Subacute bacterial endocarditis due to Actinobacillus actinomycetemcomitans

Sixteen documented cases of Actinobacillus actinomycetemcomitans endocarditis have been reported in the past 15 years. The characteristic granular growth and the fastidious nature and slow-growing character of this organism decrease the yield of positive blood cultures. Two recently observed cases of subacute endocarditis due to Actinobacillus are reported, one in a patient who required surgical intervention for complications of his disease and the other case associated with an aortic prosthetic valve. The first patient had late embolic complications which are commonly seen with Actinobacillus endocarditis. A review of the literature including a synoptic table with clinical failures, treatment, and outcome is presented. Unless special care is taken to isolate these slow growing organisms, these cases will be misclassified as culture negative endocarditis.