ABSTRACT
Resumen Haemophilus parainfluenzae forma parte de la microbiota normal de la cavidad oral y del tracto respiratorio superior. Es un reconocido agente causal de endocarditis y, con menor frecuencia, de enfermedades como neumonía, sepsis, osteomielitis, celulitis, meningitis y gastroenteritis aguda. Aquí se presenta un caso de orquiepididimitis en un joven adulto donde H. parainfluenzae, confirmado por espectrometría de masas (MALDI-TOF MS), fue el único patógeno detectado. Este caso contribuye a valorar el rol de H. parainfluenzae como patógeno humano, aislado a partir de sitios diferentes del torrente sanguíneo y las vías respiratorias.
Abstract Haemophilus parainfluenzae is part of the normal microbiota of the oral cavity and the upper respiratory tract. It is a recognised causal agent of endocarditis and, less frequently, of diseases such as pneumonia, sepsis, osteomyelitis, cellulitis, meningitis, and acute gastroenteritis. A case of orchiepididymitis in a young adult is reported, where H. parainfluenzae, confirmed by mass spectrometry (MALDI-TOF MS), was the only pathogen detected. This case contributes to assess the role of H. parainfluenzae as a human pathogen, isolated from sites other than the bloodstream and the respiratory tract.
Resumo Haemophilus parainfluenzae faz parte da microbiota normal da cavidade oral e do trato respiratório superior. É um reconhecido agente causal de endocardite e, menos frequentemente, de doenças como pneumonia, sepse, osteomielite, celulite, meningite e gastroenterite aguda. Aqui é relatado um caso de orquiepididimite em um adulto jovem onde H. parainfluenzae, confirmado por espectrometria de massa (MALDI-TOF MS), foi o único patógeno detectado. Este caso contribui para avaliar o papel do H. parainfluenzae como patógeno humano, isolado de outros locais que não sejam a corrente sanguínea e o trato respiratório.
ABSTRACT
INTRODUCCIÓN Haemophilus parainfluenzae (HP) es un cocobacilo gram negativo y un patógeno oportunista. Rara vez se asocia a infecciones vertebrales o musculoesqueléticas, y está muy poco reportado en la literatura. PRESENTACIÓN DELO CASO Una mujer de 45 años, sana, que presentaba un historial de dos semanas de lumbalgia progresiva, fiebre, coriza y congestión nasal, y que tenía discitis intervertebral causada por HP, confirmada por dos hemocultivos positivos y hallazgos progresivos de resonancia magnética (RM) de columna lumbar. Los hallazgos de la RM fueron atípicos, y consistían en un absceso del psoas y pequeñas colecciones de líquido epidural e intraespinal anterior asociadas con espondilodiscitis. El diagnóstico inicial se retrasó debido a que la RM inicial no reveló hallazgos que sugirieran un proceso infeccioso. El tratamiento consistió en un ciclo prolongado de administración intravenosa seguida de antibióticos orales, lo que finalmente produjo una buena respuesta clínica. DISCUSIÓN Y CONCLUSIÓN El HP es un patógeno muy raro en la espondilodiscitis. No obstante, debe tenerse en cuenta, especialmente en pacientes que presentan lumbalgia y fiebre y/o bacteriemia por microorganismos gram negativos. El estudio inicial debe incluir una RM de la columna con contraste. Aunque es poco común, la espondilodiscitis y un absceso del psoas pueden presentarse concomitantemente. Los antibióticos prolongados son el pilar del tratamiento.
INTRODUCTION Haemophilus parainfluenzae (HP) is a gram-negative coccobacillus and an opportunistic pathogen. It is rarely associated with spinal- and musculoskeletal-site infections, and very little reported in the literature. CASE PRESENTATION An otherwise healthy, 45-year-old woman who presented with a two-week history of progressive low back pain, fever, coryza and nasal congestion, was found to have intervertebral discitis caused by HP, confirmed by two positive blood cultures and progressive lumbar spine magnetic resonance imaging (MRI) findings. The MRI findings were atypical, consisting of a psoas abscess and small anterior epidural and intraspinal fluid collections associated with spondylodiscitis. The initial diagnosis was delayed because the initial MRI failed to reveal findings suggestive of an infectious process. The treatment consisted of a long course of intravenous followed by oral antibiotics, ultimately yielding a good clinical response. DISCUSSION AND CONCLUSION Haemophilus parainfluenzae is a very rare pathogen in spondylodiscitis. Nonetheless, it should be considered, especially in patients presenting with low back pain and fever and/or gram negative bacteremia. The initial work-up should include contrast-enhanced MRI of the spine. Although rare, spondylodiscitis and a psoas abscess can present concomitantly. Prolonged antibiotics are the mainstay of treatment.
