Abiotrophia defectiva as a cause of infective endocarditis with embolic complications in children
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CASE REPORT
Abiotrophia defectiva as a cause of infective endocarditis with embolic complications in children Seung Ha Song1 · Bin Ahn1 · Eun Hwa Choi1,2 · Seung‑Pyo Lee3 · Eun Young Cho4 · Eun Jung Bae1,2 · Sang Yun Lee1,2 · Mi Kyoung Song1 · Woong Han Kim5 · Geena Kim4 · Taek Soo Kim6 · Mi Seon Han1,7 Received: 19 February 2020 / Accepted: 24 May 2020 © Springer-Verlag GmbH Germany, part of Springer Nature 2020
Abstract Abiotrophia defectiva is a rare pathogen of infective endocarditis (IE) but is frequently involved in embolic complication and valvular dysfunction. IE caused by A. defectiva in children is poorly studied. This study reports four cases of A. defectiva IE in children and reviews previously reported five pediatric cases of A. defectiva IE. Most of the patients presented with a subacute course, with prolonged fever or atypical symptoms. Eight patients had embolic complications at presentation. All nine children were treated with combination antimicrobial therapy and six of them received surgical intervention. All patients recovered well without relapse. A. defectiva should be considered in children with infective endocarditis, especially in those with atypical presentations. As complications are frequent and more than half of the patients need surgical treatment, prompt diagnosis along with appropriate treatment is necessary. Keywords Abiotrophia · Infective endocarditis · Embolism · Children
Background Abiotrophia defectiva forms Gram-positive cocci that is part of the normal flora of the oropharyngeal, genitourinary tract and intestinal mucosa [1]. The organism grows as satellite colonies around other bacteria and requires complex * Mi Seon Han msh‑[email protected] 1
medium supplemented with pyridoxine or cysteine to grow [2]. The taxonomy of this organism has been repeatedly revised, and with 16S ribosomal RNA gene sequencing in 1995, the organism was placed in the new genus Abiotrophia [3]. A. defectiva is implicated in a variety of severe invasive diseases, and among them, infective endocarditis (IE) is the most frequently reported, with an estimated rate of 5–6% of all streptococcal endocarditis [4, 5]. Because of the diagnostic difficulties due to its fastidious nature, requiring supplemented medium to grow, A. defectiva is likely to be misdiagnosed as culture-negative endocarditis (CNE), and thus, its role in IE is underestimated [4]. IE caused by A. defectiva has been rarely reported in the pediatric population, and its clinical course and complications in children are not well described. Herein, we report four cases of A. defectiva IE in children, along with literature review of previously reported pediatric A. defectiva IE cases.
Department of Pediatrics, Seoul National University Children’s Hospital, Seoul, Korea
2
Department of Pediatrics, Seoul National University College of Medicine, Seoul, Korea
3
Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
4
Department of Pediatrics, Chungnam National University Hospital, Daejeon, Korea
5
Dep
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