Sepsis, Endocarditis, and Purulent Arthritis due to a Rare Zoonotic Infection with Streptococcus equi Subspecies zooepidemicus

Table 1

Published cases with endocarditis due to Streptococcus equi subsp. zooepidemicus.

Number	Age/sex	Year/nationality	Diagnosis	Comorbidity	Contamination	Antibiotic therapy	Pattern of resistance	Duration of treatment	Outcome	Reference
1	83/M	2016, Faroe Islands	Endocarditis, purulent arthritis, suspected osteomyelitis, sepsis	DMII, HD, IHD, low malignant prostate cancer	Horses	IV cefuroxime, benzylpenicillin, gentamicin (in total 5 days), oral amoxicillin, and rifampin	Sensitive to penicillin, ampicillin, cefotaxime, erythromycin, and clindamycin	12 weeks and 4 days	Recovered	Present case
2	59/F	2009, Canada	Meningitis, mitral endocarditis, endophthalmitis	AH, DMII, dyslipidemia, IHD, chronic renal failure, obesity, left ophthalmic vein thrombosis, ostium primum atrial septal defect, hypothyroidism, primary hyperparathyroidism and anemia	No relation to unpasteurised milk products. Her husband had daily contact with healthy horses	IV ceftriaxone and rifampin	Susceptible to all tested antibiotics according to the Clinical and Laboratory Standard Institute criteria	6 weeks	Blindness	[4]
3	70/F	2003, Spain	Pneumonia, endocarditis, bacteraemia	None	Milk-borne outbreak	Beta-lactam agent	Sensitive to penicillin, erythromycin, vancomycin, rifampin, and levofloxacin, but resistant to clindamycin and tetracycline	Unknown	Disorientation to time and place	[3]
4	73/M	Spain	Bacteraemia, endocarditis	AH, dyslipidemia, mechanical aortic valve replacement	Contact to stillborn foal two weeks before admission	Penicillin (6 weeks) and gentamicin (first 2 weeks)	Unknown	6 weeks	Recovered	[6]
5		2012, France	Bacteraemia, endocarditis	Pituitary adenoma, mechanical aortic valve	Unknown	Amoxicillin and gentamicin	Sensitive to beta-lactamins, macrolides, chloramphenicol, co-trimoxazole, glycopeptides, and rifampin, but resistant to tetracycline	6 weeks	Recovered	[7]
6	79/M	2010, England	Bacteraemia, endocarditis	None	Horse manure	Benzylpenicillin and vancomycin	Unknown	6 weeks	Recovered	[8]
7	57/M	2011, Finland	Sepsis, meningitis, endocarditis	Aortic valve insufficiency	Horses	Penicillin (5 weeks) and gentamicin (10 first days)	Sensitive to erythromycin, clindamycin, penicillin, vancomycin, and cephalexin	5 weeks	Recovered	[1]
8	58/F	1980’s, China	Bacteraemia, endocarditis	None	No relation to horses or unpasteurised milk	Benzylpenicillin	Unknown	Unknown	Recovered	[9]
9	51/M	1982, unknown	Bacteraemia, endocarditis	Rheumatic HD	Unknown, but was a farmer	IV penicillin (4 weeks) and IM streptomycin (2 weeks)	Unknown	4 weeks	Recovered	[10]
10	52/F	1984, England	Sepsis, bacteraemia, endocarditis	Unknown	A milk-borne outbreak	Penicillin and cephalosporin	Unknown	4 weeks	Impairment of peripheral flow in one arm	[11]
11	73/M	1984, England	Sepsis, bacteraemia, endocarditis, meningitis	IHD	A milk-borne outbreak	Unknown	Unknown	Unknown	Died	[11]
12	79/M	1984, England	Sepsis, bacteraemia, endocarditis		A milk-borne outbreak	Cephalosporin, ampicillin, and metronidazole	Unknown	2 weeks	Died	[11]
13	81/M	1979, England	Bacteraemia, endocarditis, cholecystitis	Chronic rheumatic HD	Unknown	Oral ampicillin, IV benzyl penicillin (3 weeks and 3 days) and gentamicin (first 10 days), changed to oral amoxicillin (2 weeks)	Unknown	5 weeks and 3 days	Died	[12]

The table includes 12 of the 17 cases, exclusive the present cases. The last three cases are not included because the information in the articles was either impossible to get access to or not detailed enough to fulfil the table: two cases of endocarditis due to S. zooepidemicus from the article “Endocarditis due to group C streptococci according to Group C streptococcal bacteremia: analysis of 88 cases.” One case in “Prolonged fever Streptococcus equi spp. zooepidemicus (endocarditis aortic complicated with mycotic aneurysm infrarenal).” The article “Group C streptococcal infections associated with eating home cheese–New Mexico” describes one case with endocarditis. AH: arterial hypertension; IHD: ischemic heart disease; HD: heart disease; DMII: diabetes mellitus type II; IV: intravenous; IM: intramuscular injection.