Posted on Authorea 22 Jun 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159284826.61673369 — This a preprint and has not been peer reviewed. Data may be preliminary. eengtv.Ssetblt vlainwspromdi ule itnBod(H)Bohmedium Broth Piperacillin/tazobactam (MHB) clarithromycin. and Blood erythromycin Hinton 0.5), tip [?] Mueller (CVC) cultures (MIC catheter vancomycin in blood ceftriaxone, venous concomitant performed penicillin, central peripheral units the was and forming to tip evaluation epsilometry. CVC relation colony and Susceptibility removed. in 32 was mm) CVC 15.6 negative. and 2). x were 8 (Figure mm septum (11.6 for interatrial atrium the positive right in the were in hours. cultures vegetation 14 and of at blood vancomycin for positive on each peripheral was respectively, commenced 10 culture and was (CFU) blood x central and Peripheral 8 (PICU) quantitative drawn. Unit was were The Care cultures count Intensive blood platelet Pediatric after to and piperacillin/tazobactam 10 admitted g/dL) was x He 10.2–12.7 450 mg/L). range, – (reference 150 he fever g/dL range, admission, of 7.2 before cells/ hours days was 120 III of Six 48 grade level count and leucocytes 5.5–14.5 with then. revealed neutropenia tests since range, presented febrile Laboratory neutropenia (reference (ALL), chemotherapy. experienced profound of leukemia he cycle with consolidation earlier, lymphoblastic third persisted weeks received acute and Three scale) risk room. (WHO high emergency mucositis at with source boy a old without years 3 A endocarditis bacteremia, as 1 such CASE infections, serious in implicated been meningitis has and it hosts, immunocompromised humans In in flora normal as tract respiratory Rothia mucilaginosa Rothia severe of agent causative emerging factors. an INTRODUCTION mentioned as the bacterium of this recov- presence consider Rothia the completely to venous of in were central important cases especially of Both is patients, clinical use It immunocompromised neutropenia, two endocarditis. in prolonged steroid. and Immuno- and infection with dose review profound high them humans. include short and of infection in a mucositis mucilaginosa one cavity catheter, present Rothia leukemia, oral for We factors with and Predisposing infections. children tract ered. severe in respiratory develop infection upper to the bloodstream risk in mucilaginosa more detected have agent hosts opportunistic compromised an is mucilaginosa Rothia Abstract 2020 22, June 2 1 Gutierrez the Valentina of review and cases 2 of literature in Report disease leukemia: invasive with of children cause important an mucilaginosa, Rothia otfii nvria aoiad hl autdd Medicina de Facultad Chile de Catolica Rio Universidad del Pontificia Sotero Doctor Asistencial Complejo hc eog othe to belongs which , 2 . ohamucilaginosa Rothia safclaieaarbc rmpstv,cauaengtv atru rmtegenus the from bacterium coagulase-negative gram-positive, anaerobic, facultative a is 3 1 aoiaCerda Carolina , cells/ × ohamucilaginosa Rothia 10 μ Micrococcae .Cratv rti CP ee a 83 gL(eeec range, (reference mg/L 88.32 was level (CRP) protein C-reactive ). L 3 cells/ a eitn oslhmtoaoetiehpi n ucpil to susceptible and sulphamethoxazole/trimethoprim to resistant was μ )wt naslt etohlcuto 0cells/ 20 of count neutrophil absolute an with L) 1 aiy tcnb eetda ato h rlcvt n upper and cavity oral the of part as detected be can It family. 2 . lxAlcantara Alex , Fgr 1) (Figure 1 . coadormsoe niaesuggestive image an showed Echocardiogram 1 n ieaClaverie Ximena and , 3 cells/ μ 1 .Hemoglobin L. μ (reference L < μ L 5 Posted on Authorea 22 Jun 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159284826.61673369 — This a preprint and has not been peer reviewed. Data may be preliminary. tmtccu mucilaginosus with Stomatococcus days 10 mucilaginosa completed Rothia She treatment. of was hours She 72 DISCUSSION admission. at after cultures complications. hours blood no 48 negative with Unit vancomycin with 0.5), intravenous Oncology hours, to [?] 24 transferred (MIC after was vancomycin afebrile She to clarithromycin. susceptible and and erythromycin incubation. penicillin, of to hours intermediate 10 sulphamethoxazole/trimethoprim, for at positive positive were was cultures culture blood nosa. peripheral blood and Peripheral central quantitative was prescribed. The count were amikacin leucocytes and the meropenem fever carbapenems-resistant that previous with consol- to revealed Due room third 10 values PICU. x emergency the Laboratory 2 to at was then. corresponding presented count chemotherapy since leukemia received neutropenic lymphoblastic cells/ she was 60 acute admission, and T before cycle early days idation with Five girl headache. old and of years weeks treatment. 