Hidalgo-García L, Hurtado-Mingo A, Olbrich P, Moruno-Tirado A, Neth O, Obando I
Hospital Universitario Virgen del Rocío, Pediatric Infectious Diseases and Immunopathology, Seville, Spain.
Hispalense Institute of Pediatrics, Seville, Spain.
Klin Padiatr. 2015 Mar;227(2):89-92. doi: 10.1055/s-0034-1398536. Epub 2015 Mar 9.
Uncommon microorganisms are increasingly being recognized as causative agents of paediatric infectious endocarditis (IE). We report a 4-year old girl with congenital heart disease, who suffered from 2 IE episodes secondary to Aggregatibacter aphrophilus (formerly Haemophilus aphrophilus) and Staphylococcus lugdunensis, both rarely reported pathogens in this age group. The patient was initially successfully treated with prolonged intravenous antibiotic courses, however removal of the Contegra valved conduit during the second episode was required due to recurrence of fever and development of pulmonary embolism despite completion of antibiotic therapy. A. aphrohilus is a member of the fastidious gram negative microorganisms of the HACEK group (Haemophilus spp., Aggregatibacter spp, Cardiobaterium hominis, Eikenella corrodens and Kingella kingae), that colonize the oropharynx and are a recognised cause of IE. Prognosis of children with IE due to HACEK group members varies, half of them suffering from complications and mortality rates of 10-12.5%. Although S. lugdunensis belongs to coagulase negative staphylococci (CONS), it behaves more like S. aureus species rather than CONS. This microorganism is a well-described cause of endocarditis in adult patients, associated with high requirements of surgical procedures and mortality (42-78%). In conclusion, paediatric IE can be caused by uncommon microorganisms associated with severe complications and potential fatality. The isolation of S. lugdunensis or A. aphrophilus in febrile patients should be considered clinically relevant and cardiac involvement must be ruled out. Those patients with proved IE will require prolonged intravenous antibiotic courses and in complicated cases surgical intervention.
罕见微生物越来越被认为是儿童感染性心内膜炎（IE）的病原体。我们报告一名患有先天性心脏病的4岁女孩，她继发于嗜沫凝聚杆菌（以前称为嗜沫嗜血杆菌）和路邓葡萄球菌，经历了2次IE发作，这两种病原体在该年龄组中均鲜有报道。患者最初通过延长静脉抗生素疗程成功治疗，然而在第二次发作期间，尽管完成了抗生素治疗，但由于发热复发和肺栓塞的发生，仍需要切除Contegra带瓣管道。嗜沫凝聚杆菌是挑剔的革兰氏阴性HACEK菌群（嗜血杆菌属、凝聚杆菌属、人心杆菌、腐蚀埃肯菌和金氏金氏杆菌）的成员，它们定殖于口咽部，是公认的IE病因。HACEK菌群成员导致的儿童IE预后各不相同，其中一半会出现并发症，死亡率为10-12.5%。虽然路邓葡萄球菌属于凝固酶阴性葡萄球菌（CONS），但其行为更类似于金黄色葡萄球菌而非CONS。这种微生物是成年患者心内膜炎的常见病因，与高手术需求和死亡率（42-78%）相关。总之，儿童IE可由罕见微生物引起，伴有严重并发症和潜在死亡风险。发热患者中分离出路邓葡萄球菌或嗜沫凝聚杆菌应被视为具有临床相关性，必须排除心脏受累情况。那些确诊为IE的患者需要延长静脉抗生素疗程，复杂病例则需要手术干预。
