Cardiac microlesions form during severe bacteremic enterococcus faecalis infection

Armand O. Brown, Kavindra V. Singh, Melissa R. Cruz, Karan Gautam Kaval, Liezl E. Francisco, Barbara E. Murray, Danielle A. Garsin

Research output: Contribution to journalArticlepeer-review


Enterococcus faecalis is a significant cause of hospital-acquired bacteremia. Herein, the discovery is reported that cardiac microlesions form during severe bacteremic E. faecalis infection in mice. The cardiac microlesions were identical in appearance to those formed by Streptococcus pneumoniae during invasive pneumococcal disease. However, E. faecalis does not encode the virulence determinants implicated in pneumococcal microlesion formation. Rather, disulfide bond forming protein A (DsbA) was found to be required for E. faecalis virulence in a Caenorhabditis elegans model and was necessary for efficient cardiac microlesion formation. Furthermore, E. faecalis promoted cardiomyocyte apoptotic and necroptotic cell death at sites of microlesion formation. Additionally, loss of DsbA caused an increase in proinflammatory cytokines, unlike the wild-type strain, which suppressed the immune response. In conclusion, we establish that E. faecalis is capable of forming cardiac microlesions and identify features of both the bacterium and the host response that are mechanistically involved.

Original languageEnglish (US)
Pages (from-to)508-516
Number of pages9
JournalJournal of Infectious Diseases
Issue number3
StatePublished - Feb 1 2021


  • bacteremia
  • cardiac
  • disulfide bond
  • Enterococcus faecalis
  • infection
  • microlesions
  • necroptosis
  • sepsis
  • thioredoxin
  • virulence

ASJC Scopus subject areas

  • Immunology and Allergy
  • Infectious Diseases


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