Granulicatella is a fastidious Gram-positive nutritionally variant streptococcus (NVS) that is classified in two different genera: Abiotrophia which includes only A. defectiva and the genus Granulicatella which comprises three species (G. adiacens, G. elegans and G. balaenopterae). Since these organisms require pyridoxal or thiol group supplementation for growth, their isolation may be difficult. Granulicatella spp is part of the normal flora of the oral cavity, the genitourinary tract, and the intestinal tract. Although NVS are found as part of normal flora of the upper respiratory, urogenital, and gastrointestinal tracts, their ability to cause clinically significant disease has been increasingly recognized. The most frequent clinical syndromes caused by NVS are endocarditis and bacteraemia  but these microorganisms have been implicated also in several others infections such as central nervous system infections , sinusitis, otitis media, prostatitis, cholangitis, arthritis . In vivo and in vitro antimicrobial susceptibility tests suggest that peniclillin plus aminoglycoside or vancomycin alone should be considered as therapeutically equivalent , although antibiotic resistance has been described for both these drugs [5, 6].
IE is uncommon in children under 17 years of age, but it is a cause of significant morbidity. Notably, 90% of IE cases occur in individuals who have structural heart disease, usually congenital. However, even children with normal hearts, could be at risk of IE due to invasive procedures such as bronchoscopy, tonsillectomy etc. . The clinical presentation of IE is usually indolent with prolonged low grade fever associated with non-specific symptoms such as myalgia, arthralgia, headache and generalize malaise whilst classical signs of IE (e.g. Roth spots, Osler nodes) are very rare in children . Mortality rate ranges from 4% to 18% and complications include valvular insufficiency, congestive heart failure, embolization, mycotic aneurism, etc. Cardiovascular surgery may be life-saving in these patients, but decision for surgical intervention must be individualized [7, 8].
NVS have been implicated in approximately 5% of cases of bacterial endocarditis in the adult population  and carry a worse prognosis compared to infection with other streptococci . In patients with endocarditis caused by Granulicatella, classic endocarditis signs such as digital clubbing, Osler nodes and petechiae are rare. Pre-existing valvular pathology is a frequent predisposing factor. Because of the difficulties in isolating this organism its role as a pathogen in endocarditis could be underestimated. Consequently, some cases of culture-negative endocarditis could be attributed to this microorganism .
Here, we report two cases of paediatric NVS bacteraemia, one of which with confirmed heart localization and review of the literature.