Holmes Anthony A, Hung Tawny, Human Derek G, Campbell Andrew I M
Division of Pediatric Cardiovascular and Thoracic Surgery, BC Children's Hospital, Vancouver, Canada.
Ann Pediatr Cardiol. 2011 Jul;4(2):210-2. doi: 10.4103/0974-2069.84664.
Kingella kingae, a HACEK (Haemophilus parainfluenzae, Aggregatibacter actinomycetemcomitans, Aggregatibacter aphrophilus, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae) organism, is a common resident of the upper airway in children; it has been associated with endocarditis in children with pre-existing heart conditions. This case report describes K. kingae endocarditis leading to valvular damage in a previously healthy 18-month-old child. Our patient developed a K. kingae bacteremia that was later complicated by meningitis, septic embolic stroke, and endocarditis of the mitral valve, leading to perforation of the posterolateral leaflet. The patient was initially treated conservatively with cefotaxime but, subsequently, required a mitral valve repair with a pericardial patch and annuloplasty. This report draws attention to the need for clinicians to be aware of the potentially serious complications of K. kingae infection in young children. If K. kingae infection is suspected then therapy should be initiated promptly with a β-lactam, followed by early echocardiographic assessment. This case also highlights the lack of specific guidelines available for K. kingae endocarditis.
金氏金杆菌是一种HACEK（副流感嗜血杆菌、伴放线聚集杆菌、嗜沫聚集杆菌、人心杆菌、腐蚀埃肯菌、金氏金杆菌）菌群，是儿童上呼吸道的常见定植菌；它与患有先天性心脏病的儿童的心内膜炎有关。本病例报告描述了一名此前健康的18个月大儿童发生金氏金杆菌心内膜炎并导致瓣膜损害的情况。我们的患者发生了金氏金杆菌菌血症，随后并发脑膜炎、脓毒性栓塞性中风和二尖瓣心内膜炎，导致后外侧瓣叶穿孔。患者最初接受头孢噻肟保守治疗，但随后需要用心包补片进行二尖瓣修复和瓣环成形术。本报告提醒临床医生注意金氏金杆菌感染在幼儿中可能引发的严重并发症。如果怀疑有金氏金杆菌感染，应立即开始使用β-内酰胺类药物治疗，随后尽早进行超声心动图评估。本病例还凸显了目前缺乏针对金氏金杆菌心内膜炎的具体指南。