Subject(s)
Humans , Female , Middle Aged , Haemophilus parainfluenzae , Haemophilus Infections/diagnostic imaging , Magnetic Resonance Imaging/methodsABSTRACT
Resumen Introducción: la endocarditis infecciosa (EI) es una enfermedad poco frecuente pero con elevada morbimortalidad. A pesar del incremento en la incidencia de S. aureus, el grupo HACEK constituye una etiología frecuente. Se comunica un adolescente con cardiopatía congénita que presentó EI a H. parainfluenzae. Caso clínico: 13 años, varón, comunicación interventricular (CIV). Caries. Ingresa 20/6/12 por adelgazamiento, astenia y adinamia de 2 semanas de evolución. Agrega dolor tipo puntada de lado a izquierda, disnea y fiebre. Al examen: regular estado general, frecuencia cardíaca 105 cpm, soplo sistólico 5/6, presión arterial 107/70. Polipnea 28 rpm. Abolición del murmullo alvéolovesicular y matidez en base de hemitórax izquierdo. Leucocitosis 17.700/mL, hemoglobina 8,7 g/dL, Proteína C reactiva 226 mg/dL. Radiografía de tórax: derrame paraneumónico izquierdo. Persiste febril, aumenta dolor torácico, peoría del estado general. Hemocultivo desarrolla H. parainfluenzae. Ecocardiograma transtorácico (ET): CIV sin repercusión hemodinámica, sin vegetaciones. Se reitera ET y se constata vegetación de 12 mm adherida al borde de CIV. En la evolución episodios de probables embolias pulmonares sépticas. A los 12 días cirugía cardíaca con evolución favorable. Discusión: el aislamiento de H. parainfluenzae fue decisivo en la búsqueda de EI. Es importante mantener alto índice de sospecha cuando existen factores de riesgo (CIV, caries). El riesgo embólico aumenta cuando la vegetación es mayor a 10 mm. Es una enfermedad médico-quirúrgica. La indicación y oportunidad de la cirugía es decisiva. Este caso se pudo haber evitado mediante prevención y tratamiento de las caries.
Summary Introduction: infective endocarditis (IE) is a rare disease with high morbidity and mortality rates. The incidence of S. aureus has increased but the agents of the HACEK group are frequent cause of EI. The case reported is an adolescent with congenital heart disease with an IE caused by H. parainfluenzae. Clinical report: 13 years old, male, ventricular septal defect (VSD). Tooth decay. The patient evidenced weight loss and asthenia since June 20, 2012 and in 2 weeks developed adinamia. Later on he presented pleuritic pain, dyspnea and fever. Physical findings: fair general condition; 105 bpm heart rate, 5/6 systolic murmur, blood pressure 107/70 mmHg. Polypnea 28 rpm. Abolition of vesicular murmur and dullness of the left hemithorax. Leukocytosis 17.700 /mL, hemoglobin 8.7 g / dL, C reactive protein (CRP) 226 mg/dL. RxTx: left parapneumonic effusion. Persistent fever, chest pain increases and general condition worsens. H. parainfluenzae was isolated from a single sample of blood culture. Transthoracic echocardiography (TE): VSD without hemodynamic repercussion, no vegetations. TE is reiterated and vegetation of 12 mm attached to the edge of VSD is found. In the evolution the patient develops episodes of probable septic pulmonary emboli. After 12 days of hospitalization, cardiac surgery was performed. After surgery the patient improved. Discussion: the isolation of H parainfluenzae led to IE diagnosis. It is important to maintain a high index of suspicion when there are risk factors (VSD, tooth decay). The embolic risk increases when vegetation is greater than 10 mm. It is a medical-surgical disease. The indication and timing of surgery is crucial. This case could have been avoided through prevention and treatment of tooth decay.
ABSTRACT
Prosthetic valve endocarditis (PVE) caused by Haemophilus parainfluenzae (H. parainfluenzae) is very rare. Here, we report a case of H. parainfluenzae PVE that developed following the Bentall procedure complicated by a pseudoaneurysm and cerebral emboli. A diagnosis was delayed in this case because of the slow-growing nature of the organism and the unusual clinical presentation.
Subject(s)
Aneurysm, False , Diagnosis , Endocarditis , Haemophilus parainfluenzae , Heart Valve Prosthesis , Intracranial Embolism , Paramyxoviridae InfectionsABSTRACT
Prosthetic valve endocarditis (PVE) caused by Haemophilus parainfluenzae (H. parainfluenzae) is very rare. Here, we report a case of H. parainfluenzae PVE that developed following the Bentall procedure complicated by a pseudoaneurysm and cerebral emboli. A diagnosis was delayed in this case because of the slow-growing nature of the organism and the unusual clinical presentation.
Subject(s)
Aneurysm, False , Diagnosis , Endocarditis , Haemophilus parainfluenzae , Heart Valve Prosthesis , Intracranial Embolism , Paramyxoviridae InfectionsABSTRACT
Blood culture-negative infective endocarditis (CNE) can be a diagnostic dilemma. Herein, we report a case of CNE caused by Haemophilus parainfluenzae identified only via 16S rRNA sequence analysis directly from valve tissue. A 17-year-old boy presented with high spiking fever for one month. Pansystolic murmur (Grade III) and vegetation (0.65x0.26 cm and 0.62x0.55 cm) on the anterior mitral valve leaflet via transesophageal echocardiogram suggested the diagnosis of infective endocarditis (IE). However, blood culture performed on admission was negative even after 2 weeks of incubation. Gram stain and culture of a direct tissue specimen failed to identify causative microorganism, while 16S rRNA gene sequences (548 bp) showed 100% identity with those of Haemophilus parainfluenzae (GenBank: FJ939586.1). The 16S rRNA sequence analysis with a direct tissue specimen might be useful in cases of CNE.
