A Unique Pathogen Causing Infective Endocarditis in a Three-year-old Girl

Abstract

The overall incidence of infective endocarditis (IE) in adults has been reported to be 1.5 to 6.0 per 100,000 patient-years. In children, the incidence of IE in the general population is approximately three times lower. The presence of cyanotic congenital heart disease is considered to be the most strongly associated risk factor to develop IE. In approximately 8% to 10% of pediatric cases, IE develops without structural heart disease or any other readily identifiable risk factors. In these situations, the infection usually involves the aortic or mitral valve secondary to Staphylococcus aureus bacteremia. Streptococcus pneumoniae endocarditis in a female with no known risk factors is extremely rare and has no established optimal therapy. We hereby present a case of a three-year-old girl, with no identifiable risk factors diagnosed with IE caused by S. pneumoniae .

Fever of Unknown Origin in a Previously Healthy Child

“…2 While previously dominated by rheumatic heart disease, children with complex congenital heart defects and those with a history of central indwelling catheters now represent the largest at-risk groups for IE. 2,3 Although several cases of methicillin resistant S. aureus (MRSA), Streptococcus pneumoniae, 4 and fungal 5 endocarditis have been previously reported in children without risk factors, an exhaustive literature review yielded very few cases of MSSA tricuspid endocarditis in a child without risk factors. [6][7][8] Isolated, right-sided endocarditis in a structurally normal heart can occur in pediatric patients with sepsis or a focal bacterial infection but is usually associated with risk factors discussed above.…”