Brucella anthropi Bacterial Endocarditis: An Emerging Pathogen

Brucella anthropi Bacterial Endocarditis: An Emerging Pathogen | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Case Report Brucella anthropi Bacterial Endocarditis: An Emerging Pathogen Fernando Baires, Erin Arias, María José Díaz, Cesar Burgos, Carlos Umaña, and 7 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8150156/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Background: The genus Brucella has expanded considerably in the 21st century. With the advent of advanced phylogenetic analyses such as whole genome sequencing, a close genetic proximity between Brucella and Ochrobactrum has been revealed, leading to the integration of the Ochrobactrum genus into the Brucella genus. Among the species in the newly expanded Brucella genus, Brucella anthropi (formerly Ochrobactrum anthropi ) has emerged as a rare, albeit increasingly recognized, invasive human pathogen. While this report focuses on infective endocarditis, we also briefly summarize other clinical syndromes associated with this organism. Methods: A systematic review of the English-language medical literature from 1984 to 2025 was conducted. Cases of B. anthropi endocarditis were identified and analyzed for demographics, clinical presentation, antimicrobial susceptibility, and outcomes. Results: Seven reported cases of acute endocarditis due to B. anthropi were identified in the English-language medical literature, in addition to our own. Most patients had predisposing valvular disease or prosthetic material, which held true with the patient case described herein. The overall mortality rate of patients with B. anthropi acute endocarditis approached 25% in the literature. Antimicrobial susceptibility patterns were variable, underscoring the importance of targeted therapy guided by microbiologic testing. Conclusion: Consistent with other gram negative bacilli, B. anthropi is a rare but proven cause of acute bacterial endocarditis. Despite its rarity, it may represent an emerging, under-recognized cause of invasive disease. This manuscript provides clinicians with guidance on its recognition, susceptibility profile, and management, supporting the translation of evolving taxonomic and molecular insights into successful patient care. Infectious Diseases Brucella anthropi Ochrobactrum anthropi Brucella Genus Acute Endocarditis Taxonomy Figures Figure 1 Figure 2 Figure 3 INTRODUCTION In 2020, Hördt et al proposed combining the Ochrobactrum genus into the Brucella genus, based on whole genome sequencing analyses revealing that genetic differences between the two genera were insufficient to warrant separate classifications [ 1 ]. Leclerq et al conducted a broad phylogenomic analysis of Brucellaceae confirming that species formerly classified as Ochrobactrum cluster within Brucella , thereby providing additional support for the taxonomic reclassification [ 2 ]. As a result, former Ochrobactrum species were reclassified as Brucella . Because the term Brucella evoked concern among clinicians, given its association with severe zoonotic infection, microbiologists emphasized differentiating the classical pathogenic brucellosis-causing Brucella species (BBS), which require biosafety level 3 containment, from the non-brucellosis-causing Brucella species (NBBS), which pose less pathogenic risk (Fig. 1) [ 3 ]. Figure 1. Classification of the Brucella Genus Brucella anthropi (formerly Ochrobactrum anthropi ) has been increasingly recognized as a human pathogen capable of causing severe invasive disease, including acute endocarditis. This manuscript describes a novel case of bivalvular endocarditis caused by B. anthropi , supplemented by a systematic review of the English-language literature on acute endocarditis due to this organism and its unique antimicrobial susceptibility patterns. METHODS This manuscript focuses on acute endocarditis produced by B. anthropi . A systematic review of PubMed, Medline, Science Direct and Google Scholar was conducted using the following terms: “ Brucella anthropi ”, “ Ochrobactrum anthropi ”, “acute endocarditis”, “taxonomy and Brucella ”. Peer-reviewed, English language manuscripts were included if they reported a diagnosis of acute endocarditis attributed to O. anthropi or B. anthropi , established by either pathology, imaging, or the universally accepted modified Dkue criteria (2023 revision). Broader inclusion criteria were applied to accommodate variations in diagnostic/technological capabilities between developed and resource-limited settings. CASE REPORT A 75-year-old man with a medical history of hypertension, diabetes mellitus type 2, prostate cancer treated with radiation therapy, and a prior episode of streptococcal endocarditis in his aortic prosthetic valve successfully treated at another institution 18 months prior. He was referred to the Infectious Disease clinic for evaluation of fever of unknown origin, weight loss and night sweats. At the initial clinic visit, the patient revealed a history of three cryptogenic transient ischemic attacks. Given his history of prior endocarditis and his current symptoms, he was admitted electively to the hospital for further evaluation of his fever of unknown origin. Consistent with FUO recommendations, empiric antibiotics were not initiated. Blood cultures were obtained and held for 21 days on multiple growth media. During his three-day hospitalization, he remained afebrile, and initial culture results were negative. The patient felt clinically well and requested discharge, which was granted with instructions to follow up in the Infectious Disease clinic within the week. Approximately five days after discharge, initial blood cultures resulted positive for non-lactose-fermenting gram-negative rods. After unsuccessful attempts to notify the patient, he presented to the emergency department with chest pain. The Infectious Disease team at the hospital was notified, repeat blood cultures were obtained, and empiric cefepime was initiated based on recent culture positivity with gram-negative rods. On physical examination, a grade III/VI holosystolic murmur was heard along the right parasternal border and the left 2nd intercostal space, unchanged from the clinic visit. Crackles were present in the posterior right lung field, and a non-pruritic maculopapular rash was observed on the torso. Initial laboratory results showed a leukocyte count of 6.83 x 10 3 /µl, hemoglobin of 10.4 g/dL, hematocrit of 32.7%, platelet count of 204 x 10 3 /µl, erythrocyte sedimentation rate (ESR) of 52 mm/h, and a D-dimer level of 1,008 ng/mL x 10 3 /µl. Urinalysis was unremarkable. After 120 hours of incubation, blood cultures identified Brucella anthropi . Susceptibility testing demonstrated sensitivity to quinolones, aminoglycosides, meropenem, tetracycline, and trimethoprim-sulfamethoxazole, but resistance to cephalosporins, penicillins, and other β-lactam agents. Cultures obtained in the emergency room again identified B. anthropi. An additional set of blood cultures was obtained before changing therapy, which also identified B. anthropi. A transthoracic echocardiogram revealed preserved prosthetic aortic valve function with no overt vegetations, although valve leaflet visualization was limited. A transesophageal echocardiogram reported vegetations in both the aortic and tricuspid valves. A definitive diagnosis of acute endocarditis was therefore established (Figs. 2a and 2b). Figure 2a. Aortic valve vegetation Figure 2b . Tricuspid valve vegetation With blood culture and imaging results, the antibiotic regimen was changed from cefepime to meropenem 1 g IV every 8 hours. Persistent bacteremia led to the addition of ciprofloxacin 250mg orally every 12 hours, after which blood cultures cleared. On hospital day 8, the patient developed Clostridioides difficile colitis, confirmed by stool testing, and was treated successfully with vancomycin 125 mg orally every 6 hours. A peripherally inserted central catheter (PICC) line was placed to complete a six-week course of intravenous antibiotics for infective endocarditis. With these interventions, the patient remained clinically stable and afebrile, with normalization of his inflammatory markers. He was discharged home on hospital day 10 with close Infectious Disease follow-up. After completion of his 6-week