10 6 of A days completed 38 patient cerebral at The vegetation a 2 of and normal. evidence CASE ultrasound resulted he no abdominal As all with scintigram, Unit. ceftriaxone performed, Oncology bone plus were the vancomycin a intravenous (MRI) to hospitalization transferred image of was resonance he eight hospitalization magnetic day of until day febrile third On persisted ceftriaxone. by replaced was eakby thssonpoietahrnepoete,wihices h ooiainrs fcatheters, of risk colonization patients bacteremic the gray/white, in increase valves which to cardiac prosthetic properties, clear dermatitis or adherence and damaged prominent forms peritonitis shown , surface agar, meningitis has pneumonia, agar it chocolate Remarkably, endocarditis, the media bacteremia, and including nonselective to reported, blood most been adhere have sheep on that disease well On periodontal colonies grows and sticky plaque that systems. or in anaerobic culture mucoid facultative appear blood is can nonhemolytic, standard It that in cocci clusters. gram-positive and irregular encapsulated or non-spore-forming, tetrads, reveals pairs, sequencing staining rRNA Gram 16S bacterium. on based 2000 norfis ae h ain a ihrs L,poogdnurpnaascae ihCCueadthree and use CVC with associated neutropenia prolonged ALL, risk used high been had has patient betalactams the rifampin concomitant case, or and first gentamicin vancomycin our shock, to In septic associated or been meningitis has like vancomycin infections severe performed, with not is adults placement 1/29 days in ten users reported least devices at been for has treated Endocarditis is literature response the clinical in good reported with been therapy alone empirical also as has recommended penicillin ciprofloxacin. is and to sulfamethoxazole/trimethoprim resistance aminoglycosides, partial clindamycin, However, to relapse resistant disease frequently serie is oncology one It to in described secondary been rate died mucilaginosa has mortality patient Rothia 7% 36% one of and a rate complications mortality with a no and adults, were failure there respiratory report, and other mucositis. pneumonia and CVC meningitis, of including use ALL patients, neutropenia, relapsed pediatric prolonged or In and active profound with had associated 40% were infections infections oral those mild on that or reports mucositis few chemotherapy-induced a to secondary disruption mucosal coadormwsnra.Ssetblt nMBBohmdu hwdthat showed medium Broth MHB in Susceptibility normal. was Echocardiogram μ iha bouenurpi on f0cells/ 0 of count neutrophil absolute an with L 4,6 ramn svlerpaeetaditaeosvnoyi o i weeks six for vancomycin intravenous and replacement valve is Treatment . ohamucilaginosa Rothia 3 cells/ sgnrlyssetbet eiiln miiln eoaie mpnm n vancomycin. and imipenem, cefotaxime, ampicillin, penicillin, to susceptible generally is ohamucilaginosa Rothia a omrykonas known formerly was μ .CPlvlws2. gL h vle ihhptninadwsamte to admitted was and hypotension with evolved She mg/L. 27.5 was level CRP L. 1 elsie noanwgnsblnigt h family the to belonging genus new a into Reclassified . eety ae fopruitcifcin nimncmrmsdpatients immunocompromised in infections opportunistic of cases Recently, . 2 . 7 oe tal et Poyer h uaino ramn ildpn ftedanss Bacteremia diagnosis. the of depend will treatment of duration The . 3 netosi muoopoie children immunocompromised in infections ti noiaengtv,ctls-aibega-oiiecoccus gram-positive catalase-variable oxidase-negative, an is It . atrmahsbe soitdt opiain nu o45%, to up in complications to associated been has bacteremia suooa aeruginosa Pseudomonas tpyoocssalivarius Staphylococcus 8 eotdtesm ihteadto fseod use steroids of addition the with same the reported . . 2 ohamucilaginosa Rothia μ 4 .Hmgoi ee a . /L n platelet and g/dL, 7.2 was level Hemoglobin L. h anpra fetyi h rlcvt after cavity oral the is entry of portal main The . 2 . > rnr rc neto,vancomycin, infection, tract urinary , 0 F,ec for each CFU, 100 4 irccu mucilaginosus Micrococcus sal,i nycue dental causes only it Usually, . bacteremia 4,9 7 . hrfr,vancomycin Therefore, . hvne al et Chavan Rothia 8 4 Micrococcaceae 6 nother In . n nprosthetic in and hr r only are There . ohamucilagi- Rothia a eitn to resistant was 4 fvlere- valve If . reported Rothia 2 and , 1 In . In . 