Abstract
IntroductionNumerous pathogens can cause infective endocarditis, including Haemophilus parainfluenzae. H. parainfluenzae is part of the H. aphrophilus, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae group that may cause about 3% of the total endocarditis cases, and is characterized by a subacute course and large vegetations.Case presentationAcute H. parainfluenzae endocarditis developed in a 54-year-old woman, with no underlying predisposing factors. The patient presented with fever of 3 days duration and a severe headache. Magnetic resonance imaging of the brain revealed multiple cerebral emboli with hemorrhagic foci. Upon suspicion of endocarditis, cardiac transesophageal ultrasonography was performed and revealed massive vegetations. The patient underwent emergency mitral valve replacement, and was further treated with ceftriaxone. Blood cultures grew H. parainfluenzae only after valve replacement, and a 6-week course of ceftriaxone was prescribed.ConclusionWe underline the typical presentation of large vegetations in H. parainfluenzae endocarditis, which are associated with embolic phenomena and resulting severity. Although the majority of the few cases reported in the literature are subacute in progress, our case further underlines the possibility that H. parainfluenzae endocarditis may develop rapidly. Thus, awareness of the imaging characteristics of the pathogen may enhance early appropriate diagnosis and therapeutic response.
Highlights
Numerous pathogens can cause infective endocarditis, including Haemophilus parainfluenzae
We underline the typical presentation of large vegetations in H. parainfluenzae endocarditis, which are associated with embolic phenomena and resulting severity
The majority of the few cases reported in the literature are subacute in progress, our case further underlines the possibility that H. parainfluenzae endocarditis may develop rapidly
Summary
Endocarditis is a common severe medical entity for which guidelines are continuously updated [1], its etiology can sometimes be vague, implicating rare pathogens. Some of them have been categorized jointly as part of the Haemophilus aphrophilus, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella kingae (HACEK) group of rare bacteria that are responsible for a small, but recognizable percentage (roughly 3%) of endocarditis cases. They are all Gram-negative bacteria belonging to the oropharyngeal microflora, and are slow-growing; their growth is enhanced by the presence of carbon dioxide [2]. Journal of Medical Case Reports 2009, 3:7494 http://jmedicalcasereports.com/jmedicalcasereports/article/view/7494 endocarditis, including H. influenzae, H. aphrophilus, H. paraphrophilus, and H. parainfluenzae. Its findings were further assessed by magnetic resonance imaging (MRI), which revealed (Figure 1) multiple cerebellar, white matter, and sub-grey matter, low-signal T1-weighted and highsignal T2-weighted lesions Some of these lesions exhibited no-signal T2-weighted areas, consistent with a hemorrhage. Ceftriaxone was administered, uneventfully, for six more weeks, together with gradual initiation of warfarin therapy
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