Subject(s)
Endocarditis , Fever , Genes, rRNA , Haemophilus , Haemophilus parainfluenzae , Mitral Valve , Sequence AnalysisABSTRACT
We report a 48-year-old male admitted to hospital due to a severe alcoholic pancreatitis. At four weeks of evolution of the acute episode, an abdominal CAT scan showed a fluid collection of 20 cm diameter located in the pancreatic tail and 2 small collections in the head. The patient received several antimicrobials and during the seventh week of evolution, while receiving vancomycin, presented fever. A fine needle aspiration of the cyst revealed the presence of Haemophilus parainfluenzae biotype VIII. The patient was treated with amoxicillin-clavulanic acid and a laparoscopic cysto-gastrostomy, with a good clinical response.
Subject(s)
Humans , Male , Middle Aged , Haemophilus Infections , Haemophilus parainfluenzae/isolation & purification , Pancreatic Pseudocyst/microbiology , Amoxicillin-Potassium Clavulanate Combination/therapeutic use , Anti-Bacterial Agents/therapeutic use , Haemophilus Infections/drug therapy , Pancreatic Pseudocyst , Tomography, X-Ray ComputedABSTRACT
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.
Subject(s)
Humans , Male , Middle Aged , Cerebral Infarction , Dyspnea , Echocardiography , Endocarditis , Endocarditis, Bacterial , Haemophilus , Haemophilus parainfluenzae , Heart Valve Prosthesis Implantation , Incidence , Intracranial Embolism , Mitral Valve , Mitral Valve Stenosis , Paramyxoviridae InfectionsABSTRACT
The HACEK group of bacteria (Haemophilus parainfluenzae, H. aphrophilus, H. paraphrophilus, Actinobacilus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corodens, and Kingella kingae) are the normal flora of the upper respiratory tract and oropharynx. The organisms infect abnormal cardiac valves, causing subacute native endocarditis or prosthetic valve endocarditis more than one year after valve surgery. Haemophilus species are responsible for only 0.5~1% of all infective endocarditis cases. Embolization occurs in 60% and the mortality rate ranges from 16~45% of cases of infective endocarditis caused by H. parainfluenzae. We experienced a case of infective endocarditis due to H. parainfluenzae in a 37-year-old male admitted with high fever, chills, nausea & vomiting, chest discomfort, and blurred vision. The organism was isolated from a blood culture and was identified as H. parainfluenzae by factor V requirement, negativity at urea, positivity at ornithine decarboxylase, and acid production from glucose and maltose. The patient was treated with antibiotics and symptoms and signs were improved
Subject(s)
Adult , Humans , Male , Anti-Bacterial Agents , Bacteria , Cardiobacterium , Chills , Eikenella , Endocarditis , Factor V , Fever , Glucose , Haemophilus , Haemophilus parainfluenzae , Heart Valves , Kingella , Maltose , Nausea , Ornithine Decarboxylase , Oropharynx , Paramyxoviridae Infections , Respiratory System , Thorax , Urea , Vision, Ocular , VomitingABSTRACT
HACEK organisms are the normal flora of upper respiratory tract and orophaynx. They infect abnormal cardiac valves, causing subacute native valve endocarditis or prosthetic valve endocarditis more than one year after valve surgery. Haemophilus species are responsible for only 0.5-1% of all infectious endocarditis cases. Embolization occurs in 60% and the mortality rate ranges from 16-45% of cases of infective endocarditis caused by H. parainfluenzae. We report two cases of H. parainfluenzae endocarditis, one of them is a 25-year-old male with tricuspid valve vegetations complicated with pulmonary embolism and the other is a 22-year-old female presented with heart failure.
Subject(s)
Adult , Female , Humans , Male , Young Adult , Endocarditis , Haemophilus parainfluenzae , Haemophilus , Heart Failure , Heart Valves , Mortality , Paramyxoviridae Infections , Pulmonary Embolism , Respiratory System , Tricuspid ValveABSTRACT
HACEK organisms are the normal flora of upper respiratory tract and orophaynx. They infect abnormal cardiac valves, causing subacute native valve endocarditis or prosthetic valve endocarditis more than one year after valve surgery. Haemophilus species are responsible for only 0.5-1% of all infectious endocarditis cases. Embolization occurs in 60% and the mortality rate ranges from 16-45% of cases of infective endocarditis caused by H. parainfluenzae. We report two cases of H. parainfluenzae endocarditis, one of them is a 25-year-old male with tricuspid valve vegetations complicated with pulmonary embolism and the other is a 22-year-old female presented with heart failure.