Jundishapur Journal of Microbiology
Volume:6 Issue: 6, Aug 2013

Hepatitis B virus (HBV) genetic and protein variations have been observed in chronic patients frequently. However, their role in the pathogenesis of chronicity has not been explored yet.. The aims of this study were to determine the genotypes as well as the patterns of variations distribution in chronically infected patients from the north western part of Iran.. The surface genes from 17 chronic carriers were amplified, sequenced and subsequently aligned using international and national Iranian database.. All strains belonged to genotype D, subgenotype D1 and subtype ayw2. Of all 56 “mutations” that occurred at 37 nucleotide positions, 25 (44.6%) were missense (amino acid altering) and 31 (55.4%) were silent (no amino acid changing) (S/M ratio: 1.2). At the amino acid level, 21 (91.3%) out of 23 amino acid mutations occurred in different immune epitopes within the surface proteins, of which 3 (14.3%) occurred in B cell, 8 (38%) in T helper and 10 (47.7%) inside CTL epitopes. In general, the association between amino acid mutations and especially, immune epitope substitutions was more significant in terms of HBeAg status than ALT levels in patients.. The distribution of amino acid mutations as well as the ratio between missense and silent nucleotide mutations (dN/dS) showed that a narrowly focused immune pressure had already been on the surface protein (especially CTL epitopes) which led to the emergence of escape mutants in these patients who were in tolerance phase of chronicity..

Methicillin -resistant staphylococcus aureus (MRSA) is associated with serious infections. Having the ability of biofilm-formation decrease their susceptibility to antibiotics.. The aim of this study was to determine the prevalence of biofilm formation among MRSA isolated from nasal carriers in the Beheshti Teaching Hospital in Kashan, Iran.. A cross-sectional study was conducted in 810 patients referred to emergency department in Beheshti Hospital in Kashan. Sterilized nasal swabs were used for collecting nasal bacteria. Nasal specimens were further recognized as S. aureus strains by standard biochemical tests, and MRSA isolates were detected by disk diffusion method. PCR assay was used for detecting mecA gene in MRSA isolates. The susceptibility of MRSA isolates to amikacin, clindamycin, gentamicin, ciprofloxacin, SXT, erythromycin, tetracycline were determined by using disk diffusion method according to recommendation of CLSI. Biofilm formation ability of MRSA isolates were examined by crystal violet microtitre plate assay and Congo red agar (CRA).. Two hundred and ninety six (36.5%) out of 810 isolates were S. aureus. Twenty six (8.8%) of all S. aureus isolates were recognized as MRSA. All the MRSA isolates have the ability of biofilm formation which 15.4%, 19.2% and 65.4% of them were strong, medium and weak biofilm producer respectively. The resistance rate of strong biofilm producer were; erythromycin (100%), clindamycin (75%), ciprofloxacin (75%), SXT (75%), gentamycin (50%), tetracycline (0%), amikacin (0%).. High rate of MRSA nasal carrier and having the ability of biofilm formation which decrease their susceptibility to antibiotics, is an alarming for public health. Statistically significant correlation between susceptibility to tetracycline and MRSA carrier was observed..

Nanosilver compounds are admired in different fields of medicine and industry, due to their unique antibacterial properties. Maximum contact of silver particles in nanosilver suspension causes increasing antibacterial effect of this compound.. The aim of this study was to evaluate the stability of antibacterial properties of nanosilver solution during a period of 9 months against Streptococcus mutans, Staphylococcus aureus and Pseudomonas aeruginosa.. In this in vitro study, the antibacterial effect of serial concentrations of nanosilver solution and amoxicillin antibiotic as control group on the standard bacteria S. mutans, S. aureus and P. aeruginosa were measured in 0-3-6-9 month period by Disc diffusion methods.. The antibacterial activity and stability of nanosilver solution in comparison with amoxicillin antibiotic were measured and the results were examined by t-test statistical analysis. During 9 months, no significant changes were seen in antibacterial activity of nanosilver solution (4000 µg.ml-1), except for S. mutans. In other concentrations of nanosilver solution and amoxicillin, reduction of antibacterial activity was observed.. Antibacterial activity of 4000 µg.ml-1 nanosilver was stable in a 9 month duration but reduction of antibacterial activity in lower nanosilver concentrations and amoxicillin were significant in the same time period..

