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Haemophilus parainfluenzae infective endocarditis
Abstract:
Gram-negative endocarditis was uncommon in the past, accounting for 1% to 3% of cases. With the advent of antibiotics, immunosuppressive agents and narcotic abuse, the number has increased to 5% to 10% in the native valves and as high as 17% in the prosthetic valves, with Haemophilus species as the commonest aetiological agent, accounting for about 1% of the cases. We report a case of Haemophilus parainfluenzae endocarditis in a 39-year-old man who presented with heart failure and persistent fever. Echocardiography showed bi-leaflet mitral valve prolapse and severe mitral regurgitation. A small vegetation was seen at the flail anterior valve leaflet. He responded well to 4 weeks of intravenous ampicillin at 9 g/day and 2 weeks of gentamicin at 4 mg/kg/day, and subsequently underwent valve replacement.
Insights
Gram-negative endocarditis, particularly from Haemophilus parainfluenzae, is increasing. This case highlights a successful treatment of native valve endocarditis with antibiotics and valve replacement.
Area of Science:
- Infectious Diseases
- Cardiology
- Microbiology
Background:
- Gram-negative endocarditis incidence has risen due to factors like immunosuppression and substance abuse.
- Haemophilus species are increasingly identified as a common cause of native and prosthetic valve endocarditis.
Observation:
- A 39-year-old male presented with heart failure and persistent fever, indicative of infective endocarditis.
- Echocardiography revealed bi-leaflet mitral valve prolapse with severe mitral regurgitation and a vegetation on the flail anterior leaflet.
Findings:
- The patient was diagnosed with Haemophilus parainfluenzae endocarditis.
- Treatment involved 4 weeks of intravenous ampicillin and 2 weeks of gentamicin, leading to a positive clinical response.
Implications:
- This case underscores the importance of considering Gram-negative bacteria, specifically Haemophilus species, in infective endocarditis.
- Prompt diagnosis and appropriate antibiotic therapy, followed by potential valve replacement, are crucial for managing this condition.