Acute Haemophilus parainfluenzae endocarditis: a case report

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.

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

“… 1 - 7 Patients with endocarditis due to H parainfluenzae , and other HACEK organisms, tend to be of younger age, 1 - 4 and a large majority of patients suffer from embolic phenomena, such as stroke. 1 , 5 - 7 In addition, if antibiotic therapy is delayed, the potential for valvular damage is significant. 2 , 3 , 5 , 6 , 8 …”

“… 1 , 5 - 7 In addition, if antibiotic therapy is delayed, the potential for valvular damage is significant. 2 , 3 , 5 , 6 , 8 …”

“…Although H parainfluenzae endocarditis is quite uncommon, review of the literature suggests that those who are infected by this particular type of endocarditis may share similar characteristics. [1][2][3][4][5][6][7] Patients with endocarditis due to H parainfluenzae, and other HACEK organisms, tend to be of younger age, [1][2][3][4] and a large majority of patients suffer from embolic phenomena, such as stroke. 1,[5][6][7] In addition, if antibiotic therapy is delayed, the potential for valvular damage is significant.…”

“…Review of the literature demonstrates that previously reported cases of H parainfluenzae endocarditis have also been associated with severe systemic complications, including septic cerebral emboli and mitral valve perforation. 1 - 7 …”

Phenotypic diversity of Haemophilus influenzae and Haemophilus parainfluenzae isolates depending on origin and health condition

“…Both H. influenzae and the less common H. parainfluenzae can cause pharyngitis and tonsillitis, otitis, sinusitis, epiglottitis, meningitis, bronchitis, sepsis or bacterial endocarditis [32,45,55]. They are also frequently identified in chronic obstructive pulmonary disease (COPD) and even in acute septic arthritis or osteoarthritis [6,9,17,18,21,38,55]. Currently, H. parainfluenzae is more commonly recognized as an opportunistic pathogen rather than a normal inhabitant [10], especially according to its increased resistance to beta-lactams [11].…”