Parainfluenzae Endocarditis Research Articles

An unusual presentation of subacute Haemophilus parainfluenzae endocarditis in a low-risk woman treated by minimally invasive mitral valve repair: a case report

BackgroundHACEK endocarditis is usually insidious and can often be difficult to diagnose due to the slow-growing nature of the organisms. This report presents our experience in treating a patient with Haemophilus parainfluenzae endocarditis.Case presentationWe describe the case of a previously fit and well 23 year-old woman who presented to her local emergency department with a four-week history of persistent febrile illness. She had associated nausea, vomiting, and lethargy. This was preceded by an episode of mucopurulent rhinorrhoea. She was treated empirically with oral amoxicillin for a putative diagnosis of rhinosinusitis. Initially, her symptoms abated, however, she was readmitted with high fevers and a new pansystolic murmur. Transthoracic echocardiography revealed a large, mobile, echogenic mass, tethered to the posterior mitral valve leaflet (PMVL) and mild mitral regurgitation (MR). On examination, she had multiple non-tender, erythematous macules on the plantar surface of her feet, consistent with Janeway lesions. Two separate blood cultures grew H. parainfluenzae. Infectious diseases recommended a four-week course of intravenous ceftriaxone. Transesophageal echocardiography demonstrated a perforation within the P3 segment of the PMVL. Subsequently, the patient underwent mitral valve repair surgery with an uneventful recovery.ConclusionsOur case highlights the importance of promptly diagnosing HACEK endocarditis. A prolonged course of antibiotic therapy can be lifesaving, and surgery is often necessary to address complications such as perforation within the mitral valve leaflets. In our patient, we were able to perform a sliding P2 leaflet plasty for good quality repair of the mitral valve, through a minimally invasive right anterior thoracotomy.

Acute Severe Mitral Regurgitation Secondary to Haemophilus parainfluenzae Infective Endocarditis

Haemophilus parainfluenzae is an exceedingly rare cause of infective endocarditis, with only a few case reports describing its potential invasiveness. This case reports on a 25-year-old female who was admitted with a fever and was subsequently found to have H. parainfluenzae endocarditis. She was managed with intravenous antibiotics and mitral valve replacement.

Haemophilus parainfluenzae Endocarditis Associated With Maxillary Sinusitis and Complicated by Cerebral Emboli in a Young Man.

HACEK endocarditis is often difficult to diagnose given the slow-growing characteristics of the organisms involved. Haemophilus parainfluenzae, one of the HACEK organisms, is an uncommon cause of endocarditis. We describe a case of a previously healthy young man with H parainfluenzae endocarditis that was associated with maxillary sinusitis and severe systemic complications, including septic cerebral emboli and mitral valve perforation. Previously reported cases have also described a predilection for younger people, cardiac valve pathology, and a high prevalence of stroke.

Acute Haemophilus parainfluenzae endocarditis: a case report

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.

A case of Haemophilus Parainfluenzae endocarditis during pregnancy

Infective endocarditis during pregnancy is rare and results in high maternal and fetal mortality. We report a case of Haemophilus parainfluenzae endocarditis in a pregnant woman with complex management issues and a late, unexpected embolic complication.

Hhemophilus Parainfluenz AE Endocarditis

SummaryThree patients with bacterial endocarditis caused by Haemophilus parainfluenzal 2 are presented. In the three cases the aortic valve was involved. Congestive heart failure developed in two patients and lead to the insertion of a Bjork-Shiley prosthetic valve. One patient died after the operation. A review of the recent literature on parainfluenzae endocarditis is given with a discussion of the epidemiological, bacteriological, and clinical aspects of the disease. The most typical feature is the occurence of major arterial embolism. Prognosis quoad vitam is better than in most other forms of bacterial endocarditis. The best treatment consists of a combination of ampicillin and gentamicin. Monotherapy with ampicillin is admissible provided that the organism is fully susceptible.

