Haemophilus parainfluenzaeendocarditis presenting with symptoms of COVID-19

Abstract

A young man presented early in the UK’s second COVID-19 pandemic surge with a twelve-day history of fever, dry cough, breathlessness, myalgia and loss of smell and taste. His chest X-ray showed bilateral ground-glass opacities. He was treated for COVID-19 pneumonitis but covered for bacterial infection with antibiotics. He developed shock and respiratory failure, requiring vasopressors and continuous positive airway pressure. He improved but experienced transient visual disturbances and headache. Nasopharyngeal swabs and antibody tests for COVID-19 were negative. Blood cultures grew Haemophilus parainfluenzae. A new murmur prompted an echocardiogram. This confirmed a large, mobile mitral valve vegetation. An MRI of the brain showed bilateral embolic infarcts. He underwent urgent mitral valve repair and made an excellent recovery. Whether COVID-19 caused his presenting symptoms or facilitated the bacteraemia remains unclear. It seems more likely that infective endocarditis masqueraded as COVID-19. Clinicians should be aware of how context of the pandemic can bias diagnostic reasoning.

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

“…Additionally, the 16S rRNA polymerase chain reaction and mass spectrometry are reliable means of differentiating Hemophilus spp. and the HACEK organisms without culturing[ 18 ].…”

Haemophilus parainfluenzaeinfective endocarditis complicated by multiorgan septic emboli

“…Patients are often misdiagnosed with a respiratory illness prior to diagnosis of endocarditis, in large part due to the non-specific symptoms often reported on presentation. Case reports have documented patients being misdiagnosed and treated for both bacterial and viral pneumonias, including one patient initially misdiagnosed with COVID-19 before subsequently being diagnosed with endocarditis 13. Frequently these patients do have some transient improvement in symptoms if prescribed an antimicrobial with activity against H. parainfluenza , followed by decompensation once the antibiotic course is complete 14.…”

Endocarditis caused by Aspergillus fumigatus in a patient 9 months after COVID-19 infection recovery: a case report and review of the literature

“…However, her A. fumigatus strain showed resistance to amphotericin B, resulting in an initial lack of clinical response to treatment. Antifungal resistance has been reported among COVID-19-associated aspergillosis cases [ 41 , 42 ]. This emphasizes the importance of early pathogen resistance profiling to optimize patients’ treatment regimen and prognosis.…”