Rothia dentocariosa bacteremia in the newborn: causative pathogen or contaminant?

Diego A. Mazabanda López; Desiderio Reyes Suárez; Lourdes Urquía Martí; Fermín García-Muñoz Rodrigo

doi:10.1515/crpm-2021-0026

Article Publicly Available

Rothia dentocariosa bacteremia in the newborn: causative pathogen or contaminant?

Diego A. Mazabanda López , Desiderio Reyes Suárez , Lourdes Urquía Martí and Fermín García-Muñoz Rodrigo

Published/Copyright: November 29, 2021

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From the journal Case Reports in Perinatal Medicine Volume 10 Issue 1

Abstract

Objectives

To describe an infrequent case of bacteremia by Rothia dentocariosa in a newborn and to discuss its potential pathogenicity.

Case presentation

R. dentocariosa is an aerobic or facultative anaerobic gram-positive bacillus, common in the human oral cavity that has been isolated in cases of endocarditis, pneumonia, endophthalmitis and peritonitis in adults. Infections in the fetus and newborn have been scarcely reported. We present a full-term newborn with prolonged rupture of membranes, acute elevation of C-reactive protein, and isolation of R. dentocariosa in the blood culture. Endocarditis was ruled out and the patient did well with five days of intravenous broad spectrum antibiotics. To date, only a previous case of sepsis by R. dentocariosa in a neonate with meconium aspiration syndrome and an antenatal death of a full-term fetus with hemorrhagic brain lesions probably related to R. dentocariosa have been reported.

Conclusions

Until more information about the pathogenicity of this germ in the newborn is available, an individualized approach and a close clinical control of the patient with infectious risk factors and bacteremia by R. dentocariosa seem to be prudent.

Keywords: bacteremia; neonatal sepsis; Rothia dentocariosa

Introduction

Rothia dentocariosa is an aerobic or facultative anaerobic gram-positive bacillus, non-spore-forming, immobile, common in the human oral cavity, having been related mainly to periodontal disease. Traditionally it has been considered an “unculturable or difficult-to-culture” bacterial species [1]. In adults, although it is considered a low virulence pathogen, it has been isolated in cases of endocarditis, pneumonia, endophthalmitis and peritonitis [2]. Vaginal colonization or isolation in intrauterine bacterial infections is exceptional [3]. However, periodontal disease in pregnant women due to this and other bacteria has been related to premature labor and low birth weight [1], although infections in the fetus and newborn have been scarcely reported. To our knowledge, the first and only case of R. dentocariosa sepsis in a neonate was referred by Shin et al. in 2004 in a patient with meconium aspiration syndrome [4]. Subsequently, other cases with different clinical significance have been reported in infants and children [5].

Case presentation

A male newborn of 39⁺² weeks of gestational age, with a birth weight of 4,030 g, was born to a healthy 27-year-old primigravida mother by cephalic vaginal delivery, after an uneventful gestation. The time since the membranes rupture was 48 h. The Apgar score at 1 and 5 min was 9 and 9, respectively. The initial adaptation to extrauterine life and the physical examination in the first hours of life were normal. He was admitted 24 h after birth because of elevation of C reactive protein (CRP) to 4.94 mg/dL and, although asymptomatic, empirical antibiotic therapy with ampicillin and gentamicin was started after collecting a blood sample for microbiological study. Blood was incubated on the BACTECTM FX automated system for five days and then, cultured on chocolate agar and MacConkey agar at 35 °C in an atmosphere with 5% CO₂ for 48 h. After 48 h of blood culture, the presence of a Gram positive bacillus was observed, which 48 h later was identified as R. dentocariosa by mass spectrometry with MALDI Biotyper^®. After endocarditis was ruled out, antibiotic therapy was maintained for five days, until normalization of CRP (0.92 mg/dL). The patient was discharged without complications and remained asymptomatic during the outpatient follow-up.

Discussion

R. dentocariosa has been traditionally considered a low virulence pathogen, although a body of literature is growing regarding systemic infections in immunocompromised and healthy adults and children [2], and it has been suggested that its presence outside the oropharynx, especially in blood, should be handled with caution. In 2007, Karlson et al. reported a case of intrauterine fetal death of a full-term fetus possibly associated with R. dentocariosa infection, in whom extensive brain hemorrhagic lesions were revealed at autopsy [6]. As far as we know, our patient is the second live newborn reported in which this pathogen is isolated. Given the absence of clinical symptoms and the good evolution of the patient, it could have been an accidental contamination or a transient bacteremia. However, because of the elevation of acute phase reactants and the potential risk of complications reported at other ages, antibiotic treatment for a short period of time was considered appropriate. A limitation of our case is that only a blood culture was taken and no other specimens were sent to confirm the infection. We reviewed our microbiology lab files from the last five years in search of other isolations of R. dentocariosa and we only found two cases, both in adults: a 67-year-old male with disseminated lung cancer and pancytopenia under chemotherapy, and a 69-year-old male with fever, pneumonia, pleural effusion, and cardiac tamponade. No signs of endocarditis were observed in either of them. However, both received broad-spectrum antibiotics until clinical stabilization.

In conclusion, as modern microbiological techniques are implemented, it is possible that more cases of R. dentocariosa infection will be identified in human patients. Regarding the perinatal period, although contamination or transient bacteremia are possible, until more information is available on the pathogenicity of this germ, an individualized approach and a close clinical control of the patient with infectious risk factors and bacteremia by R. dentocariosa seems to be prudent.

Corresponding author: Fermín García-Muñoz Rodrigo, Neonatal Unit, Hospital Universitario Materno Infantil de Canarias, Avenida Marítima del Sur S/N, 35016 Las Palmas de Gran Canaria, Spain, Phone: +34 680406241, Fax: +34 928444694, E-mail: fgarciamu@gmail.com

Research funding: None declared.
Author contributions: All authors have accepted responsibility for the entire content of this manuscript and approved its submission.
Competing interests: Authors state no conflict of interest.
Informed consent: Written informed consent could not be obtained, however the article does not contain sensitive identifiable information of the patient.
Ethical approval: The local Institutional Review Board deemed the study exempt from review.

References

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Received: 2021-03-22

Accepted: 2021-10-06

Published Online: 2021-11-29

Articles in the same Issue

https://doi.org/10.1515/crpm-2021-0026

Keywords for this article

bacteremia; neonatal sepsis; Rothia dentocariosa