Haemophilus parainfluenzae Endocarditis Associated With Maxillary Sinusitis and Complicated by Cerebral Emboli in a Young Man

Abstract

HACEK endocarditis is often difficult to diagnose given the slow-growing characteristics of the organisms involved. Haemophilus parainfluenzae, one of the HACEK organisms, is an uncommon cause of endocarditis. We describe a case of a previously healthy young man with H parainfluenzae endocarditis that was associated with maxillary sinusitis and severe systemic complications, including septic cerebral emboli and mitral valve perforation. Previously reported cases have also described a predilection for younger people, cardiac valve pathology, and a high prevalence of stroke.

An unusual presentation of subacute Haemophilus parainfluenzae endocarditis in a low-risk woman treated by minimally invasive mitral valve repair: a case report

“…Clinically, this translates into a delay in initiating appropriate antibiotics and worse outcomes (e.g., multiple systemic emboli, perforation or destruction of valve apparatus, abscess formation, lethal arrhythmias). The average incubation period for H. parainfluenzae is 5 days; in our case, we suspect that a high bacterial inoculum, which was reflected by the severity of our patient’s illness, resulted in quicker speciation [ 5 , 11 , 12 , 14 ].…”

“…In our patient, we suspect that the source of bacteremia was a recent upper respiratory or sinus infection, given her symptoms of BIE were heralded by mucopurulent rhinorrhoea. Haemophilus parainfluenzae bacteremia has previously been reported in association with maxillary sinusitis, and was complicated by mitral valve endocarditis, which presented with multiple cerebral emboli [ 12 ]. Although in our patient, there were no clinical signs of a stroke, she had a head computed tomography (CT) scan to rule out a clinically silent cerebral embolus.…”

Acute Severe Mitral Regurgitation Secondary to Haemophilus parainfluenzae Infective Endocarditis

“…8 Because of their oropharyngeal affiliation, HACEK endocarditis has been associated with risk factors such as dental work and nasopharyngeal infections. 9 The literature describing H. parainfluenzae endocarditis is sparse, but there are two reviews of H. parainfluenzae endocarditis that describe it as having a subacute onset (<2 months) and a predominance in young people, with a median age of onset of 27 years. Over half of the affected patients had no underlying valvular disease, the mitral valve was most commonly affected, and no portal of entry was identified in 80% of cases.…”

“…Over half of the affected patients had no underlying valvular disease, the mitral valve was most commonly affected, and no portal of entry was identified in 80% of cases. 3,4,[7][8][9][10] H. parainfluenzae endocarditis has been associated with severe complications, including cerebral emboli and mitral valve perforation. 6 Given this pathogen's propensity to embolise, close attention should be paid to any new neurologic symptoms with a low threshold for neuroimaging to evaluate for a microbial aneurysm or embolism.…”

Septic Embolism in Endocarditis: Anatomic and Pathophysiologic Considerations

“…Microorganisms most often implicated include Staphylococci, Beta-hemolytic Streptococci, Haemophilus, Actinobacteria, Caridobacterium, Eikenella, and Kingella. The latter 5 are often listed under the acronym, "HACEK", and are less likely to cause IE than Staphylococci and Streptococci [10,32,35,36]. Identifying the causative organism is critical to instituting prompt treatment with the most appropriate antibiotics.…”