2,5 2 in 1 . . . Posted on Authorea 22 Jun 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159284826.61673369 — This a preprint and has not been peer reviewed. Data may be preliminary. .Pnk L ictliV atro E noadtscue yrltvl eiilnrssatStomatococcus penicillin-resistant relatively by caused Endocarditis JE. Patterson mucilaginosus. V, Piscitelli RL, in Pinsky bacteremia 9. Rothia to attributable mortality and doi:10.1016/j.diagmicrobio.2016.01.005 Morbidity 120. P. patients. Hari nonneutropenic A, and Banerjee N, neutropenic Ledeboer MZ, Abidi al. 8. et K, al. Moritani et Ochi H, leukemia: Tauchi F, Ochi 7. Cerebral J. Diseases Vilaseca-Momplet Infectious Endocarditis. MT, Infective of mucilaginosus Falgueras Stomatococcus FJ, Complicating Castro-Bohorquez Aneurysm Mycotic G, Calvo Narv´aez P´erez-Vega J, Rothia C, With 6. Associated Dermatitis Granulomatous Infectious al. doi:10.1097/DAD.0b013e3181b1c5ad Report: et Case AD, A Jarell Bacteremia: TJ, mucilaginosa Henrich EA, Morgan Infec- 5. Device Endocarditis. Prosthetic Valve mucilaginosa Rothia Prosthetic At- JA. of DeSimone doi:10.1128/JCM.03173-12 Case D, Mortality a Jungkind MJ, tions: Tokarczyk and Rothia J, Bruminhent as Morbidity mucilaginosus 4. Stomatococcus mouse: Significant of a from reclassification organism and nov. Rothia-like MICROBIOLOGY a nov. of comb. Characterization al. sp. E. mucilaginosa nasimurium Falsen Rothia V, et Baverud of RA, description Hutson RA, MD, Collins Luna 3. PS, Transplantation. Pannaraj doi:10.3109/08880018.2013.783893 Cell Stem RS, Hematopoietic Chavan to tributable 2. al. center. et cancer C, care Hutter tertiary W, pediatric Friesenbichler F, Poyer 1. interest. of conflict no REFERENCES is there that predisposing declare authors with The especially bacteremia. patients, bacteria Pediatricians STATEMENT gram-positive pediatric INTEREST out. a oncology ruled OF of DECLARATION be treating context to the when needs echocardiogram, in organism that an and complication this of factors severe performance of described a the aware is and be endocarditis results infrequent, should testing is susceptibility if until even vancomycin virulence, If because Pre- of low patients. use described. of immunocompromised initial in been the organism pathogen has an opportunistic factors emerging of be an disposing physiopathology to as the recognized believed in being crucial traditionally increasingly is although which summary, mucositis, In III for grade factors prolonged rapid predisposing with use a presented recent of Rothia had was case presence patients There first the Both native factors. the and treatment. predisposing only a initial dose the the had steroids with were improvement patient high changed use clinical the of CVC and was cultures and because of regimen blood neutropenia gentamicin report of antibiotic profound first or clearance fever, ALL the rifampin case, is persistent use this second with not knowledge, the our endocarditis did To We of endocarditis. context valve ceftriaxone. the plus vancomycin In to mucositis. of weeks atrma hsmyiflecdtecmlcto ihendocarditis. with complication the influenced may This bacteremia. ohaMucilaginosa Rothia ora fCiia Microbiology Clinical of Journal 005()14-21 doi:10.1099/00207713-50-3-1247 2000;50(3):1247-1251. . eiti lo Cancer & Blood Pediatric 023(1:6-6.doi:10.1080/0036554021000026956 2002;34(11):863-866. . NENTOA ORA FSSEAI N EVOLUTIONARY AND SYSTEMATIC OF JOURNAL INTERNATIONAL netosi hlrnwt eaooia ainniso Following or Malignancies Hematological with Children in Infections eiti lo Cancer & Blood Pediatric ohamucilaginosa Rothia ohamucilaginosa Rothia h mrcnJunlo Dermatopathology of Journal American The igotcMcoilg n netosDisease Infectious and Microbiology Diagnostic eiti eaooyadOncology and Hematology Pediatric 076()2526 doi:10.1002/pbc.26145 2017;64(1):205-206. . 992()2526 doi:10.1128/JCM.27.1.215-216.1989 1989;27(1):215-216. . ohamucilaginosa Rothia ora fCiia Microbiology Clinical of Journal 3 neto nacidwt ct lymphoblastic acute with child a in infection sioae nbodclue,w recommend we cultures, blood in isolated is Rothia 096()e79.doi:10.1002/pbc.27691 2019;66(7):e27691. . ohamucilaginosa Rothia atrma 0ya xeineo a of experience 10-year A bacteremia: noadtsi eiti ains In patients. pediatric in endocarditis 2013;51(5):1629-1632. . ohamucilaginosa Rothia 2013;30(5):445-454. . cniainJournal Scandinavian 2010;32(2):175-179. . neto.However, infection. 2016;85(1):116- . is Posted on Authorea 22 Jun 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159284826.61673369 — This a preprint and has not been peer reviewed. Data may be preliminary. olwn slto rmteptetadclueo lo grpaeicbtda 37 at incubated 2 plate Figure agar blood a on culture and atmosphere. patient the from 37 isolation at following cultured bottle sample blood 1 Figure LEGENDS arsoi n irsoi perneof appearance microscopic and Macroscopic coadormta hw eeaini h ih atrium. right the in vegetation shows that Echocardiogram ° o 4hus B arsoi perneof appearance Macroscopic (B) hours. 24 for C 4 ohamucilaginosa. Rothia A rmsann masfrom smears staining Gram (A) .mucilaginosa R. ° o 4husi CO2 in hours 24 for C colonies Posted on Authorea 22 Jun 2020 — The copyright holder is the author/funder. All rights reserved. No reuse without permission. — https://doi.org/10.22541/au.159284826.61673369 — This a preprint and has not been peer reviewed. Data may be preliminary. 5