Prosthetic Valve Endocarditis due to Haemophilus parainfluenzae Biotype II

Haemophilus parainfluenzae endocarditis is characterized by great variation in the acuteness of presentation, difficulty in isolation of the pathogen, a 50% to 60% incidence of major arterial emboli, and variability of response to therapy. Prosthetic valve endocarditis (PVE) due to H parainfluenzae biotype II occurred in a 14-year-old girl with congenital heart disease and a Starr-Edwards mitral valve prosthesis. Management was complicated by a prolonged culture-negative period (eight days), intermittent bacteremia (only five of 15 positive blood cultures), an embolus to the right femoral artery, progressive congestive heart failure, and urgent prosthestic valve replacement. Cure was achieved with 44 days of ampicillin sodium-gentamicin sulfate therapy monitored by serum bactericidal titers.

Hemophilus parainfluenzae Endocarditis

We describe a case of Hemophilus parainfluenzae endocarditis in a previously healthy 26-year-old man, and review 21 cases from the literature. Although H parainfluenzae is considered to be part of the normal flora of the upper respiratory tract in man, it can cause serious disease. H parainfluenzae endocarditis is often difficult to diagnose. The patients generally had a history of recent infection of the upper respiratory tract, but a majority denied previous heart disease. Upon entry to the hospital, after an average of seven weeks of febrile illness, nearly one third of patients were found not to have a heart murmur. Furthermore, the organism was often difficult to grow from blood cultures, a problem possibly related to the need for accessory growth factors. The mortality with modern therapy was 12%, and the major complication was cerebral embolus. Antibiotic therapy of choice is ampicillin, generally used together with an aminoglycoside, though ampicillin alone may be sufficient.

Haemophilus parainfluenzae mitral valve vegetation without hemodynamic abnormality: Demonstration by angiography and serial echocardiography

The occurrence of Haemophilus parainfluenzae endocarditis on a previously normal mitral valve of a drug addict is described. A large mitral valve vegetation was demonstrated by serial echocardiography and cineangiography. The vegetation did not produce hemodynamic abnormalities preventing detection by physical examination. Multiple septic emboli to various organs, including brain, resulted in death. The role of serial echocardiography and the levophase of right heart cineangiography in detecting mitral valve vegetation in a patient suspected of having infective endocarditis is emphasized.

HAEMOPHILUS PARAINFLUENZAE AND INFLUENZAE ENDOCARDITIS

Two cases of bacterial endocarditis caused by Haemophilus parainfluenzae are reported with a review of 33 other cases of H. parainfluenzae endocarditis and 5 cases of H. influenzae endocarditis. Although H. parainfluenzae is usually considered a non-pathogenic microorganism, this review firmly establishes its role as a causative agent in endocarditis. Furthermore, several clinical features were noted which were atypical when compared to findings usually present in patients with bacterial endocarditis. The mean age of the patients was only 27 years. Over 60% of the patients had no identifiable predisposing illness, an unexpected finding in view of the low degree of pathogenicity associated with this microorganism. Polymicrobial bacteremia, usually with viridans streptococci, was found in 11% of patients. Major arterial emboli were documented in 57% of patients, an incidence unchanged from the pre-antibiotic era. Diagnosis of the disease is dependent upon an awareness of the fastidious cultural requirements necessary for isolation of Haemophilus species. Culture media must contain a source of X and V factors. Mortality from H. parainfluenzae endocarditis has been reduced from 100 per cent prior to 1940 to about 12 per cent by use of appropriate antimicrobial agents. Awareness that Haemophilus species can cause bacterial endocarditis is important because the diagnosis is dependent upon utilization of special culture methods and the patient may not respond to some of the empiric regimens used for treating bacterial endocarditis. It should be especially considered as a possible cause of "culture-negative" or "abacteremic" endocarditis.

Bacterial Endocarditis due to Haemophilus Parainfluenzae

We have evaluated three patients with Haemophilus parainfluenzae endocarditis. Two of the three had underlying heart disease. All presented with fever, chills and malaise of less than two weeks' duration. Mitral valve involvement led to congestive heart failure in two of three cases. Treatment proved difficult, despite normally adequate dosages of antibiotics to which the pathogens were sensitive in vitro (ampicillin, 12-20 gm/dag; gentamicin, 3-5 mg/kg/day). Two patients were cured; one died. There was a suggestion of an inverse correlation between vegetation mass and favorable clinical response. Review of the English literature disclosed 22 documented cases of H parainfluenzae endocarditis, including 12 in the antibiotic era.

