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

• Kang MH
• Lim KR
• Kim TS
• Kim SH
• Kim GH
• Oh WS
• Yie K

• KMID: 2170350
• DOI: http://doi.org/10.3947/ic.2011.43.3.270

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

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  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.

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  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.

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  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.

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