.2.03Crossref Scopus (3) Google Scholar) of streptococcal infective endocarditis. Classical infective endocarditis clinical signs are rarely seen with NVS. Vegetations tend to be smaller and embolization more prominent (Shailaja et al., 2013Shailaja T.S. Sathiavathy K.A. Unni G. Infective endocarditis caused by Granulicatella adiacens.Indian Heart J. 2013; 65: 447-449https://doi.org/10.1016/j.ihj.2013.06.014Abstract Full Text Full Text PDF PubMed Scopus (14) Google Scholar). They are notoriously difficult to culture, requiring special media supplements. Infective endocarditis cases with NVS have high mortality rates, treatment failure, relapse, and antibiotic resistance (Verdecia et al., 2019Verdecia J. Vahdat K. Isache C. Trivalvular infective endocarditis secondary to Granulicatella adiacens and Peptostreptococcus spp.IdCases. 2019; 17e00545https://doi.org/10.1016/j.idcr.2019.e00545Crossref PubMed Scopus (1) Google Scholar). NVS cardiac vegetations grow slowly and result in structural abnormalities such as filament formation, thick cell walls, and multivalvular involvement (Patil et al., 2019Patil S.M. Arora N. Nilsson P. Yasar S.J. Dandachi D. Salzer W.L. Native valve infective endocarditis with osteomyelitis and brain abscess caused by Granulicatella adiacens with literature review.Case Rep Infect Dis. 2019; 20194962392https://doi.org/10.1155/2019/4962392Crossref PubMed Google Scholar). No conflict of interest to declare. None.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.000 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.000 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".