HACEK infectious endocarditis: case report

Abstract

Background: Infectious endocarditis (IE) is an infection of the cardiac endothelium that can usually be caused by bacteria and fungi. The superficial growth of these microorganisms (MOs) can cause embolism in various organs, such as kidneys, lungs, skin, brain and central nervous system, leading to death if not treated properly. IE caused by HACEK bacteria (Haemophilus spp., Aggregatibacter actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens and Kingella kingae) mainly affects patients with previous heart disease or artificial valves, and is characterized by an insidious course, with an average delay in diagnosis of one month (when caused by Haemophilus spp.) to 3 months (when caused by Aggregatibacter or Cardiobacterium spp.). Aim: To report a case of IE caused by MOs from the HACEK group.

Method: This is the report of a patient treated at the Hospital Universitário São Francisco na Providência de Deus – HUSF, located in the city of Bragança Paulista – SP, Brazil. Case Report: This report describes the case of a 50-year-old male patient with a history of persistent fever, sweating, chills, fatigue and weight loss. After clinical evaluation, the patient was diagnosed with IE, based on clinical, laboratory and imaging findings, including microcytic anemia, leukocytosis with left shift, elevated PCR and VHS, presence of diastolic murmur, in addition to evidence of cardiac valve involvement in the transthoracic echocardiogram. Blood cultures identified the bacteria A. aphrophilus as the cause of IE, and treatment with ceftriaxone was initiated. Due to significant valve dysfunction, the patient underwent cardiac surgery with replacement of the tricuspid valve with a mitral prosthesis, followed by outpatient/cardiological monitoring and dental evaluation.

Conclusion: HACEK MOs can cause IE in patients of different age groups, including children, and their ability to affect both native and prosthetic valves highlights the importance of a broad clinical approach and a high index of suspicion for accurate diagnosis. Furthermore, maintaining oral health is an important factor in preventing these infections, and the use of imaging tests, such as CT scans and echocardiograms, and blood cultures play a fundamental role in identification and appropriate treatment of patients with IE caused by HACEK. Therefore, understanding these aspects is essential to improve the diagnosis and clinical management of these infections, which can lead to substantial morbidity and mortality if not detected and treated in a timely manner.