IV antibiotic course, his PICC line was removed without incident. Blood cultures at 2, 4, and 6 weeks remained negative. Cardiology and cardiothoracic surgery evaluations agreed that he would require open aortic valve replacement; however, the patient died unexpectedly four days before the scheduled surgery due to an accidental, non-medical event. Autopsy findings confirmed chronic valvular shear damage and embolic brain lesions consistent with prior strokes, without evidence of valve rupture or chordae tendineae damage. DISCUSSION Taxonomy, the classification of organisms into hierarchical groups based on similarities of phenotype or genotype, is often regarded as immutable. However, new discoveries occasionally occur that lead to classification reconfiguration, or even to entire paradigm shifts. Technology is often the catalyst for these discoveries, as can be seen with the reclassification of Ochrobactrum genus members under the genus Brucella based on results of whole genome sequencing [ 1 ]. The new classification resolves questions regarding ancestral links. However, genotypic commonality does not always beget phenotypic equivalence. There remain striking biological differences between the previous Ochrobactrum genus and the classical Brucella genus: intracellular vs free-living environment preference, zoonotic vs opportunistic pathogenicity, and genomic size, etc. [ 4 ]. Acknowledging the marked biological distinctions, we nonetheless include a diagram illustrating the placement of the expanded Brucella genus within the gram negative spectrum, reflecting its current taxonomic reclassification (Fig. 3). For an in-depth review of Ochrobactrum genus members, we refer readers to the work of Ryan and Pembroke [ 5 ]. Figure 3. Phylogenetic placement of Brucella anthropi. B. anthropi is an environmental bacterium found in water, soil, and diverse ecological niches. Unlike the Brucella species of the BBS (brucellosis-causing Brucella species) group, there is no evidence that B. anthropi transmits communicable disease among humans. Since its initial description in 1984 and official classification in 1988 [ 6 ], much has been learned about this organism. Originally, it was thought to be an opportunistic and/or nosocomial organism, due to its association with immunocompromised individuals. Over the first quarter of the 21st century, it has been increasingly recognized as a global pathogen, albeit still an uncommon one. Over 140 cases of serious infection by B. anthropi have been reported, affecting both immunocompetent and immunocompromised individuals. Documented syndromes include pneumonia, invasive skin and soft tissue infections, complicated bloodstream infections, septic arthritis, osteomyelitis, and acute endocarditis (Table 1 ). Table 1 Syndromes associated with B. anthropi infections Clinical Syndromes Associated with Brucella anthropi 1. Pneumonia 2. Invasive Skin and Soft Tissue Infections 3. Complicated Bloodstream Infections 4. Septic Arthritis 5. Osteomyelitis 6. Acute Endocarditis Clinically, it is important to emphasize that despite genetic proximity and recent taxonomic reclassification, the species within this recently expanded genus maintain distinct microbiological and clinical characteristics. Recognizing these differences enables clinicians to accurately interpret laboratory reports and avoid undue concern when the name Brucella appears. The key distinguishing microbiological features are summarized in Table 2 . Table 2 Features That Distinguish Brucella anthropi from Brucellosis-Causing Brucella Species (BBS) Brucella anthropi Brucellosis-producing Brucella species Gram negative rods Rapid growth on MacConkey agar Mucoid morphology Non lactose fermenting Catalase positive Oxidase positive Obligate aerobes Motile, possessing peritrichous flagella Extracellular Gram negative rods Slow to no growth on MacConkey agar Non-mucoid morphology Non lactose fermenting Catalase positive Oxidase positive Possibly facultative anaerobes Non-motile, lacking flagella Intracellular Consistent with current recommendations for the diagnosis and treatment of fever of unknown origin [ 7 ], antibiotics were withheld initially because the patient was hemodynamically stable. We believe this decision was critical for establishing the diagnosis; had empiric antibiotics been started, the responsible organism might not have been identified. Retrospective review of prior evaluations revealed that empiric antibiotics had likely delayed diagnosis in those instances. Additionally, extending the incubation period of the blood cultures beyond typical practice was another key factor in isolating the organism. In 1986, the Joint FAO/WHO Committee on Brucellosis published their 6th report and provided treatment recommendations: oral doxycycline 100 mg twice daily for 6 weeks with oral rifampin 600 mg to 900 mg daily for 6 weeks. As an alternative to rifampin, the aminoglycoside streptomycin 1 gram could be given intramuscularly daily for 2–3 weeks [ 8 ]. These regimens remain the standard of care decades later [ 9 ]. Because B. anthropi is a rare cause of acute infective endocarditis, empiric coverage was not initially considered for our patient. Cefepime was administered based on preliminary results of the initial blood cultures, showing growth consistent with non-lactose-fermenting gram-negative rods. Subsequently, susceptibility testing and minimum inhibitory concentration (MIC) analysis (Table 3 ) identified the organism as B. anthropi , resistant to most cephalosporins, prompting discontinuation of cefepime. Although tetracyclines and aminoglycosides were predicted to be effective, meropenem and ciprofloxacin were chosen based on their favorable side effect profile and MIC results. Table 3 B. anthropi susceptibilities and MIC Antibiotic agent Susceptibility MIC Ampicillin/Sulbactam Resistant > 16/8 Cefotaxime Intermediate 16 Ceftazidime Resistant > 16 Ceftriaxone Sensitive 8 Ciprofloxacin Sensitive < 1 Gentamicin Sensitive < 4 Levofloxacin Sensitive < 2 Meropenem Sensitive < 1 Tetracycline Sensitive < 4 Tobramycin Sensitive < 4 Trimethoprim/Sulfamethoxazole Sensitive < 2/38 The observed resistance pattern of B. anthropi can be attributed to two broad mechanisms: horizontal acquisition of plasmids [ 10 , 11 ], and upregulation of efflux pumps [ 12 ]. In a 2023 study, Ma et al [ 12 ] examined multiple Brucella species and reported that approximately 60% of resistance genes were related to efflux pump activity. These findings underscore the importance of performing meticulous susceptibility testing, as B. anthropi is resistant to most cephalosporins and penicillins but largely sensitive to trimethoprim sulfamethoxazole, anti-pseudomonal carbapenems, fluoroquinolones, and aminoglycosides. This case has inherent limitations. The excised valve could not be obtained in vivo for PCR testing. No definitive source of infection was identified despite suspicion that it was acquired during a previous hospitalization vs procedure, where the patient underwent iliac crest aspiration. Nevertheless, this case provided invaluable clinical experience with a little-encountered organism and established a susceptibility profile that may guide future clinicians. Analysis of the seven known cases of acute endocarditis as shown in Table 4 revealed a male predominance. While some patients lacked underlying valvular predispositions, those who did had conditions such as prosthetic valves, rheumatic heart disease, or aortic stenosis. Our case is unique in demonstrating vegetations affecting two separate valves, whereas prior cases involved a single valve. Age did not appear to be a determining factor, with reported patients ranging from 28 to 75 years old. The overall mortality rate was 25%; our patient’s death was unrelated to infection. Pathologic examination confirmed irregular valvular surfaces consistent with treated endocarditis, without evidence of valve perforation or chordae tendineae rupture. Notably, B. anthropi remained susceptible to meropenem in all reported susceptibility panels. Unlike other non-endocarditis cases, only two of the eight cases were deemed nosocomial. Although our patient had been hospitalized eighteen months earlier, this interval makes it less likely that hospitalization was the source, although his tricuspid valve involvement raises lingering questions. Table 4 Reported Cases of Acute Endocarditis with Brucella anthropi ( Ochrobactrum anthropi ) Case History Clinical Presentation Age Sex Definitive Treatment Outcome Country Reference 1. (1990) Bicuspid aortic valve replaced with pulmonary autograft and pulmonary homograft 1 week of lethargy, fever, malaise, pleuritic chest pain, sweating and exertional dyspnea. 