Haemophilus parainfluenzae endocarditis.

Three cases of Haemophilus parainfluenzae endocarditis in previously healthy patients were diagnosed in one six-month period. The presenting clinical picture was not typical of endocarditis. The initial physical examination and laboratory studies were normal except for hectic fever. Blood cultures were negative until subculture to chocolate agar and incubation in CO2 was done. Antibiotic susceptibility testing in vitro revealed that the penicillins, cephalothin, and gentamicin were active against the organisms isolated. It is recommended that blood cultures be subcultured to chocolate agar and incubated in CO2 whenever endocarditis is expected and the initial cultures are negative. Two of the patients were treated with ampicillin; the third patient received ampicillin, streptomycin and tetracycline. All patients were treated for six weeks and were cured.

STREPTOMYCIN THERAPY OF HEMOPHILUS INFLUENZAE ENDOCARDITIS LENTA

Case Reports1 September 1949STREPTOMYCIN THERAPY OF HEMOPHILUS INFLUENZAE ENDOCARDITIS LENTAWILLIAM S. MIDDLETON, M.D., F.A.C.P.WILLIAM S. MIDDLETON, M.D., F.A.C.P.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-31-3-511 SectionsAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail ExcerptRenewed interest in the etiology of endocarditis lenta has been a natural by-product of the availability of a series of agents with therapeutic promise. The success attendant upon the use of penicillin in treating Streptococcus viridans endocarditis lenta gave further impetus to similar attacks upon other etiologic backgrounds. Among these, Hemophilus influenzae and para-influenzae invited particular attention by reason of their sensitivity to streptomycin.The incidence ofHemophilus influenzaeandpara-influenzaeendocarditis is probably less common than Thayer's 2.94 per cent.1In 1940 Craven, Poston and Orgain2collected only 36 instances of this condition from the literature, to which they...Bibliography1. THAYER WS: Bacterial or infective endocarditis, Edinburgh Med. Jr., 1931, xxxviii, 237 and 307. Google Scholar2. CRAVENPOSTONORGAIN EBMAES: Hemophilus parainfluenzae endocarditis, Am. Heart Jr., 1940, xix, 434. CrossrefGoogle Scholar3. ROSE HM: Hemophilus influenzae Type A endocarditis, Am. Jr. Med. Sci., 1941, ccii, 187. CrossrefGoogle Scholar4. HUNTERDUANE THRB: Subacute bacterial endocarditis due to gram negative organisms, Jr. Am. Med. Assoc., 1946, cxxxii, 209. CrossrefGoogle Scholar5. MARTINSPINK WBWW: Endocarditis due to Type B Hemophilus influenzae involving only the tricuspid valve, Am. Jr. Med. Sci., 1947, ccxiv, 139. CrossrefGoogle Scholar6. PRIESTMCGEE WSCJ: Streptomycin in the treatment of subacute bacterial endocarditis, Jr. Am. Med. Assoc., 1946, cxxxii, 124. CrossrefGoogle Scholar7. BLANDPETERSON EFEW: Cases from Medical Grand Rounds, Massachusetts General Hospital, Case 14, Subacute bacterial endocarditis, Am. Practitioner, 1947, i, 498. Google Scholar This content is PDF only. To continue reading please click on the PDF icon. Author, Article, and Disclosure InformationAffiliations: Madison, Wisconsin*Received for publication December 2, 1947.From the Department of Medicine, University of Wisconsin Medical School. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetails Metrics Cited byErkrankungen des EndokardTreatment of Bacterial Endocarditis 1 September 1949Volume 31, Issue 3Page: 511-513KeywordsEndocarditisEtiologyHaemophilus influenzaePenicillinStreptococcusStreptomycin Issue Published: 1 September 1949 PDF downloadLoading ...

Hemophilus para-influenzae endocarditis: A report of two cases and a review of the literature of the influenzal endocarditides

Since the discovery by Pfeiffer, in 1893, of B. influenzae, instances of bacterial endocarditis caused by organisms of the influenza group have been reported periodically. It is the purpose of this paper to attempt a critical review of these reports in the light of more recent bacteriologic studies of the H. influenzae group, and to present two new cases of subacute bacterial endocarditis caused by H. para-influenzae ( Rivers, 1922).