Toxoplasma gondii is an obligatory intracellular protozoan parasite, which infects human beings. Since the current antigens used for diagnosis or vaccination are contaminated with non parasitic material in which the parasite is grown, it is tried to produce recombinant antigens to design vaccines against toxoplasmosis, or make diagnostic kits. Choosing the type of antigen to produce recombinant vaccine or diagnostic kits is considerably important. The rhoptry protein 1 is one of the excretory-secretary antigens of Toxoplasma which seems to be an appropriate candidate in production of recombinant vaccines and diagnostic kits.. The current study aimed to produce rhoptry protein 1 from Iranian strains of Toxoplasma for further investigations.. Genomic DNA was isolated from tachyzoite of parasite by phenol chloroform method and gene fragment was amplified by polymerase chain reaction. The polymerase chain reaction products were ligated into restriction enzymes sites of pTZ57R/T cloning vector. The product was sub-cloned into a prokaryotic expression plasmid (pET32a). The recombinant expression vector containing rhoptry protein 1 sequence was transformed into Escherichia coli BL21 pLysS and was induced by isopropyl β-D-1-thiogalactopyranoside. The sodium dodecyl sulfate polyacrylamide gel electrophoresis and western blotting methods were used to confirm the production of protein.. The result showed that the desired molecular weight protein is produced. Recombinant protein was confirmed by western blot using Ni-NTA- conjugate.. The result of this study showed that recombinant ROP1 Toxoplasma was produced successfully. In the present study, unlike other studies, the goal was to express full length of ROP1. Also this protein was produced alone not fused with other proteins..

Intestinal parasitic disease can cause serious complications for Immunosuppressed patients.. This study determines the prevalence of intestinal parasites in children, with lymphohematopoietic malignancy in Mashhad, Iran..Patients and In this cross-sectional study stool samples were collected from 89 children (53 boys, 36 girls) with lymphohematopoitic malignancies under chemotherapy, between the age of 1 and 18 years (mean age 7.5 years). Three fresh stool samples taken for three consecutive days were examined by direct smear, formalin-ether method, trichrome staining and ELISA test for Giardia lamblia coproantigens.. In this study 35.9% of our patients had parasitic infections and the following parasites were identified; G. lamblia (the most prevalent parasite in children) 16 (18%), Entamoeba coli 6 (6.7%) Blastocystis hominis 5 (5.6%) Iodamoeba butschlii 2 (2.2%). Chilomastics mesnili 1 (1.1%), Hymenolepis nana 1 (1.1%) and Enterobius vermicularis 1 (1.1%).. With regards to the high incidence of gasterointestinal parasitic diseases and also because of asymptomatic cases of giardiasis, we recommend evaluation of pediatric patients with malignant lymphohematopoitic disease by at least two different diagnostic methods and three rounds of stool examination in order to prevent possible life threatening outcomes. Coproparasitoscopic study for oncologic patients should be performed and anti-parasitic treatment provided before starting chemotherapy to prevent disseminated parasitic infections. The coproantigen-ELISA is especially advantageous in situations where only a single stool sample can be examined..

Leishmaniais which is one of the six most important tropical diseases in the world are in Iran in 3 forms. Cutaneous leishmaniasis (CL) is endemic in Iran, however, Zoonotic Cutaneous Leishmaniasis (ZCL) is endemic in Khuzestan province.. This study aimed to determine the species of Leishmania in vector and reservoir hosts of cutaneous leishmaniasis based on molecular methods in Roffaye District, Khuzestan, Iran.. In this study sand flies were collected from indoors and outdoors using sticky traps and rodents using Sherman live traps. They were both subjected to the nested PCR method to detect Leishmania parasite.. Phlebotomus papatasi was the most common species of sandflies in outdoor and indoor resting places and Tatera indica (Indian gerbil) was the most common species among rodents. PCR technique showed that only 2 out of the 27 P. papatasi (7.4%) and1 of the Tatera indica out of 12 rodents (8.3%) were positive for parasite due Leishmania major. The trapped Alactaga sp. were not infected by L. major.. This is the first molecular report on parasite infection of both vector (P. papatas) and reservoir (T. indica) to L. major from this area. Therefore, the population of both sandflies and rodents should be reduced using control methods..