28 Male Cefuroxime 1.5 grams daily + Gentamicin dose unspecified. Complete Recovery India [ 13 ] 2. (2000) Rheumatic heart disease with mild mitral stenosis, DM2, severe asthma Sudden, severe right leg pain of 2 h duration. 15 days prior she had high-grade fever with chills and rigors. Subsequent repeated episodes of fever. 39 Female Gentamicin 1 mg/kg IV every 8 hours + Vancomycin 500 mg IV every 6 hours + Ofloxacin 400 mg IV every 12 hours Complete Recovery Pakistan [ 14 ] 3. (2004) HTN, rheumatic heart disease, mitral insufficiency secondary to commissurotomy, mitral valve replacement 2 years prior 3 day history of fever, abdominal pain, dyspnea. 65 Female Meropenem 1 g IV every 6 hours + Gentamicin 60 mg IV every 8 hours No complications other than gentamicin associated ototoxicity Spain [ 15 ] 4. (2006) Surgery 6 months prior for traumatic rupture of bladder and terminal ileum, fracture of pelvis and pneumothorax 2 day history of fever, chills, rigors, abdominal pain, lethargy, urinary retention. 42 Male Vancomycin 500 mg IV every 12 hours + Meropenem 500 mg IV every 12 hours Death Turkey [ 16 ] 5. (2011) Prosthetic aortic valve Fever, chills 75 Male Meropenem 500 mg IV every 8 hours Death India [ 17 ] 6. (2016) History of Atrial fibrillation not on anticoagulation, coronary artery disease, moderate aortic stenosis, pacemaker for 3rd degree heart block, ESRD with failed kidney transplant, now on dialysis 2 day history of substernal sharp chest pain, nonradiating, 8/10 intensity. 58 Female IV Meropenem dose unspecified and hemodialysis catheter removal Complete Recovery United States [ 18 ] 7. (2024) Chronic myelomonocytic leukemia transformed into acute myeloid leukemia under azacitidine. Indwelling PICC line for weekly hematological medication, with weekly blood transfusions. ICD placed secondary to dilated cardiomyopathy Fever and mental confusion intermittently for several days. 68 Male IV Gentamicin and Trimethoprim sulfamethoxazole unspecified dose + IV meropenem unspecified dose Complete recovery Italy [ 19 ] 8. (2025) HTN, DM2, prostate cancer treated with radiation therapy, three cryptogenic transient ischemic attacks, aortic valve replacement with bioprosthetic valve, two previous occurrences of streptococcal endocarditis Persistent fever, malaise, chills, fatigue, significant weight loss (exceeding 20 pounds), night sweats over several weeks. 75 Male Meropenem 1 g IV every 8 hours + Ciprofloxacin 250 mg every 12 hours Complete recovery, with subsequent unrelated death United States Our Patient Diabetes Mellitus Type 2 (DM2), Hypertension (HTN), Intravenous (IV), End-stage renal disease (ESRD), Implantable cardioverter-defibrillator (ICD) Importantly, this case represents the first reported instance of endocarditis by B. anthropi involving both the aortic and tricuspid valves. This bivalvular involvement is unique, as previous reports have described infection limited to a single valve. The presence of both right and left sided endocarditis poses additional therapeutic challenges, given the difficulty in achieving complete eradication and the potential for persistent infection despite appropriate antimicrobial therapy. CONCLUSION Taxonomical changes are inevitable, driven by the ongoing evolution of science. Clinicians must remain current with changing nomenclature to be able to translate emerging knowledge into effective patient care. This case documents a rare bivalvular endocarditis caused by B. anthropi , highlights its unusual resistance profile, and serves as guidance for future clinicians encountering this organism. Declarations Statement on Participant Consent to Publish The participant provided informed consent for participation in this study and explicitly agreed to the Ipublication of the research findings. He granted permission for the use of his images and any other related materials within the manuscript and accompanying publications. All personally identifying information has been removed or anonymized in accordance with journal and institutional guidelines, and only the participant-approved images and details necessary for scientific understanding are included. In this particular case since the publication is occurring after his death the spouse provided the consent. ETHICS STATEMENT Written consent was obtained from the patient's immediate family. References Hördt A, López MG, Meier-Kolthoff JP, Schleuning M, Weinhold LM, Tindall BJ, Gronow S, Kyrpides NC, Woyke T, Göker M (2020) Analysis of 1,000 + Type-Strain Genomes Substantially Improves Taxonomic Classification of Alphaproteobacteria . Front Microbiol 11:468 PMID: 32373076; PMCID: PMC7179689 Leclercq SO, Cloeckaert A, Zygmunt MS (2020) Taxonomic Organization of the Family Brucellaceae Based on a Phylogenomic Approach. Front Microbiol. ;10:3083. 10.3389/fmicb.2019.03083 . 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J Infect 40(3):287–290. 10.1053/jinf.2000.0644 Romero Gómez MP, Peinado Esteban AM, Sobrino Daza JA, Sáez Nieto JA, Alvarez D, Peña García P (2004) Prosthetic mitral valve endocarditis due to Ochrobactrum anthropi : case report. J Clin Microbiol 42(7):3371–3373. 10.1128/JCM.42.7.3371-3373.2004 PMID: 15243121; PMCID: PMC446288 Ozdemir D, Soypacaci Z, Sahin I, Bicik Z, Sencan I (2006) Ochrobactrum anthropi endocarditis and septic shock in a patient with no prosthetic valve or rheumatic heart disease: case report and review of the literature. Jpn J Infect Dis 59(4):264–265 PMID: 16936348 Shivaprakasha S, Rajdev S, Singh H, Velivala S (2011) Prosthetic aortic valve endocarditis due to Ochrobactrum anthropi . Indian J Med Sci 65(2):69. 10.4103/0019-5359.103968 Ashraf F (2013) A case of Ochrobactrum anthropi -induced septic shock and infective endocarditis. R I Med J 2016;99(7):27 – 8. PMID: 27379356 Salvotti F, Rossoni G, Pilia MC, Carleo P, Kofler V, Carmignani C, Marin MG, Bonfante FP, Zagni I (2024) Ochrobactrum anthropi: a rare case of endocarditis. Italian J Med 18(4):1821. 10.4081/itjm.2024.1821 Additional Declarations The authors declare no competing interests. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-8150156","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Case Report","associatedPublications":[],"authors":[{"id":547245378,"identity":"8be4858c-d06c-4ce1-b032-682657114f95","order_by":0,"name":"Fernando Baires","email":"","orcid":"https://orcid.org/0009-0008-0682-068X","institution":"Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras","correspondingAuthor":false,"prefix":"","firstName":"Fernando","middleName":"","lastName":"Baires","suffix":""},{"id":547245379,"identity":"b43b3651-fc0f-495d-9135-0714bd7b2571","order_by":1,"name":"Erin Arias","email":"","orcid":"https://orcid.org/0009-0001-9001-075X","institution":"Universidad Latina de Costa Rica powered by Arizona State University, San Jose, Costa Rica","correspondingAuthor":false,"prefix":"","firstName":"Erin","middleName":"","lastName":"Arias","suffix":""},{"id":547245380,"identity":"d5138ff3-63ef-4568-b113-9a9602521bf3","order_by":2,"name":"María José Díaz","email":"","orcid":"https://orcid.org/0009-0002-5141-8776","institution":"Universidad de Ciencias Médicas, San José, Costa Rica.","correspondingAuthor":false,"prefix":"","firstName":"María","middleName":"José","lastName":"Díaz","suffix":""},{"id":547245381,"identity":"8d7ec861-48d2-46e4-83e0-2ebeff0bf5c2","order_by":3,"name":"Cesar Burgos","email":"","orcid":"https://orcid.org/0009-0004-3874-183X","institution":"Instituto Nacional Cardiopulmonar El Tórax, Tegucigalpa, Honduras","correspondingAuthor":false,"prefix":"","firstName":"Cesar","middleName":"","lastName":"Burgos","suffix":""},{"id":547245382,"identity":"88b1a48d-93e3-4959-921b-ee8d7ca539bd","order_by":4,"name":"Carlos Umaña","email":"","orcid":"https://orcid.org/0009-0001-5779-7407","institution":"Universidad Autónoma de Guadalajara, Guadalajara, México","correspondingAuthor":false,"prefix":"","firstName":"Carlos","middleName":"","lastName":"Umaña","suffix":""},{"id":547245383,"identity":"f0f6205e-cfed-4136-b51d-3bed8ff2b5cc","order_by":5,"name":"Justice