Uncommon Infections in Children Suggest Underlying Immunodeficiency: A Case of Infective Endocarditis in a 3-Year-Old Male

Abstract

Infective endocarditis (IE) results from bacterial or fungal infection and is associated with significant morbidity and mortality. Several known risk factors exist for endocarditis, and 90% of pediatric cases have an underlying structural or congenital heart disease or prosthetic heart valve. Literature on IE in previously healthy children is relatively sparse, and the pathogenesis and underlying risk factors remain mostly unknown. Our patient was a 3-year-old male with a unique presentation of IE. His lack of structural and congenital risk factors for endocarditis prompted further workup, and labs were consistent with insufficient immunoglobulin, suggesting a primary immunodeficiency (PAD). PAD presents as heightened susceptibility to infections, commonly seen as recurrent pneumonia, meningitis, septic arthritis, and otitis media. Pediatric patients commonly have infections, yet as many as in 1 in 2000 patients have PAD. Our case emphasizes the potential need for further investigation into PAD in a young patient with no known risk factors who develops an uncommon infection such as IE.

Update on Infections in Primary Antibody Deficiencies

“…Recently, refractory cellulitis, pyoderma gangrenosum, and bacteremia due to non- Helicobacter pylori Helicobacter (NHPH) such as Helicobacter bilis (Flexispira ) and Helicobacter cinaedi have been reported in XLA ( 15 , 92 ). In addition, case reports describing septic arthritis due to Mycoplasma or Ureoplasma ( 9 ), a disseminated infection caused by Spiroplasma apis (a honey bee pathogen) ( 10 ), sepsis due to Achromobacter xylosoxidans mimicking juvenile idiopathic arthritis ( 11 ), Morganella morganii pericarditis ( 12 ), and infective endocarditis due to Enterococcus faecalis ( 14 ) have been published. Aichi virus, a common contaminant in ponds, sewages, and shellfish, causing self-limiting gastroenteritis in immunocompetent persons, may cause chronic and severe infection including fever, bloody diarrhea, chronic hepatitis, and splenomegaly in XLA ( 13 ).…”

Infektiöse Endokarditis und Endokarditisprophylaxe

“…Die Inzidenz der IE im Kindesalter wird mit 0.34 bis 0.64 Fälle / 100.000 Kinder / Jahr angegeben [15,18,[21][22][23][24][25][26][27][28]. Allgemein wird die Inzidenz der IE seit Änderung der Richtlinien für die Antibiotikaprophylaxe nach 2007 als konstant [23] bzw.…”

“…Bei Kindern mit IE ohne Vorliegen eines angeborenen oder erworbenen Herzfehlers bzw. ohne implantiertes Fremdmaterial sollte eine Immundefizienz ausgeschlossen werden [27]. Die Inzidenz der IE ist im Kindesalter niedrig (0.04% pro Jahr) und steigt bei EMAH an (0.1% pro Jahr).…”

Infektiöse Endokarditis und Endokarditisprophylaxe

“…Die Inzidenz der IE im Kindesalter wird mit 0.34 bis 0.64 Fälle / 100.000 Kinder / Jahr angegeben [15,18,[21][22][23][24][25][26][27][28]. Allgemein wird die Inzidenz der IE seit Änderung der Richtlinien für die Antibiotikaprophylaxe nach 2007 als konstant [23] bzw.…”