Cutaneous leishmaniasis with zoonotic and anthroponotic forms is an endemic disease and a health problem in our country. Identification of parasite species and the type of disease is very important for treatment of disease as well as planning the control program. This study was carried out to identify the parasite species causing cutaneous leishmaniasis by Nested PCR in Poledokhtar district, Lorestan province, Iran.. Identification of Leishmania species on patients’ leishmanial infections in Poledokhtar district, Lorestan province, Iran.. This descriptive study was performed on 52 cutaneous leishmaniasis patients who referred to Poledokhtar health centre laboratory since 2008 - 2011. DNA was extracted from slide samples by phenol- chloroform- isoamyl alcohol method, and was evaluated by specific primers of kinetoplast DNA (CSB1XR, CSB2XF, LiR and 13Z) using Nested-PCR.. From 52 confirmed parasitological cases, 31 (59.62%) were male and 21 (40.38%) were female. The results of PCR electrophoresis indicated that 50 (96.15%) cases were Leishmania major and 2 (3.85%) L. tropica.. The results of the current study indicated that most of the recognized cases of cutaneous leishmaniasis in Poledokhtar were due to L. major. Further studies based on reservoir and vector of cutaneous leishmaniasis must be carried out in order to clarify the epidemiological aspect of leishmaniasis in Poledokhtar district..

Hepatitis B is the most serious type of viral hepatitis infection. It can cause chronic liver disease and puts people at a high risk of death from cirrhosis of the liver and liver cancer. Worldwide, about two billion people have been infected with the hepatitis B virus (HBV) and more than 240 million have chronic (long-term) liver infections. About 600,000 people die every year from this serious infection. Unfortunately, high rate of intravenous drug use, high-risk sexual behaviors and overcrowding have increasingly made prisons a breeding ground for hepatitis B infection.. The aim of the present study was to determine the rate, risk factors and genotypes of Hepatitis B virus amongst imprisoned men as a high-risk subpopulation..Patients and This study was an anonymous cross-sectional study conducted on 3000 sentenced men in Karaj jails from 1 December 2008 to 28 November 2009. HBV serological markers [hepatitis B surface antigen (HBsAg) and hepatitis B e antigen (HBeAg)], human immunodeficiency virus antibody (anti-HIV) and hepatitis C antibody (anti-HCV) were analyzed by the ELISA technique. Nested PCR was done for the detection of HBV DNA and patterns of restriction fragment length polymorphisms (RFLP) were obtained to determine the HBV genotypes. These patterns were confirmed by direct sequencing.. Hepatitis B surface antigen (HBsAg) was found in 122/3000 (4.1%) prisoners. Hepatitis B e antigen (HBeAg), anti-HIV, anti-HCV and anti-HIV/anti-HCV were detected in 52/122 (42.6%), 12/122 (10%), 22/122 (18%) and 3/122 (2.4%) prisoners, respectively. The HBV-DNA was found in 115/122 (94.3%) prisoners. The most high risk behavior was to utilize the collaborative syringe by injecting drug users (IDUs) with or without other risk factors (75.3%). Genotype D1 was obviously the only predominant type (100%).. The rate of HBV in prisoners was significantly higher than that reported for the general population (4.1% vs. < 2%). Blood borne viral co-infections were prevalent in HBsAg positive prisoners. Continual tracing of genotypes and risk factors are helpful for identifying transmission patterns and target at-risk groups for preventive programs. High rates of HBV in prisoners indicates the need for extensive free of charge vaccination of this subpopulation..

The genus Malassezia is part of the normal mycota of the skin of humans and other warm-blooded animals as etiological agents of pityriasis versicolor.. Several species from the Malassezia genus are known based on morphological, biochemical and molecular approaches. Therefore, the aim of this study was to determine the distribution of Malassezia species in patients with pityriasis versicolor based on morphological, physiological and biochemical criteria in Sari, Iran.. In total, among 134 patients clinically suspected of having pityriasis versicolor, attending the Department of Mycology, Boali Sina Hospital and Referral Laboratory of the Mazandaran University of Medical Sciences, 116/134 (86.5%) positive patients for Malassezia elements, namely, yeast cells and short hyphae in microscopic examination, were included in the study. All 116 samples were inoculated on plates containing modified Leeming and Notman agar medium and identified at species level based on mycological criteria.. However, only 100/116 (86.2%) or 100/134 (74.6 %) of the patients showed Malassezia spp in culture. Malassezia. globosa (54%) was the most commonly isolated species followed by M. furfur (32%), M. slooffiae (6%), M. restricta (6%) and M. sympodialis (2%). Mixed Malassezia species were not identified.. M. globosa was found to be the predominant pityriasis versicolor isolate in Sari, Iran. Since Malassezia species show different responses in their antifungal therapy, thus correct identification of Malassezia species and antifungal susceptibility test could facilitate selection of appropriate antifungal agents..