Cruz","email":"","orcid":"https://orcid.org/0009-0005-3272-2539","institution":"Texas A\u0026M University, Victoria TX, United States of America","correspondingAuthor":false,"prefix":"","firstName":"Justice","middleName":"","lastName":"Cruz","suffix":""},{"id":547245384,"identity":"18b7543f-60ea-4f52-ace6-6bbe699c3e5a","order_by":6,"name":"Joanne Codero Guerra","email":"","orcid":"","institution":"Infectious Disease and Pulmonary Consultants, Victoria TX, United States of America","correspondingAuthor":false,"prefix":"","firstName":"Joanne","middleName":"Codero","lastName":"Guerra","suffix":""},{"id":547245385,"identity":"3a7a710a-c741-4e2d-8ffe-98f858ecefd0","order_by":7,"name":"Helen Hoffman","email":"","orcid":"https://orcid.org/0009-0008-2480-7526","institution":"Universidad Latina de Costa Rica powered by Arizona State University, San Jose, Costa Rica","correspondingAuthor":false,"prefix":"","firstName":"Helen","middleName":"","lastName":"Hoffman","suffix":""},{"id":547245386,"identity":"2bf7451e-9d85-4aaa-bb9e-9e5535a7a5c1","order_by":8,"name":"Jack Bordovsky","email":"","orcid":"https://orcid.org/0009-0000-6723-1389","institution":"Alabama College of Osteopathic Medicine, Dothan AL, United States of America","correspondingAuthor":false,"prefix":"","firstName":"Jack","middleName":"","lastName":"Bordovsky","suffix":""},{"id":547245387,"identity":"465d20c8-5789-48e6-87a4-d48daaa707af","order_by":9,"name":"Jana Radwanski","email":"","orcid":"https://orcid.org/0009-0004-0413-5292","institution":"Citizens Medical Center, Victoria TX, United States of America.","correspondingAuthor":false,"prefix":"","firstName":"Jana","middleName":"","lastName":"Radwanski","suffix":""},{"id":547245388,"identity":"9b7754a9-55f3-4046-b5bb-29bdd048b5a6","order_by":10,"name":"Miguel Sierra-Hoffman","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA6ElEQVRIie3PMQrCMBiG4T8E6hJ1FkFPIPyhIAiKV1Fcq17AQRDqUnWtk7dwbhddIq6FLIIXaBcRKaLtIDqY6iaYd0i+Ic8QAJ3uJ2NPI7xfRu4zgukgbkLoN4SmO4vUFjuPslE8LE53/rF5WVcLFEgYWe9JPRh0iLvBhisGPbM/l9ymQEvLtYowhNBAhIDVy31HkjsxaF5F9gKhc0WsJqThyHY28SyEyEbEhMBZdrNJYKG/nJvIhWXy2Vj2bEom6r/sBT+yUwUrW8EP51i2VtOJH0YKkuQ9FrHTc6x+/1r8zWOdTqf7l27YfEv4FSzwNgAAAABJRU5ErkJggg==","orcid":"https://orcid.org/0000-0002-9851-3976","institution":"Sam Houston State University, Conroe TX, United States of America","correspondingAuthor":true,"prefix":"","firstName":"Miguel","middleName":"","lastName":"Sierra-Hoffman","suffix":""},{"id":547245389,"identity":"c1124d8c-4925-4ad8-85ec-529ec997aa6e","order_by":11,"name":"Amy C. Madril","email":"","orcid":"https://orcid.org/0009-0002-6629-0007","institution":"Department of Hospital Medicine, El Campo Memorial Hospital, El Campo TX, United States of America","correspondingAuthor":false,"prefix":"","firstName":"Amy","middleName":"C.","lastName":"Madril","suffix":""}],"badges":[],"createdAt":"2025-11-19 02:56:15","currentVersionCode":1,"declarations":{"humanSubjects":true,"vertebrateSubjects":false,"conflictsOfInterestStatement":false,"humanSubjectEthicalGuidelines":true,"humanSubjectConsent":true,"humanSubjectClinicalTrial":false,"humanSubjectCaseReport":true,"vertebrateSubjectEthicalGuidelines":false},"doi":"10.21203/rs.3.rs-8150156/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-8150156/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":96557337,"identity":"5c147cac-f7ba-42af-9f24-efbe096365f5","added_by":"auto","created_at":"2025-11-23 11:53:09","extension":"docx","order_by":0,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":3595107,"visible":true,"origin":"","legend":"","description":"","filename":"FinalManuscript1.docx","url":"https://assets-eu.researchsquare.com/files/rs-8150156/v1/842085342a18b5ded64ac2ab.docx"},{"id":96557354,"identity":"e45ee3df-179f-4cad-90f3-63fc564de5b8","added_by":"auto","created_at":"2025-11-23 11:53:11","extension":"json","order_by":1,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":342,"visible":true,"origin":"","legend":"","description":"","filename":"rs8150156.json","url":"https://assets-eu.researchsquare.com/files/rs-8150156/v1/1871f6771e4b0acdba96d907.json"},{"id":96557347,"identity":"c570c5a1-b850-4f9f-a09b-f36780b6b7b5","added_by":"auto","created_at":"2025-11-23 11:53:10","extension":"xml","order_by":2,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":79285,"visible":true,"origin":"","legend":"","description":"","filename":"rs81501560enriched.xml","url":"https://assets-eu.researchsquare.com/files/rs-8150156/v1/089a24e4b48be918100420aa.xml"},{"id":96557343,"identity":"270e1b41-9476-453a-a742-80ac17c596c5","added_by":"auto","created_at":"2025-11-23 11:53:09","extension":"xml","order_by":3,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":77077,"visible":true,"origin":"","legend":"","description":"","filename":"rs81501560structuring.xml","url":"https://assets-eu.researchsquare.com/files/rs-8150156/v1/8a787b65cf8958ad408856ca.xml"},{"id":96557352,"identity":"f204e606-5651-421c-9846-72d1730aa40a","added_by":"auto","created_at":"2025-11-23 11:53:10","extension":"html","order_by":4,"title":"","display":"","copyAsset":false,"role":"acdc-reference","size":90054,"visible":true,"origin":"","legend":"","description":"","filename":"earlyproof.html","url":"https://assets-eu.researchsquare.com/files/rs-8150156/v1/268483b486a9cdeab9d97e36.html"},{"id":96557338,"identity":"ee832c5c-c1ab-440d-ba58-8e5b2ec6bcec","added_by":"auto","created_at":"2025-11-23 11:53:09","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":102213,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 1.\u003c/strong\u003e Classification of the \u003cem\u003eBrucella \u003c/em\u003eGenus\u003c/p\u003e","description":"","filename":"Figure1.png","url":"https://assets-eu.researchsquare.com/files/rs-8150156/v1/cdf837ce4bc516117ac5c25c.png"},{"id":96557346,"identity":"dd0ca87e-4fde-4225-b618-6eba4c8119f3","added_by":"auto","created_at":"2025-11-23 11:53:10","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":514420,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 2a.\u003c/strong\u003e Aortic valve vegetation\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFigure 2b\u003c/strong\u003e. Tricuspid valve vegetation\u003c/p\u003e","description":"","filename":"Figure2a.png","url":"https://assets-eu.researchsquare.com/files/rs-8150156/v1/c1f8ed683c9d845c93e6c418.png"},{"id":96557335,"identity":"6f0fd871-58e3-4542-89da-776ff70905fd","added_by":"auto","created_at":"2025-11-23 11:53:09","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":177074,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cstrong\u003eFigure 3.\u003c/strong\u003e Phylogenetic placement of \u003cem\u003eBrucella anthropi.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"Figure3.png","url":"https://assets-eu.researchsquare.com/files/rs-8150156/v1/b6647a14d265b65d997df8f0.png"},{"id":96557433,"identity":"ebc7d51b-b04b-4693-8060-a55221d16715","added_by":"auto","created_at":"2025-11-23 11:53:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1600768,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8150156/v1/bf2195cf-0ccc-4cfe-8bc2-24275d6d202a.pdf"}],"financialInterests":"The authors declare no competing interests.","formattedTitle":"\u003cp\u003e\u003cem\u003eBrucella anthropi\u003c/em\u003e Bacterial Endocarditis: An Emerging Pathogen\u003c/p\u003e","fulltext":[{"header":"INTRODUCTION","content":"\u003cp\u003eIn 2020, H\u0026ouml;rdt \u003cem\u003eet al\u003c/em\u003e proposed combining the Ochrobactrum genus into the Brucella genus, based on whole genome sequencing analyses revealing that genetic differences between the two genera were insufficient to warrant separate classifications [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Leclerq \u003cem\u003eet al\u003c/em\u003e conducted a broad phylogenomic analysis of Brucellaceae confirming that species formerly classified as \u003cem\u003eOchrobactrum\u003c/em\u003e cluster within \u003cem\u003eBrucella\u003c/em\u003e, thereby providing additional support for the taxonomic reclassification [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. As a result, former \u003cem\u003eOchrobactrum\u003c/em\u003e species were reclassified as \u003cem\u003eBrucella\u003c/em\u003e. Because the term \u003cem\u003eBrucella\u003c/em\u003e evoked concern among clinicians, given its association with severe zoonotic infection, microbiologists emphasized differentiating the classical pathogenic brucellosis-causing \u003cem\u003eBrucella\u003c/em\u003e species (BBS), which require biosafety level 3 containment, from the non-brucellosis-causing \u003cem\u003eBrucella\u003c/em\u003e species (NBBS), which pose less pathogenic risk (Fig.