Fulminant Infective Endocarditis Due to Kingella Kingae and Several Complications in a 6-Year-Old Girl: A Case Report

Abstract

Kingella kingae is a gram-negative coccobacillus belonging to the HACEK group (Haemophilus species, Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, and Kingella species) and is a common oropharyngeal colonizer of healthy young children. Osteoarticular infection is the most commonly reported invasive Kingella kingae infection in children, usually presenting a mild clinical picture. However, it can also cause severe invasive infections, especially infective endocarditis, with a high complication rate. We report the case of a 6-year-old girl, with no past medical history, who presented with fulminant infective endocarditis due to Kingella kingae. She received emergency venoarterial extracorporeal membrane oxygenation support, rapidly underwent cardiac surgery, and was then treated using ceftriaxone for 4 weeks as recommended by the American Heart Association. The patient's postoperative course was marked by a cerebral ischemic stroke consistent with septic embolism. She also presented with a para-aortic pseudoaneurysm that required a secondary surgical procedure, with a good postoperative result. This report illustrates a case of fulminant infective endocarditis due to Kingella kingae and responsible for two major complications. We also describe the preventive valve surgery performed to ensure the preservation of valve function and its capacity for growth.

Virulent endocarditis due to Haemophilus parainfluenzae: A systematic review of the literature

“…The risk of embolic events in IE is common with Staphylococcus aureus , Candida spp., and HACEK organisms[ 51 ]. The reported incidence ranges between 28% and 66% for S. aureus , with central nervous system (CNS) embolism being the most common[ 53 , 54 ]. In this review, ~70% of embolic complications were in the CNS.…”

“…appeared to have the highest rate of CNS embolism of all HACEK organisms, with a rate of 20%–30%[ 55 ]. Embolic events have been associated with worse prognosis in IE, with the risk proportional to vegetation size > 10 mm[ 53 , 54 ]. The indolent or subacute course of HPI IE may explain why the mortality remains lower compared to IE involving other organisms, despite significant vegetation size.…”

Infective Endocarditis Due to Kingella kingae

“…K. kingae belongs to the HACEK group ( Haemophilus species, Aggregatibacter specie s , Cardiobacterium hominis , Eikenella corrodens , and Kingella species) responsible for 3–5% of all IE cases [ 6 ], with the majority of these reported in children and infants [ 1 ]. We reviewed the literature and identified 32 articles describing 45 children diagnosed with K. kingae IE [ 8 , 19 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 ]. While osteoarticular infections mostly occur in children <4 years, 22% (10/45) of IE occurred in children >4 years.…”

“…In patients with neurological complications, they recommend delaying cardiac surgery in order to reduce the risk of secondary cerebral hemorrhage or infarction following cardiopulmonary bypass, and to facilitate valve repair when endocarditis is no longer active [ 75 ]. Furthermore, early surgery, especially when dealing with a large vegetation on the left side, can improve neurological prognosis and allow retention of the native valve [ 64 ]. It is indeed of paramount importance to aim for valve preservation without foreign material implantation and to minimize the risk for subsequent surgery, especially in children [ 64 , 75 ].…”

“…Furthermore, early surgery, especially when dealing with a large vegetation on the left side, can improve neurological prognosis and allow retention of the native valve [ 64 ]. It is indeed of paramount importance to aim for valve preservation without foreign material implantation and to minimize the risk for subsequent surgery, especially in children [ 64 , 75 ]. Further studies are needed to determine the best surgical management timings and strategies.…”