When repetitive infective endocarditis episodes occur in the same patient, accurate species identification is essential for differentiating relapse and a new episode. We report a case, which has had four episodes of IE within 2 years: episode 1 due to Enterococcus faecalis, episode 2 due to Mitis group Streptococcus, Episodes 3 and 4 due to Salivarius group Streptococcus. Detailed molecular examinations using Multi Locus Sequence Analysis (MLSA) convincingly documented that the two strains from episodes 3 and 4 were different. Thus, it was not a relapse, but a new infection and, importantly, not the result of antibiotic treatment failure.

Keywords: Infective endocarditis , intergenic spacer region (ITS) sequencing, multi locus sequence analysis (MLSA), nonhemolytic streptococci, partial oral endocarditis treatment (POET).
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