\u0026nbsp;1) [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eFigure 1.\u003c/b\u003e Classification of the \u003cem\u003eBrucella\u003c/em\u003e Genus\u003c/p\u003e\u003cp\u003e\u003cem\u003eBrucella anthropi\u003c/em\u003e (formerly \u003cem\u003eOchrobactrum anthropi\u003c/em\u003e) has been increasingly recognized as a human pathogen capable of causing severe invasive disease, including acute endocarditis. This manuscript describes a novel case of bivalvular endocarditis caused by \u003cem\u003eB. anthropi\u003c/em\u003e, supplemented by a systematic review of the English-language literature on acute endocarditis due to this organism and its unique antimicrobial susceptibility patterns.\u003c/p\u003e"},{"header":"METHODS","content":"\u003cp\u003eThis manuscript focuses on acute endocarditis produced by \u003cem\u003eB. anthropi\u003c/em\u003e. A systematic review of PubMed, Medline, Science Direct and Google Scholar was conducted using the following terms: \u0026ldquo;\u003cem\u003eBrucella anthropi\u003c/em\u003e\u0026rdquo;, \u0026ldquo;\u003cem\u003eOchrobactrum anthropi\u003c/em\u003e\u0026rdquo;, \u0026ldquo;acute endocarditis\u0026rdquo;, \u0026ldquo;taxonomy and \u003cem\u003eBrucella\u003c/em\u003e\u0026rdquo;. Peer-reviewed, English language manuscripts were included if they reported a diagnosis of acute endocarditis attributed to \u003cem\u003eO. anthropi\u003c/em\u003e or \u003cem\u003eB. anthropi\u003c/em\u003e, established by either pathology, imaging, or the universally accepted modified Dkue criteria (2023 revision). Broader inclusion criteria were applied to accommodate variations in diagnostic/technological capabilities between developed and resource-limited settings.\u003c/p\u003e"},{"header":"CASE REPORT","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003cp\u003eA 75-year-old man with a medical history of hypertension, diabetes mellitus type 2, prostate cancer treated with radiation therapy, and a prior episode of streptococcal endocarditis in his aortic prosthetic valve successfully treated at another institution 18 months prior. He was referred to the Infectious Disease clinic for evaluation of fever of unknown origin, weight loss and night sweats. At the initial clinic visit, the patient revealed a history of three cryptogenic transient ischemic attacks.\u003c/p\u003e\u003cp\u003eGiven his history of prior endocarditis and his current symptoms, he was admitted electively to the hospital for further evaluation of his fever of unknown origin. Consistent with FUO recommendations, empiric antibiotics were not initiated. Blood cultures were obtained and held for 21 days on multiple growth media. During his three-day hospitalization, he remained afebrile, and initial culture results were negative. The patient felt clinically well and requested discharge, which was granted with instructions to follow up in the Infectious Disease clinic within the week.\u003c/p\u003e\u003cp\u003eApproximately five days after discharge, initial blood cultures resulted positive for non-lactose-fermenting gram-negative rods. After unsuccessful attempts to notify the patient, he presented to the emergency department with chest pain. The Infectious Disease team at the hospital was notified, repeat blood cultures were obtained, and empiric cefepime was initiated based on recent culture positivity with gram-negative rods.\u003c/p\u003e\u003cp\u003eOn physical examination, a grade III/VI holosystolic murmur was heard along the right parasternal border and the left 2nd intercostal space, unchanged from the clinic visit. Crackles were present in the posterior right lung field, and a non-pruritic maculopapular rash was observed on the torso.\u003c/p\u003e\u003cp\u003eInitial laboratory results showed a leukocyte count of 6.83 x 10\u003csup\u003e3\u003c/sup\u003e/\u0026micro;l, hemoglobin of 10.4 g/dL, hematocrit of 32.7%, platelet count of 204 x 10\u003csup\u003e3\u003c/sup\u003e/\u0026micro;l, erythrocyte sedimentation rate (ESR) of 52 mm/h, and a D-dimer level of 1,008 ng/mL x 10\u003csup\u003e3\u003c/sup\u003e/\u0026micro;l. Urinalysis was unremarkable.\u003c/p\u003e\u003cp\u003eAfter 120 hours of incubation, blood cultures identified \u003cem\u003eBrucella anthropi\u003c/em\u003e. Susceptibility testing demonstrated sensitivity to quinolones, aminoglycosides, meropenem, tetracycline, and trimethoprim-sulfamethoxazole, but resistance to cephalosporins, penicillins, and other β-lactam agents. Cultures obtained in the emergency room again identified \u003cem\u003eB. anthropi.\u003c/em\u003e An additional set of blood cultures was obtained before changing therapy, which also identified \u003cem\u003eB. anthropi.\u003c/em\u003e\u003c/p\u003e\u003cp\u003eA transthoracic echocardiogram revealed preserved prosthetic aortic valve function with no overt vegetations, although valve leaflet visualization was limited. A transesophageal echocardiogram reported vegetations in both the aortic and tricuspid valves. A definitive diagnosis of acute endocarditis was therefore established (Figs.\u0026nbsp;2a and 2b).\u003c/p\u003e\u003cp\u003e\u003cb\u003eFigure 2a.\u003c/b\u003e Aortic valve vegetation\u003c/p\u003e\u003cp\u003e\u003cb\u003eFigure 2b\u003c/b\u003e. Tricuspid valve vegetation\u003c/p\u003e\u003cp\u003eWith blood culture and imaging results, the antibiotic regimen was changed from cefepime to meropenem 1 g IV every 8 hours. Persistent bacteremia led to the addition of ciprofloxacin 250mg orally every 12 hours, after which blood cultures cleared. On hospital day 8, the patient developed \u003cem\u003eClostridioides difficile\u003c/em\u003e colitis, confirmed by stool testing, and was treated successfully with vancomycin 125 mg orally every 6 hours. A peripherally inserted central catheter (PICC) line was placed to complete a six-week course of intravenous antibiotics for infective endocarditis.\u003c/p\u003e\u003cp\u003eWith these interventions, the patient remained clinically stable and afebrile, with normalization of his inflammatory markers. He was discharged home on hospital day 10 with close Infectious Disease follow-up. After completion of his 6-week IV antibiotic course, his PICC line was removed without incident. Blood cultures at 2, 4, and 6 weeks remained negative. Cardiology and cardiothoracic surgery evaluations agreed that he would require open aortic valve replacement; however, the patient died unexpectedly four days before the scheduled surgery due to an accidental, non-medical event. Autopsy findings confirmed chronic valvular shear damage and embolic brain lesions consistent with prior strokes, without evidence of valve rupture or chordae tendineae damage.\u003c/p\u003e\u003c/div\u003e"},{"header":"DISCUSSION","content":"\u003cp\u003eTaxonomy, the classification of organisms into hierarchical groups based on similarities of phenotype or genotype, is often regarded as immutable. However, new discoveries occasionally occur that lead to classification reconfiguration, or even to entire paradigm shifts. Technology is often the catalyst for these discoveries, as can be seen with the reclassification of \u003cem\u003eOchrobactrum\u003c/em\u003e genus members under the genus \u003cem\u003eBrucella\u003c/em\u003e based on results of whole genome sequencing [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. The new classification resolves questions regarding ancestral links. However, genotypic commonality does not always beget phenotypic equivalence. There remain striking biological differences between the previous \u003cem\u003eOchrobactrum\u003c/em\u003e genus and the classical \u003cem\u003eBrucella\u003c/em\u003e genus: intracellular vs free-living environment preference, zoonotic vs opportunistic pathogenicity, and genomic size, etc. [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. Acknowledging the marked biological distinctions, we nonetheless include a diagram illustrating the placement of the expanded \u003cem\u003eBrucella\u003c/em\u003e genus within the gram negative spectrum, reflecting its current taxonomic reclassification (Fig.