Brucella is an intracellular parasite of the disease brucellosis throughout the world. Although several molecular typing methods are introduced to find DNA polymorphism that is able to identify Brucella species and biovars, but among these methods, detection of polymorphisms by PCR–RFLP has several advantages including the easy implementation, interpretation and the ease of use for large quantities of samples.. In the current study, the technique was used for molecular typing of Brucella abortus and B. melitensis that was isolated from human blood samples.. Blood samples of 160 patients were transferred to Kerman clinical centers with chief complain of acute brucellosis and showed high blood serum level (about 1.80). Their DNAs were extracted by Phenol chloroform method, and the PCR was optimized by using the fragments of designed primers for omp2a and omp2b. Therefore PCR products were restricted by restriction endonuclease as PstI and Hinf1. Finally they were electrophoresed for analyzing the digestion results on agarose gels (2%).. In 160 blood samples that were studied with PCR technique, 52 cases obtained bands of 1100 bp for omp2a locus and 1200 bp for omp2b locus from within 52 positive samples by PCR–RFLP method 25 cases (48%) were positive out of which 56% were B. melitensis biovar1 and 44% were B. abortus biovars of 3, 5, 6 or 9.. The results of this study showed that PCR–RFLP technique was a fast and applicable method especially for separation, detection and differentiation between species of B. melitensis and B. abortus biovars in blood sample. Also the presented data showed that B. melitensis biovar 1 was the prevalence biovar..

Rhodotorula species are common airborne contaminant fungi and are also considered as normal inhabitants of the skin, lungs, urine and feces in humans. The most common species of Rhodotorula include; Rhodotorula. mucilaginosa, R. glutinis and R. minuta. Rhodotorula species are considered as an important agent for invasive infection among immunocompromised patients. Both amphotericin B and flucytosine were active against Rhodotorula in vitro, whereas fluconazole was inactive.. In the present study Rhodotorula species were isolated from two educational hospitals in Ahvaz and their sensitivity profiles were evaluated against several antifungal agents including; amphotericin B, nystatin, miconazole, clotrimazole, fluconazole and terbinafine.. Six hundred samples were collected from different areas of two educational hospitals of Ahvaz. Wet and sterile cotton swabs were drawn on the studied surfaces and inoculated on Sabouraud agar plates containing chloramphenicol. All culture media were incubated at room temperatures for one week. During incubation times, all red-orange yeast colonies were selected and their morphology was confirmed by a microscopic examination. Yeasts were identified by a commercial system ID 32 C. In vitro susceptibility testing was performed by the disc diffusion method.. In the present study 72 strains of Rhodotorula were recovered from two educational hospitals of Ahvaz. R. glutinis (86.1%) was the most common species among the isolates, followed by R. mucilaginosa (6.9%), R. minuta (4.2%) and Rhodotorula species (2.8%). Most of the isolated yeasts were recovered from cardiology, nephrology and urology wards. Resistance to amphotericin B was found in 5.8% of isolates whereas 52.2% and 42.0% of isolates were dose dependent and sensitive to drugs, respectively. Fluconazole exhibited no activity in vitro against all strains of Rhodotorula. Resistance to terbinafine was found in 37.7% of isolates, whereas only 26.1% of the tested isolates were sensitive and the rest were dose dependent.. In conclusion we can state that Rhodotorula have considerable distribution in critical wards and could be regarded as important invasive mycosis causative agents. In addition all tested antifungal agents, except fluconazole, are effective against Rhodotorula species in vitro..

