Infective endocarditis caused by A. urinae in pediatric patient
Research published in the Journal of the Pediatric Infectious Diseases Society describes the course of disease and treatment of an 11-year old boy with infective endocarditis caused by Aerococcus urinae — bacteria typically found among the elderly with urinary tract infections. The boy also experienced mycotic aneurysms, making his case unique.
The researchers noted a significant medical history that included an unrepaired ventricular septal defect and an imperforate anus that was repaired in infancy.
Initially, his pediatrician treated him for streptococcal pharyngitis when his fevers began and administered oseltamivir for presumed influenza infection. His fever continued for 1 month, and he was admitted to the hospital for 4 days with bilateral pneumonia.
Upon discharge, he received a 10-day course of cefdinir. His daily fevers continued, and he presented to the ED 3 weeks after discharge with right-sided chest pain, fever (temperature of 102.9°), shortness of breath, emesis, night sweats and weight loss (5 pounds).
In the ED, physicians observed that he was tachycardic (169 beats per minute) and normotensive. Further physical examination demonstrated bilateral supraclavicular lymphadenopathy, coarse bilateral breath sounds, a harsh grade 4/6 holosystolic murmur, right and left upper quadrant abdominal tenderness and hepatomegaly.
At this time, his urinalysis results were normal, but chest X-rays exposed worsening multilobar airspace opacities. A CT scan also revealed extensive bilateral pulmonary nodular infiltrates, some with cavitation, as well as bilateral hilar, subcarinal, paratracheal and supraclavicular lymphadenopathy.
He was admitted for general pediatric inpatient care, where blood cultures grew gram-positive cocci in clusters that were later identified as A. urinae. A blood culture collected at his previous admission tested positive for the bacteria, but the organism was thought to be a contaminant, so he was not treated for the infection. The patient’s mother reported that when his fevers started, the boy had foul-smelling urine that had resolved.
The boy was then treated with penicillin G and gentamicin. Large aneurysms were observed on later CT scans, so he was transferred to a hospital with pediatric cardiothoracic surgery services. At this hospital, he underwent a right thoracotomy and right lower lobectomy. The findings were consistent with a perforated pulmonary artery and debris indicating an infected embolism. An additional course of penicillin G was prescribed for 6 weeks.
The researchers observed that only two previous cases of severe systemic infection caused by A. urinae in pediatric patients have been reported.
“With improved technology used to identify aerococci in cultures, the prevalence of reported systemic infections might rise,” the researchers suggested. – by Katherine Bortz
Disclosures: The authors report no relevant financial disclosures.