PDF(Pubmed)
Abstract：
Infective endocarditis caused by Gemella species is increasingly recognized as an emerging clinical entity. Gemella species are fastidious gram-positive cocci that are typically commensal organisms but can become opportunistic pathogens. This systematic review aimed to provide a comprehensive overview of endocarditis due to Gemella species by synthesizing existing evidence. A total of 52 case reports were identified through a rigorous search and selection process. The most prevalent causative species were G. morbillorum (46.3%) and G. haemolysans (25.9%), with a striking male predominance (79.6%). The clinical presentation was largely nonspecific, mirroring typical infective endocarditis. However, the indolent nature of the illness and fastidious growth requirements of Gemella species often led to diagnostic delays. Echocardiography, particularly transesophageal echocardiography, played a crucial role in the diagnosis, enabling the detection of valvular vegetation and the assessment of complications. Management posed significant challenges, including the need for broad-spectrum empirical antibiotic therapy and increasing antimicrobial resistance among Gemella isolates. Surgical intervention was frequently required for severe valvular dysfunction, persistent infection, or embolic complications. Despite advances in diagnosis and treatment, endocarditis due to Gemella species remains associated with significant morbidity and mortality, underscoring the importance of early recognition and multidisciplinary management. This review highlights the emerging clinical significance of Gemella species as causative agents of infective endocarditis and identifies areas for further research.
摘要：
由Gemella物种引起的感染性心内膜炎越来越被认为是新兴的临床实体。Gemella物种是挑剔的革兰氏阳性球菌，通常是共生生物，但可能成为机会性病原体。本系统综述旨在通过综合现有证据，提供由Gemella物种引起的心内膜炎的全面概述。通过严格的搜索和选择过程，共确定了52例病例报告。最常见的致病物种是莫氏G（46.3％）和氏G（25.9％），男性占主导地位(79.6%)。临床表现基本上是非特异性的，反映典型的感染性心内膜炎。然而,疾病的惰性性质和Gemella物种苛刻的生长要求通常会导致诊断延迟。超声心动图,特别是经食管超声心动图，在诊断中起着至关重要的作用，能够检测瓣膜植被和评估并发症。管理提出了重大挑战，包括需要广谱经验性抗生素治疗和增加Gemella分离株的抗菌素耐药性。严重的瓣膜功能障碍经常需要手术干预，持续性感染,或栓塞并发症。尽管在诊断和治疗方面取得了进展，由Gemella物种引起的心内膜炎仍然与显著的发病率和死亡率相关,强调早期识别和多学科管理的重要性。这篇综述强调了Gemella物种作为感染性心内膜炎病原体的新兴临床意义，并确定了进一步研究的领域。
