Infect Chemother.  2011 Jun;43(3):270-274. 10.3947/ic.2011.43.3.270.

A Case of Early Valve Replacement for Haemophilus parainfluenzae Endocarditis Complicated with Acute Cerebral Infarctions

Affiliations
  • 1Department of Internal Medicine, Kangwon National University School of Medicine & Hospital, Chuncheon, Korea. wsoh@ymail.com
  • 2Department of Cardiothoracic Surgery, Kangwon National University School of Medicine & Hospital, Chuncheon, Korea.

Abstract

Haemophilus parainfluenzae, one of the member of the HACEK group of gram-negative oropharyngeal species, is a rare cause of subacute native valve endocarditis. Infective endocarditis caused by H. parainfluenzae appears to carry a high incidence rate of cerebral embolism, often making the timing of surgical intervention difficult. A 52-year-old male was diagnosed with acute endocarditis caused by H. parainfluenzae complicated with acute cerebral infarctions. After institution of antibiotic therapy, this patient was mechanically ventilated because of the sudden onset of dyspnea. Repeated two-dimensional echocardiography demonstrated rate-dependent mitral stenosis without interval change of vegetations on the mitral valve. Making a decision regarding the timing of surgical intervention was difficult because of a fear of clinical deterioration after early valve replacement.

Keyword

Bacterial endocarditis; Haemophilus parainfluenzae; Cerebral infarction; Mitral valve stenosis; Heart valve prosthesis implantation

MeSH Terms

Cerebral Infarction
Dyspnea
Echocardiography
Endocarditis
Endocarditis, Bacterial
Haemophilus
Haemophilus parainfluenzae
Heart Valve Prosthesis Implantation
Humans
Incidence
Intracranial Embolism
Male
Middle Aged
Mitral Valve
Mitral Valve Stenosis
Paramyxoviridae Infections

Figure

  • Figure 1 Diffusion weighted magnetic resonance imaging of the brain on hospital day 1. Multiple high intense lesions were seen on both cerebral hemispheres, suggesting acute cerebral infarctions.

  • Figure 2 Radiographic findings of the chest on day 1. (A) Posteroanterior view at the emergency department. (B) Anteroposterior view just after endotracheal intubation, suggesting pulmonary edema.

  • Figure 3 Operative finding of mitral valve area on hospital day 4. A large-sized (15×15 mm) vegetation, indicated by the black arrow, is observed on posterior mitral leaflet. Several small vegetations, indicated by the white arrow, are evident on the anterior mitral leaflet.


Cited by  1 articles

Haemophilus parainfluenzae Infective Endocarditis Diagnosed by Direct 16S rRNA Sequencing of Vegetation
Sung-Hee Oh, Min-Chul Cho, Jae-Wook Kim, Dongheui An, Mun-Hui Jeong, Mi-Na Kim, Sang-Ho Choi
Lab Med Online. 2012;2(2):111-115.    doi: 10.3343/lmo.2012.2.2.111.


Reference

1. Darras-Joly C, Lortholary O, Mainardi JL, Etienne J, Guillevin L, Acar J. Haemophilus Endocarditis Study Group. Haemophilus endocarditis: report of 42 cases in adults and review. Clin Infect Dis. 1997. 24:1087–1094.
Article
2. Heiro M, Nikoskelainen J, Engblom E, Kotilainen E, Marttila R, Kotilainen P. Neurologic manifestations of infective endocarditis: a 17-year experience in a teaching hospital in Finland. Arch Intern Med. 2000. 160:2781–2787.
Article
3. Vilacosta I, Graupner C, San Román JA, Sarriá C, Ronderos R, Fernández C, Mancini L, Sanz O, Sanmartín JV, Stoermann W. Risk of embolization after institution of antibiotic therapy for infective endocarditis. J Am Coll Cardiol. 2002. 39:1489–1495.
Article
4. Snygg-Martin U, Gustafsson L, Rosengren L, Alsiö A, Ackerholm P, Andersson R, Olaison L. Cerebrovascular complications in patients with left-sided infective endocarditis are common: a prospective study using magnetic resonance imaging and neurochemical brain damage markers. Clin Infect Dis. 2008. 47:23–30.
Article
5. Gillinov AM, Shah RV, Curtis WE, Stuart RS, Cameron DE, Baumgartner WA, Greene PS. Valve replacement in patients with endocarditis and acute neurologic deficit. Ann Thorac Surg. 1996. 61:1125–1129. discussion 1130.
Article
6. Piper C, Wiemer M, Schulte HD, Horstkotte D. Stroke is not a contraindication for urgent valve replacement in acute infective endocarditis. J Heart Valve Dis. 2001. 10:703–711.
7. Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Bolger AF, Levison ME, Ferrieri P, Gerber MA, Tani LY, Gewitz MH, Tong DC, Steckelberg JM, Baltimore RS, Shulman ST, Burns JC, Falace DA, Newburger JW, Pallasch TJ, Takahashi M, Taubert KA. Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease. Council on Cardiovascular Disease in the Young. Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia. American Heart Association. Infectious Diseases Society of America. Infective endocarditis: diagnosis, antimicrobial therapy, and management of complications: a statement for healthcare professionals from the Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease, Council on Cardiovascular Disease in the Young, and the Councils on Clinical Cardiology, Stroke, and Cardiovascular Surgery and Anesthesia, American Heart Association: endorsed by the Infectious Diseases Society of America. Circulation. 2005. 111:e394–e434.
8. Ryu KH, Choi HJ, Park SH, Park SH, Lee MA. Two cases of Haemophilus parainfluenzae endocarditis. Infect Chemother. 2003. 35:345–349.
9. Oh EY, Bae SS, Chung YJ, Lee CK, Lee H, Kim S, Park SW, Peck KR, Song JH. A case of Haemophilus parainfluenzae endocarditis with cerebral embolism. J Korean Soc Chemother. 1998. 16:249–253.
10. Huh Jh, Bae SY, Kim JS, Lee KN, Lee CK. A case of Haemophilus parainfluenzae endocarditis. Korean J Clin Microbiol. 2009. 12:78–81.
11. Angstwurm K, Borges AC, Halle E, Schielke E, Einhäupl KM, Weber JR. Timing the valve replacement in infective endocarditis involving the brain. J Neurol. 2004. 251:1220–1226.
Article
12. Eishi K, Kawazoe K, Kuriyama Y, Kitoh Y, Kawashima Y, Omae T. Surgical management of infective endocarditis associated with cerebral complications. Multi-center retrospective study in Japan. J Thorac Cardiovasc Surg. 1995. 110:1745–1755.
Article
13. Zisbrod Z, Rose DM, Jacobowitz IJ, Kramer M, Acinapura AJ, Cunningham JN Jr. Results of open heart surgery in patients with recent cardiogenic embolic stroke and central nervous system dysfunction. Circulation. 1987. 76:V109–V112.
14. Matsushita K, Kuriyama Y, Sawada T, Yamaguchi T, Nagata S, Kawazoe K, Omae T. Hemorrhagic and ischemic cerebrovascular complications of active infective endocarditis of native valve. Eur Neurol. 1993. 33:267–274.
Article
15. Elliott TS, Foweraker J, Gould FK, Perry JD, Sandoe JA. Working Party of the British Society for Antimicrobial Chemotherapy. Guidelines for the antibiotic treatment of endocarditis in adults: report of the Working Party of the British Society for Antimicrobial Chemotherapy. J Antimicrob Chemother. 2004. 54:971–981.
Article
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