\u0026nbsp;3). For an in-depth review of \u003cem\u003eOchrobactrum\u003c/em\u003e genus members, we refer readers to the work of Ryan and Pembroke [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].\u003c/p\u003e\u003cp\u003e\u003cb\u003eFigure 3.\u003c/b\u003e Phylogenetic placement of \u003cem\u003eBrucella anthropi.\u003c/em\u003e\u003c/p\u003e\u003cp\u003e\u003cem\u003eB. anthropi\u003c/em\u003e is an environmental bacterium found in water, soil, and diverse ecological niches. Unlike the \u003cem\u003eBrucella\u003c/em\u003e species of the BBS (brucellosis-causing \u003cem\u003eBrucella\u003c/em\u003e species) group, there is no evidence that \u003cem\u003eB. anthropi\u003c/em\u003e transmits communicable disease among humans. Since its initial description in 1984 and official classification in 1988 [\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e], much has been learned about this organism. Originally, it was thought to be an opportunistic and/or nosocomial organism, due to its association with immunocompromised individuals. Over the first quarter of the 21st century, it has been increasingly recognized as a global pathogen, albeit still an uncommon one. Over 140 cases of serious infection by \u003cem\u003eB. anthropi\u003c/em\u003e have been reported, affecting both immunocompetent and immunocompromised individuals. Documented syndromes include pneumonia, invasive skin and soft tissue infections, complicated bloodstream infections, septic arthritis, osteomyelitis, and acute endocarditis (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eSyndromes associated with \u003cem\u003eB. anthropi\u003c/em\u003e infections\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"1\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eClinical Syndromes Associated with \u003cem\u003eBrucella anthropi\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. Pneumonia\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. Invasive Skin and Soft Tissue Infections\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. Complicated Bloodstream Infections\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. Septic Arthritis\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. Osteomyelitis\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6. Acute Endocarditis\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eClinically, it is important to emphasize that despite genetic proximity and recent taxonomic reclassification, the species within this recently expanded genus maintain distinct microbiological and clinical characteristics. Recognizing these differences enables clinicians to accurately interpret laboratory reports and avoid undue concern when the name \u003cem\u003eBrucella\u003c/em\u003e appears. The key distinguishing microbiological features are summarized in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eFeatures That Distinguish \u003cem\u003eBrucella anthropi\u003c/em\u003e from Brucellosis-Causing \u003cem\u003eBrucella\u003c/em\u003e Species (BBS)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"2\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003e\u003cem\u003eBrucella anthropi\u003c/em\u003e\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBrucellosis-producing \u003cem\u003eBrucella\u003c/em\u003e species\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGram negative rods\u003c/p\u003e\u003cp\u003eRapid growth on MacConkey agar\u003c/p\u003e\u003cp\u003eMucoid morphology\u003c/p\u003e\u003cp\u003eNon lactose fermenting\u003c/p\u003e\u003cp\u003eCatalase positive\u003c/p\u003e\u003cp\u003eOxidase positive\u003c/p\u003e\u003cp\u003eObligate aerobes\u003c/p\u003e\u003cp\u003eMotile, possessing peritrichous flagella\u003c/p\u003e\u003cp\u003eExtracellular\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eGram negative rods\u003c/p\u003e\u003cp\u003eSlow to no growth on MacConkey agar\u003c/p\u003e\u003cp\u003eNon-mucoid morphology\u003c/p\u003e\u003cp\u003eNon lactose fermenting\u003c/p\u003e\u003cp\u003eCatalase positive\u003c/p\u003e\u003cp\u003eOxidase positive\u003c/p\u003e\u003cp\u003ePossibly facultative anaerobes\u003c/p\u003e\u003cp\u003eNon-motile, lacking flagella\u003c/p\u003e\u003cp\u003eIntracellular\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eConsistent with current recommendations for the diagnosis and treatment of fever of unknown origin [\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e], antibiotics were withheld initially because the patient was hemodynamically stable. We believe this decision was critical for establishing the diagnosis; had empiric antibiotics been started, the responsible organism might not have been identified. Retrospective review of prior evaluations revealed that empiric antibiotics had likely delayed diagnosis in those instances. Additionally, extending the incubation period of the blood cultures beyond typical practice was another key factor in isolating the organism.\u003c/p\u003e\u003cp\u003eIn 1986, the Joint FAO/WHO Committee on Brucellosis published their 6th report and provided treatment recommendations: oral doxycycline 100 mg twice daily for 6 weeks with oral rifampin 600 mg to 900 mg daily for 6 weeks. As an alternative to rifampin, the aminoglycoside streptomycin 1 gram could be given intramuscularly daily for 2\u0026ndash;3 weeks [\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. These regimens remain the standard of care decades later [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. Because \u003cem\u003eB. anthropi\u003c/em\u003e is a rare cause of acute infective endocarditis, empiric coverage was not initially considered for our patient. Cefepime was administered based on preliminary results of the initial blood cultures, showing growth consistent with non-lactose-fermenting gram-negative rods. Subsequently, susceptibility testing and minimum inhibitory concentration (MIC) analysis (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) identified the organism as \u003cem\u003eB. anthropi\u003c/em\u003e, resistant to most cephalosporins, prompting discontinuation of cefepime. Although tetracyclines and aminoglycosides were predicted to be effective, meropenem and ciprofloxacin were chosen based on their favorable side effect profile and MIC results.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003e\u003cem\u003eB. anthropi\u003c/em\u003e susceptibilities and MIC\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAntibiotic agent\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSusceptibility\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMIC\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAmpicillin/Sulbactam\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResistant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;16/8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCefotaxime\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIntermediate\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCeftazidime\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eResistant\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026gt;\u0026thinsp;16\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCeftriaxone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSensitive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCiprofloxacin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSensitive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eGentamicin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSensitive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eLevofloxacin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSensitive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;2\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eMeropenem\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSensitive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;1\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTetracycline\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSensitive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTobramycin\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSensitive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;4\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003eTrimethoprim/Sulfamethoxazole\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSensitive\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e\u0026lt;\u0026thinsp;2/38\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eThe observed resistance pattern of \u003cem\u003eB. anthropi\u003c/em\u003e can be attributed to two broad mechanisms: horizontal acquisition of plasmids [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e, \u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e], and upregulation of efflux pumps [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]. In a 2023 study, Ma \u003cem\u003eet al\u003c/em\u003e [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e] examined multiple \u003cem\u003eBrucella\u003c/em\u003e species and reported that approximately 60% of resistance genes were related to efflux pump activity. These findings underscore the importance of performing meticulous susceptibility testing, as \u003cem\u003eB. anthropi\u003c/em\u003e is resistant to most cephalosporins and penicillins but largely sensitive to trimethoprim sulfamethoxazole, anti-pseudomonal carbapenems, fluoroquinolones, and aminoglycosides.