A 64-year-old female was admitted for removal of a ruptured appendix. Her medical history was unremarkable except for a case of rheumatic fever as a child that left her with an audible heart murmur. Three months after the surgery, she saw her physician complaining of fever, chills, fatigue, and dizziness for several weeks. The physician noted that her heart murmur was much more pronounced. He ordered two sets of blood cultures to be drawn. Both sets of blood cultures grow gram-positive cocci in pairs and chains. The gray, gamma-hemolytic colony is catalase negative. It hydrolyzes esculin in the presence of bile and grows in 6.5% salt broth. Given this patient history the infectious disease present is

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The patient's symptoms and the characteristics of the bacteria (gram-positive cocci in pairs and chains, gamma-hemolytic, catalase negative, hydrolyzes esculin in the presence of bile, and grows in 6.5% salt broth) are indicative of Enterococcus species, which are common causes of subacute bacterial endocarditis, especially in individuals with pre-existing heart conditions like a history of rheumatic fever.

A 64-Year-Old Female Was Admitted for Removal of a Ruptured