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Archivos de Pediatría del Uruguay

versión impresa ISSN 0004-0584versión On-line ISSN 1688-1249

Resumen

AMBROSONI, María et al. Haemophilus parainfluenzae infectious endocarditis. Arch. Pediatr. Urug. [online]. 2015, vol.86, n.4, pp.294-299. ISSN 0004-0584.

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.

Palabras clave : BACTERIAL ENDOCARDITIS; HAEMOPHILUS PARAINFLUENZAE; VENTRICULAR HEART SEPTAL DEFECTS.

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