\u003c/p\u003e\u003cp\u003eThis case has inherent limitations. The excised valve could not be obtained in vivo for PCR testing. No definitive source of infection was identified despite suspicion that it was acquired during a previous hospitalization vs procedure, where the patient underwent iliac crest aspiration. Nevertheless, this case provided invaluable clinical experience with a little-encountered organism and established a susceptibility profile that may guide future clinicians.\u003c/p\u003e\u003cp\u003eAnalysis of the seven known cases of acute endocarditis as shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e revealed a male predominance. While some patients lacked underlying valvular predispositions, those who did had conditions such as prosthetic valves, rheumatic heart disease, or aortic stenosis. Our case is unique in demonstrating vegetations affecting two separate valves, whereas prior cases involved a single valve. Age did not appear to be a determining factor, with reported patients ranging from 28 to 75 years old. The overall mortality rate was 25%; our patient\u0026rsquo;s death was unrelated to infection. Pathologic examination confirmed irregular valvular surfaces consistent with treated endocarditis, without evidence of valve perforation or chordae tendineae rupture. Notably, \u003cem\u003eB. anthropi\u003c/em\u003e remained susceptible to meropenem in all reported susceptibility panels. Unlike other non-endocarditis cases, only two of the eight cases were deemed nosocomial. Although our patient had been hospitalized eighteen months earlier, this interval makes it less likely that hospitalization was the source, although his tricuspid valve involvement raises lingering questions.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eReported Cases of Acute Endocarditis with \u003cem\u003eBrucella anthropi\u003c/em\u003e (\u003cem\u003eOchrobactrum anthropi\u003c/em\u003e)\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"9\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c8\" colnum=\"8\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c9\" colnum=\"9\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCase\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHistory\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eClinical Presentation\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAge\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eSex\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eDefinitive Treatment\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c7\"\u003e\u003cp\u003eOutcome\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c8\"\u003e\u003cp\u003eCountry\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c9\"\u003e\u003cp\u003eReference\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1. (1990)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eBicuspid aortic valve replaced with pulmonary autograft and pulmonary homograft\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1 week of lethargy, fever, malaise, pleuritic chest pain, sweating and exertional dyspnea.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eCefuroxime 1.5 grams daily\u003c/p\u003e\u003cp\u003e+\u003c/p\u003e\u003cp\u003eGentamicin dose unspecified.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eComplete Recovery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eIndia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2. (2000)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRheumatic heart disease with mild mitral stenosis, DM2, severe asthma\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSudden, severe right leg pain of 2 h duration. 15 days prior she had high-grade fever with chills and rigors. Subsequent repeated episodes of fever.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eGentamicin 1 mg/kg IV every 8 hours\u003c/p\u003e\u003cp\u003e+\u003c/p\u003e\u003cp\u003eVancomycin 500 mg IV every 6 hours\u003c/p\u003e\u003cp\u003e+\u003c/p\u003e\u003cp\u003eOfloxacin 400 mg IV every 12 hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eComplete Recovery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003ePakistan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3. (2004)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHTN, rheumatic heart disease, mitral insufficiency secondary to commissurotomy, mitral valve replacement 2 years prior\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3 day history of fever, abdominal pain, dyspnea.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e65\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMeropenem 1 g IV every 6 hours\u003c/p\u003e\u003cp\u003e+\u003c/p\u003e\u003cp\u003eGentamicin 60 mg IV every 8 hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eNo complications other than gentamicin associated ototoxicity\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eSpain\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4. (2006)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSurgery 6 months prior for traumatic rupture of bladder and terminal ileum, fracture of pelvis and pneumothorax\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 day history of fever, chills, rigors, abdominal pain, lethargy, urinary retention.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e42\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eVancomycin 500 mg IV every 12 hours\u003c/p\u003e\u003cp\u003e+\u003c/p\u003e\u003cp\u003eMeropenem 500 mg IV every 12 hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eDeath\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eTurkey\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5. (2011)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProsthetic aortic valve\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFever, chills\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMeropenem 500 mg IV every 8 hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eDeath\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eIndia\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6. (2016)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHistory of Atrial fibrillation not on anticoagulation, coronary artery disease, moderate aortic stenosis, pacemaker for 3rd degree heart block, ESRD with failed kidney transplant, now on dialysis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2 day history of substernal sharp chest pain, nonradiating, 8/10 intensity.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e58\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eFemale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eIV Meropenem dose unspecified and hemodialysis catheter removal\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eComplete\u003c/p\u003e\u003cp\u003eRecovery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eUnited States\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7. (2024)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eChronic myelomonocytic leukemia\u003c/p\u003e\u003cp\u003etransformed into acute myeloid leukemia under azacitidine. Indwelling PICC line for weekly hematological medication, with weekly blood transfusions. ICD placed secondary to dilated cardiomyopathy\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eFever and mental confusion intermittently for several days.