HACEK endocarditis in infants and children: two cases and a literature review

Abstract

We report 2 cases of Haemophilus parainfluenzae endocarditis and review 34 cases of HACEK endocarditis from the literature. HACEK organisms are the most common cause of Gram-negative endocarditis in children. They have a propensity to form friable vegetations (especially H. parainfluenzae) that break off and cause symptomatic emboli. HACEK endocarditis (from a review of the 36 published cases) may involve previously normal hearts (33%), may be complicated by embolization (31%) and may require vegetectomy or other surgery (31%). Mortality with HACEK endocarditis was 14%. HACEK organisms may be resistant to penicillins but are susceptible to third generation cephalosporins.

Gram-negative bacterial endocarditis in adults: state-of-the-heart

“…The HACEK organisms are grouped together due to their oropharyngeal inhabitancy, fastidious nature of pathogenesis and special media requirement for isolation [7]. These pathogens also share common risk factors for endocarditis, particularly poor dental hygiene and recent dental procedures, thus gaining entry to the vascular compartment at the time of local trauma or infection [4].…”

HACEK endocarditis: state-of-the-art

“…Children with K. kingae endocarditis had underlying heart disease in 62% of cases (mostly congenital), and 12/13 initially survived (92%), although two had neurological sequels (hemiplegia), and one died during cardiac surgery three months later [43]. Outbreaks of invasive infections due to K. kingae have been reported in children communities, with severe manifestations -including endocarditis and meningitis -and high prevalence of colonization, suggesting that some isolates may present with enhanced colonization fitness, increased transmissibility, and high virulence [44].…”

A 30 Year-Old Man Infectious Endocarditis and Cerebrovascular Accident

“…However, they are much less common in comparison to S. aureus and Streptococcus spp and are responsible for only 5-10% of non-IVDU native valve IE cases. 4 Those patients that develop IE, with or without prophylaxis, may present with a wide variety of clinical features. Some may present with classic signs and symptoms of low grade fevers, a new murmur, petechiae, Roth spots, Janeway lesions, and Osler's nodes.…”