Staphylococcus aureus is responsible for about one third of mastitis cases in dairy cattle and it is also the main pathogen of contagious mastitis.. Staphylococcal protein A (SPA) is one of the virulence factors of S. aureus which were encoded by spa gene. Different strains of S. aureus are varying in dissemination ability and power to infect mammary glands. The spa gene region Xr polymorphic sequence can be used for typing.. Twenty S. aureus cultures were isolated from bovine raw milk and analyzed for the number of repeats in region Xr of the spa gene by PCR.. A number of 7-11 repeats in the spa gene Xr region were determined. Strains with 10 repeats were65%, therefore they had the highest percentage in isolates. Seven repeats strains were 20% and each of the strains with 8, 9 and 11 repeats had the frequency of 5%. S. aureus strains antibiotic resistance was 35%, 5%, 45% and 40% for Tetracycline, Amoxicillin, Gentamicin and Erythromycin respectively. All strains were susceptible to Methicillin and Vancomycin.. Results of the current study indicated that 80% of strains had more than 7 repeats in the Xr region of the spa gene and these data were consistent with the previous findings. Significance and impact of the study: Evaluation of spa gene polymorphism can be useful in epidemiological studies on S. aureus distribution and its control..

Some human diseases such as tuberculosis, Legionnaire's disease and different forms of bacterial pneumonia, coccidioidomycosis, influenza, measles, and gastrointestinal illnesses are the result of exposure to bioaerosols. In addition, they are associated with some noninfectious airway diseases, such as allergies and asthma.. In the education hospitals of Hamedan University of medical sciences, there were no previous qualitative and quantitative studies of bioaerosols in the air of wards, so in this study the quality and quantity of bioaerosols in hospital ward’s air was investigated to establish a reference for future studies or measures.. In this cross sectional research, 30 wards in five educational hospitals of Hamadan city were studied. More than 180 air samples were collected from the hospitals. The samples were transferred to blood agar and Sabouraud medium and cultivated immediately. Type and number of colonies were determined in the laboratory. Bioaerosol concentrations were calculated in terms of cfu/m3. After bioaerosols isolation, the isolates were identified by morphology of colony, Gram staining and by standard biochemical tests as required for bacterial or fungal bioaerosols. The SPSS software was used for data management. ANOVA and t-test statistical analyses were also used.. As the results demonstrated, highest and lowest averages of bioaerosol density were obtained from Shahid Beheshti and Fatemieh Hospitals (36.18 cfu/m3 Vs. 24.03 cfu/m3), respectively. Highest and lowest concentrations of bioaerosols were found inWomen1 and operating room wards of Fatemiyeh Hospital, respectively (54.4cfu/m3 VS. 13.3cfu/m3). It appears that there had been no significant correlation between concentration of bioaerosols in the hospitals and available guideline values (P = 0.3). The highest fungal populations were Penicelium spp. (32.06%), Cladosporium spp. (20.5%), Aspergillus fumigatus (14.61%) and A. niger (7.43%), respectively. The highest bacterial population was coagulase-negative staphylococci (32.49%), Bacillus spp. (14.74%), Micrococcus spp. (13.68%) and Staphylococcus aureus (11.34%), respectively.. Quantitative bioaerosols concentration in the air of some hospitals was more than the available guideline i.e., 30 cfu/m3. Bioaerosol density of all surveyed hospitals can relate to patients presence in wards and their visitors, incorrect ventilation, and probably inefficient disinfection. Most surveyed hospitals have no air treatment systems thus to reduce bioaerosol concentration, standard ventilation systems should designed and utilized..

Hospital patients who are nasal carriers of methicillin-resistant Staphylococcus aureus (MRSA) are a high-risk potential threat to themselves and other hospitalized patients. The high antibiotic resistance of these isolates renders the treatment of related infections difficult.. The present study, for the first time investigated the prevalence of MRSA isolates in nasal carriers in Imam Reza Hospital in the western province of Iran.. Nasal samples from 1269 hospitalized patients were tested for S. aureus. The sensitivity of these isolates to various antibiotics was evaluated by the disk diffusion method and E-test oxacillin strips. After determining the MIC and inducible clindamycin resistance, the mecA gene was investigated by PCR.. 17.57% (223) of patients were HA-SA nasal carriers, with 82 isolates (36.8%) being resistant to methicillin (MRSA). The infant ward had the highest rate of carriage (80%). The difference in the sensitivity of MRSA and MSSA isolates to several antibiotics was significant (P< 0.05); furthermore, 80.5% of MRSA isolates and 2.8% of MSSA isolates were multi-drug resistant (MDR). A lower resistance was observed against clindamycin (58.5%), rifampicin (19.5%), and chloramphenicol (7.3%).. The high prevalence and antibiotic resistance of HA-MRSA isolates in western Iran indicates the necessity of continuous monitoring of hospital patients in the country for the presence of MRSA, particularly in infant wards..