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e68\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eIV Gentamicin and Trimethoprim sulfamethoxazole unspecified dose\u003c/p\u003e\u003cp\u003e+\u003c/p\u003e\u003cp\u003eIV meropenem unspecified dose\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eComplete recovery\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eItaly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003e[\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8. (2025)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHTN, DM2, prostate cancer treated with radiation therapy, three cryptogenic transient ischemic attacks, aortic valve replacement with bioprosthetic valve, two previous occurrences of streptococcal endocarditis\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePersistent fever, malaise, chills, fatigue, significant weight loss (exceeding 20 pounds), night sweats over several weeks.\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e75\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c5\"\u003e\u003cp\u003eMale\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c6\"\u003e\u003cp\u003eMeropenem 1 g IV every 8 hours\u003c/p\u003e\u003cp\u003e+\u003c/p\u003e\u003cp\u003eCiprofloxacin 250 mg every 12 hours\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c7\"\u003e\u003cp\u003eComplete recovery, with subsequent unrelated death\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c8\"\u003e\u003cp\u003eUnited States\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c9\"\u003e\u003cp\u003eOur Patient\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003eDiabetes Mellitus Type 2 (DM2), Hypertension (HTN), Intravenous (IV), End-stage renal disease (ESRD), Implantable cardioverter-defibrillator (ICD)\u003c/p\u003e\u003cp\u003eImportantly, this case represents the first reported instance of endocarditis by \u003cem\u003eB. anthropi\u003c/em\u003e involving both the aortic and tricuspid valves. This bivalvular involvement is unique, as previous reports have described infection limited to a single valve. The presence of both right and left sided endocarditis poses additional therapeutic challenges, given the difficulty in achieving complete eradication and the potential for persistent infection despite appropriate antimicrobial therapy.\u003c/p\u003e"},{"header":"CONCLUSION","content":"\u003cp\u003eTaxonomical changes are inevitable, driven by the ongoing evolution of science. Clinicians must remain current with changing nomenclature to be able to translate emerging knowledge into effective patient care. This case documents a rare bivalvular endocarditis caused by \u003cem\u003eB. anthropi\u003c/em\u003e, highlights its unusual resistance profile, and serves as guidance for future clinicians encountering this organism.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003eStatement on Participant Consent to Publish The participant provided informed consent for participation in this study and explicitly agreed to the Ipublication of the research findings. He granted permission for the use of his images and any other related materials within the manuscript and accompanying publications. All personally identifying information has been removed or anonymized in accordance with journal and institutional guidelines, and only the participant-approved images and details necessary for scientific understanding are included. In this particular case since the publication is occurring after his death the spouse provided the consent.\u003c/p\u003e\n\u003ch3\u003eETHICS STATEMENT\u003c/h3\u003e\n\u003cp\u003eWritten consent was obtained from the patient's immediate family.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eH\u0026ouml;rdt A, L\u0026oacute;pez MG, Meier-Kolthoff JP, Schleuning M, Weinhold LM, Tindall BJ, Gronow S, Kyrpides NC, Woyke T, G\u0026ouml;ker M (2020) Analysis of 1,000\u0026thinsp;+\u0026thinsp;Type-Strain Genomes Substantially Improves Taxonomic Classification of \u003cem\u003eAlphaproteobacteria\u003c/em\u003e. Front Microbiol 11:468 PMID: 32373076; PMCID: PMC7179689\u003c/span\u003e\u003c/li\u003e\u003cli\u003e\u003cspan\u003eLeclercq SO, Cloeckaert A, Zygmunt MS (2020) Taxonomic Organization of the Family \u003cem\u003eBrucellaceae\u003c/em\u003e Based on a Phylogenomic Approach. 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Italian J Med 18(4):1821. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.4081/itjm.2024.1821\u003c/span\u003e\u003cspan address=\"10.4081/itjm.2024.1821\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":true,"hideJournal":true,"highlight":"","institution":"This study was not sponsored by any institution","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Brucella anthropi, Ochrobactrum anthropi, Brucella Genus, Acute Endocarditis, Taxonomy","lastPublishedDoi":"10.21203/rs.3.rs-8150156/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8150156/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground:\u003c/h2\u003e\u003cp\u003eThe genus \u003cem\u003eBrucella\u003c/em\u003e has expanded considerably in the 21st century. With the advent of advanced phylogenetic analyses such as whole genome sequencing, a close genetic proximity between \u003cem\u003eBrucella\u003c/em\u003e and \u003cem\u003eOchrobactrum\u003c/em\u003e has been revealed, leading to the integration of the \u003cem\u003eOchrobactrum\u003c/em\u003e genus into the \u003cem\u003eBrucella\u003c/em\u003e genus. Among the species in the newly expanded \u003cem\u003eBrucella\u003c/em\u003e genus, \u003cem\u003eBrucella anthropi\u003c/em\u003e (formerly \u003cem\u003eOchrobactrum anthropi\u003c/em\u003e) has emerged as a rare, albeit increasingly recognized, invasive human pathogen. While this report focuses on infective endocarditis, we also briefly summarize other clinical syndromes associated with this organism.\u003c/p\u003e\u003ch2\u003eMethods:\u003c/h2\u003e\u003cp\u003eA systematic review of the English-language medical literature from 1984 to 2025 was conducted. Cases of \u003cem\u003eB. anthropi\u003c/em\u003e endocarditis were identified and analyzed for demographics, clinical presentation, antimicrobial susceptibility, and outcomes.\u003c/p\u003e\u003ch2\u003eResults:\u003c/h2\u003e\u003cp\u003eSeven reported cases of acute endocarditis due to \u003cem\u003eB. anthropi\u003c/em\u003e were identified in the English-language medical literature, in addition to our own. Most patients had predisposing valvular disease or prosthetic material, which held true with the patient case described herein. The overall mortality rate of patients with \u003cem\u003eB. anthropi\u003c/em\u003e acute endocarditis approached 25% in the literature. Antimicrobial susceptibility patterns were variable, underscoring the importance of targeted therapy guided by microbiologic testing.\u003c/p\u003e\u003ch2\u003eConclusion:\u003c/h2\u003e\u003cp\u003eConsistent with other gram negative bacilli, \u003cem\u003eB. anthropi\u003c/em\u003e is a rare but proven cause of acute bacterial endocarditis. Despite its rarity, it may represent an emerging, under-recognized cause of invasive disease. This manuscript provides clinicians with guidance on its recognition, susceptibility profile, and management, supporting the translation of evolving taxonomic and molecular insights into successful patient care.\u003c/p\u003e","manuscriptTitle":"Brucella anthropi Bacterial Endocarditis: An Emerging Pathogen","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-11-23 11:53:04","doi":"10.21203/rs.3.rs-8150156/v1","editorialEvents":[{"type":"communityComments","content":5}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"34f6ca11-e35f-4bd1-8399-374bbef6972e","owner":[],"postedDate":"November 23rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":58372344,"name":"Infectious Diseases"}],"tags":[],"updatedAt":"2025-11-23T11:53:04+00:00","versionOfRecord":[],"versionCreatedAt":"2025-11-23 11:53:04","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8150156","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8150156","identity":"rs-8150156","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}