Actinobacillus actinomycetemcomitans endocarditis in a 1.5 year old toddler

Shles, Ayelet; Wolach, Baruch; Levi, Alexander A.; Gottesman, Giora

doi:10.1136/bcr.11.2009.2462

Cited by 6 publications

(6 citation statements)

References 7 publications

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“…Besides, one case of osteomyelitis [ 13 ], one with septic arthritis [ 18 ], one with endocarditis after valvuloplasty [ 19 ] and a one case of a soft tissue mass over mandibular area [ 20 ] are reported.…”

Section: Discussionmentioning

confidence: 99%

Aggregatibacter actinomycetemcomitans infection in a 15-year-old boy with pulmonary empyema: a case report and review of literature

et al. 2023

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Background Aggregatibacter actinomycetemcomitans (Aa), previously known as Actinobacillus actinomycetemcomitans, is a slow-growing Gram-negative coccobacillus, member of the HACEK group of bacteria colonizing oral flora. Besides causing infectious diseases in the oral cavity such as dental caries and periodontitis, it is responsible for severe extra-oral infections secondary to hematogenous spread or aspiration, such as endocarditis, soft tissue abscesses and osteomyelitis. The diagnosis depends on prolonged bacterial culture of biological material obtained through biopsy. Aa is susceptible to most antibiotics but complete eradication often requires a long term treatment. Case presentation We report the case of a 15-year-old previously healthy boy diagnosed with both pulmonary empyema and subphrenic chest wall abscess caused by Aa. He was admitted to our Pediatric Emergency department for evaluation of a right mass associated with marked asthenia and dry cough. After radiological findings etiological diagnosis was made by culture of fluid drainage of pleural empyema. He started empirical antibiotic therapy with intravenous piperacillin/tazobactam, whose sensibility was confirmed by the antibiogram, then, for occurrance of hepatopathy it was switched to ciprofloxacin: the patient almost completely recovered after 6-month therapy. Conclusions Extra-oral infections caused by Aa are extremely rare, especially in children, and not well described yet. To our knowledge, there is only another similar case described in literature. However, the case described in our manuscript represents the only one presenting with pulmonary empyema without involvement of lung parenchyma in children. We also conducted a brief review of published cases of Aa infection in the pediatric population. This case report reminds us the importance of an accurate inspection of the oral cavity during the examination of pediatric patients.

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Section: Discussionmentioning

confidence: 99%

Aggregatibacter actinomycetemcomitans infection in a 15-year-old boy with pulmonary empyema: a case report and review of literature

et al. 2023

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“…Until January 2021, 20 cases of Aa infection were reported in the literature (including in the search patients aged 0 to 18), 11 females and 8 males, the age of the patients ranged from 1.5 to 18 years: in some cases it was the only isolated pathogen (15/20 cases), in 5 cases it was associated with other bacteria including Actinomyces israelii, Bacteroides ureolyticus (B. corrodens), Eikenella corrodens and Haemophilus. aphrophiIus, capnocytophaga species [8][9][10][11][12][13][14][15][16][17][18][19][20][21].…”

Section: Timeline Discussion and Conclusionmentioning

confidence: 99%

“…Besides, one case of osteomyelitis [13], one with septic arthritis [18], one with endocarditis after valvuloplasty [19] and a one case of a soft tissue mass over mandibular area [20] are reported.…”

Section: Timeline Discussion and Conclusionmentioning

confidence: 99%

“…All patients are immunocompetent, no speci c immunological de cit were associated with infections, but in some cases there are underlying conditions associated with a major risk of Aa infections according to the related pathogenic mechanism, for example pulmonary infection by Aa is described in patients with an increased risk of aspiration: two cases of cerebral palsy [8, 14], one with residual tracheal-cutaneous stula and tracheostomy with pulmonary infection by Aa [10]. In two patients Aa infection has been reported after heart and brain surgery [14,19]. In one case Aa infection occurred in a patient with diabetes mellitus [14].…”

Section: Timeline Discussion and Conclusionmentioning

confidence: 99%

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Aggregatibacter Actinomycetemcomitans Infection In A 15-Year-Old Boy With Pulmonary Empyema: A Case Report And Review Of Literature

Mesturino

Bitetti

Clemente

et al. 2023

Preprint

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Background: Aggregatibacter actinomycetemcomitans (Aa), previously known as Actinobacillus actinomycetemcomitans, is a slow-growing Gram-negative coccobacillus, member of the HACEK group of bacteria colonizing oral flora. Besides causing infectious diseases in the oral cavity such as dental caries and periodontitis, it is responsible for severe extra-oral infections secondary to hematogenous spread or aspiration, such as endocarditis, soft tissue abscesses and osteomyelitis. The diagnosis depends on prolonged bacterial culture of biological material obtained through biopsy. Aa is susceptible to most antibiotics but complete eradication often requires a long term treatment. Case presentation: We report the case of a 15-year-old previously healthy boy diagnosed with both pulmonary empyema and subphrenic chest wall abscess caused by Aa. He was admitted to our Pediatric Emergency department for evaluation of a right mass associated with marked asthenia and dry cough. After radiological findings etiological diagnosis was made by culture of fluid drainage of pleural empyema. He started empirical antibiotic therapy with intravenous piperacillin/tazobactam, whose sensibility was confirmed by the antibiogram, then, for occurrance of hepatopathy it was switched to ciprofloxacin: the patient almost completely recovered after 6-month therapy. Conclusions: Extra-oral infections caused by Aa are extremely rare, especially in children, and not well described yet. To our knowledge, there is only another similar case described in literature. However, the case described in our manuscript represents the only one presenting with pulmonary empyema without involvement of lung parenchyma in children. We also conducted a brief review of published cases of Aa infection in the pediatric population. This case report reminds us the importance of an accurate inspection of the oral cavity during the examination of pediatric patients.

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“…However, AA is the most frequent cause of gram negative endocarditis in children. Other organs can be involved and soft tissue abscess, cerebral abscess, and urethritis are described [ 1 , 3 , 13 ].…”

Section: Discussionmentioning

confidence: 99%