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Acute Kingella kingae endocarditis with recurrent cerebral emboli in a child with mitral prolapse
Insights
Kingella kingae caused bacterial endocarditis in a child, leading to a disappearing mitral valve vegetation. This case highlights the potential for spontaneous resolution, challenging standard treatment guidelines for bacterial endocarditis.
Area of Science:
- Pediatric Cardiology
- Infectious Diseases
- Critical Care Medicine
Background:
- Bacterial endocarditis is a serious infection of the heart's inner lining.
- Kingella kingae is an emerging pathogen in pediatric endocarditis.
- Mitral valve vegetation can lead to severe neurological complications.
Observation:
- An 11-year-old girl presented with acute hemiplegia and dysphasia, later diagnosed with Kingella kingae bacteremia.
- Echocardiography revealed a prolapsed mitral valve vegetation that initially enlarged despite antibiotic therapy.
- The vegetation unexpectedly resolved spontaneously after seven weeks of treatment, averting planned surgery.
Findings:
- The case demonstrates a rare instance of spontaneous resolution of a large mitral valve vegetation in bacterial endocarditis.
- Kingella kingae can cause significant cardiac pathology, including mobile vegetations.
- Clinical deterioration preceded the spontaneous resolution, complicating management decisions.
Implications:
- This case challenges the conventional approach favoring surgery for large vegetations in bacterial endocarditis.
- It suggests that conservative management might be considered in select pediatric cases with careful monitoring.
- Further research is needed to understand the mechanisms of spontaneous vegetation resolution in infective endocarditis.
Abstract:
An 11-year-old girl had sudden onset of right hemiplegia and dysphasia with fever. Blood cultures grew Kingella kingae. Echocardiography showed a prolapsed mitral valve vegetation, which became larger during a prolonged course of antibiotics. After seven weeks of therapy, when surgery was being planned, the child deteriorated abruptly. A repeat echocardiogram showed that the vegetation had disappeared. Conservative medical management is usually inadequate in treating vegetations associated with bacterial endocarditis; surgery is advised.