Angular cheilitis known as anoral candidiasis manifestation is deep fissures with ulcerated appearance, which affects angles of the mouth. Decreasing the vertical dimension (VD) of face in the elderly denture users is one of the predisposing factors for heavy colonization of Candida spp. in the cheek angles resulting angular cheilitis. Correcting vertical dimension by a new denture replacement can decrease Candida spp. colonization to prevent or improve the angular cheilitis lesions.. The current study aimed to determine the distribution profile of Candida species isolated from cheek angles of patients with old denture before and after replacing with new ones.. Twenty eight complete denture users with decreased ridge, and outwear complete dentures, who referred for denture replacement, were randomly selected and their lip angles were cultured before and 3 months after using new dentures. Frequency and the species of isolated Candida spp. colonies before denture replacement and 3 months after using new dentures and correction of their vertical dimension were compared using Mann-Whitney statistical tests by SPSS software.. All samples were colonized before denture replacement, though 3 months after using new dentures, only few cultures were positive. A significant statistical difference was observed between Candida colonization before and 3 months after denture replacement (P = 0.0001). Candida albicans, C. tropicalis, C. krusei, C. parapssilosis and C. glabrata were isolated from lesions.. The results of the current study suggest that long term use of dentures can cause a wide range of Candida species colonization, resulting angular cheilitis. There was a need for an oral manifestation management-based strategy focusing on clinical and preventative treatment. Angular cheilitis can be prevented by changing and replacing a new denture to modify the face vertical dimension, and improve the angular cheilitis lesions..

Infections due to Mycoplasmatales members can cause infertility, preterm delivery and neonatal morbidity and mortality. Therefore, rapid diagnosis is of great importance to control these infections and diminish their outcomes.. The current study aimed to develop the multiplex PCR assay to detect two genital mollicutes from a single amplification reaction and the study of their relation with habitual abortion and urogenital infection in infected females.. Urine and genital samples from symptomatic females (20-54 years old) in Imam Khomeini hospital, Ahvaz, Iran, were screened for the two common mollicutes, Mycoplasma hominis and Ureaplasma urealyticum; using multiplex PCR. The prevalence of these mollicutes in 200 healthy females was also evaluated.. The results of the current study showed that the presence of M. hominis in urine (P = 0.006) and genital samples (P = 0.01) was associated with urogenital infections. Statistical analysis based on the age, revealed that the highest prevalence of M. hominis (71.4%) and U. urealyticum (60%) were in females within 30-34 and 35-39 years old, respectively. Similarly, in genital samples, the highest incidence of M. hominis (54.5%) and U. urealyticum (53.8%) was found in females within 28-33 and 34-39 years old. Interestingly, further analyses revealed direct strong relation between the mollicutes used in this study and habitual abortion as well as urogenital infections.. There was a strong relation between the presence of the studied M. hominis and U. urealyticum with urogenital infection in the females under study in comparison with those of control groups. The studied mollicutes were highly associated with habitual abortion in symptomatic females. The multiplex PCR was developed for simultaneous, early, and easy detection of these potential pathogens..

Abiotrophia defectiva was previously known as a member of the nutritionally variant streptococcus (NVS). This microorganism is a member of the normal flora of mouth, urogenital and intestinal tracts. It causes various infections such as bacteriemia, brain abscess, septic arthritis and rarely infective endocarditis. Only < 1% of all cases of endocarditis are caused by A. defectiva..A 23 year old previously healthy female was admitted to emergency department for left hemiplegia. On physical examination, petechial rashes were detected on her palmar and plantar regions. Magnetic resonance image of brain revealed acute enfarctus in the striatocapsuler area, and total occlusion was detected in right median common arterial segment M1 with magnetic resonance imaging angiography. Urgent thrombectomy was performed. Echocardiography demonstrated a mobile vegetation on mitral valve leaflet.. Infective endocarditis was diagnosed and ceftriaxone at 2gr/day and vancomycin at 2 gr/day doses were started. A. defectiva was isolated in blood cultures. Antibiotics were changed to ampicillin/sulbactam at 8 gr/day and vancomycin at 2 gr /day doses. Infective endocarditis caused by A. defectiva and other nutritionally variant streptococci are reported to have a higher mortality, morbidity and complication rates. In the current communication we report this rather rare case of infective endocarditis..