{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,15]],"date-time":"2026-03-15T22:44:18Z","timestamp":1773614658759,"version":"3.50.1"},"reference-count":61,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T00:00:00Z","timestamp":1693785600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Deutsche Forschungsgemeinschaft"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Pathogens"],"abstract":"<jats:p>Infective endocarditis (IE) is still a life-threatening disease with high morbidity and mortality. While usually caused by a single bacterium, poly-microbial infective endocarditis (IE) is rare. Here, we report a (blood-culture-negative) dual pathogen mitral valve IE caused by Coxiella burnetii and Streptococcus gordonii: A 53-year-old woman was presented to an internal medicine department with abdominal pain for further evaluation. Within the diagnostic work up, transthoracic echocardiography (TTE) revealed an irregularly shaped echogenic mass (5 \u00d7 13 mm) adherent to the edge of the posterior mitral valve leaflet and protruding into the left atrium. As infected endocarditis was suspected, blood cultures were initially obtained, but they remained negative. Chronic Q fever infection was diagnosed using serologic testing. After the occurrence of cerebral thromboembolic events, the patient was admitted for mitral valve surgery. Intraoperatively, a massively destructed mitral valve with adhering vegetations was noted. Examination of the mitral valve by broad-range bacterial polymerase chain reaction (PCR) and amplicon sequencing confirmed Coxiella burnetii infection and yielded Streptococcus gordonii as the second pathogen. Based on the detailed diagnosis, appropriate antibiotic therapy of both pathogens was initiated, and the patient could be discharged uneventfully on the 11th postoperative day after a successful minimal-invasive mitral valve replacement.<\/jats:p>","DOI":"10.3390\/pathogens12091130","type":"journal-article","created":{"date-parts":[[2023,9,4]],"date-time":"2023-09-04T10:14:11Z","timestamp":1693822451000},"page":"1130","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["A Dual-Pathogen Mitral Valve Endocarditis Caused by Coxiella burnetii and Streptococcus gordonii\u2014Which Came First?"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6385-7632","authenticated-orcid":false,"given":"Ann-Sophie","family":"Kaemmerer","sequence":"first","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-N\u00fcrnberg, D-91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesco","family":"Ciotola","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Pneumonology (Med 1), Klinikum F\u00fcrth, Academic Teaching Hospital of the Friedrich-Alexander-University Erlangen-N\u00fcrnberg, D-90766 F\u00fcrth, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Walter","family":"Gei\u00dfd\u00f6rfer","sequence":"additional","affiliation":[{"name":"Institute of Microbiology\u2014Clinical Microbiology, Immunology, Hygiene, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-N\u00fcrnberg, D-91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1817-4207","authenticated-orcid":false,"given":"Frank","family":"Harig","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-N\u00fcrnberg, D-91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2254-6664","authenticated-orcid":false,"given":"Jochen","family":"Mattner","sequence":"additional","affiliation":[{"name":"Institute of Microbiology\u2014Clinical Microbiology, Immunology, Hygiene, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-N\u00fcrnberg, D-91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Timo","family":"Seitz","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-N\u00fcrnberg, D-91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9541-9888","authenticated-orcid":false,"given":"Mathieu N.","family":"Suleiman","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-N\u00fcrnberg, D-91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael","family":"Weyand","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-N\u00fcrnberg, D-91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5884-5856","authenticated-orcid":false,"given":"Christian","family":"Heim","sequence":"additional","affiliation":[{"name":"Department of Cardiac Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-N\u00fcrnberg, D-91054 Erlangen, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,9,4]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"982","DOI":"10.1016\/j.mayocp.2019.12.008","article-title":"Infective Endocarditis: A Contemporary Review","volume":"95","author":"Hubers","year":"2020","journal-title":"Mayo Clin. 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