Multifokal Cilt ve Eklem Enfeksiyonları Olan Bir Yenidoğanda Eşlik Eden Asemptomatik Triküspit Kapak Endokarditi

Yıl 2013, Cilt: 7 Sayı: 3, 141 - 144, 01.10.2013

Filiz Ekici Mehmet Emre Arı Sevim Ünal İbrahim İlker Çetin Abdullah Kocabaş

Öz

18 günlük bebek irritabilite ve kulak önünde şişlik nedeniyle hastanemize başvurdu. Zamanında doğan ve ikiz eşi olan bebeğin doğum ağırlığı 2540g idi. Fizik muayenesinde; vücut ağırlığı ve baş çevresi yaşı ile uyumlu idi. Vital bulguları: Vücut ısısı: 37.4 ºC, kalp hızı: 130/dakika, solunum sayısı: 50/dakika, kan basıncı: 80/50 mmHg idi. Sağ kulak önünde yumuşak doku şişliği, sağ el bileğinde ve sol dizde septik artrit, gövdede yaygın maküler döküntü ve pretibial ödem belirlendi. Laboratuvar incelemelerinde; lökositoz, trombositopeni ve C-reaktif protein yüksekliği vardı. Biyokimyasal incelemeleri total protein ve albümin düşüklüğü dışında normaldi. Ekokardiyografi ile triküspit kapak üzerinde büyük bir vegetasyon görüldü ancak hemodinamik sorun oluşturmuyordu. Kalp boşlukları ve sistolik fonksiyonları normal idi. Bu klinik ve ekokardiyografik bulgularla enfektif endokardit düşünüldü ve geniş spekturumlu antibiyotikler (vankomisin, seftazidim, amikasin) ile kombine tedavi başlandı. Kan ve abse kültürlerinde S.Aures üredi. Dizdeki abse cerrahi olarak drene edilirken boyundaki abse ise kendiliğinden drene oldu. Klinik olarak hemodinamik bozukluk saptanmaması ve periferik embolizasyon belirlenmemesi nedeniyle kardiyak cerrahi uygulanmadı. Altı hafta süre ile intravenöz antibiyotik tedavisi uygulanan hastada tamamen iyileşme elde edildi. S.Aureus bakteriyemisi yenidoğan bebeklerde derin doku enfeksiyonlarına ve enfektif endokardite neden olabileceğinden, bu bebeklere klinik bulgu olmasa bile rutin ekokardiyografi yapılmasını öneriyoruz.

Anahtar Kelimeler

Bakteriyemi, Enfektif endokardit, Stafilokokus aeureus, Yenidoğan

A Neonate with Multifocal Skin and Joint Infections Associated with Asymptomatic Tricuspid Valve Endocarditis

Öz

An 18-day-old baby was admitted to our hospital with irritability and preauricular swelling. He was born at term, as one of twins, and weighed 2540 grams. Physical examination revealed that his weight and head circumference were normal for his age. His vital signs were as follows: body temperature 37.4ºC; heart rate 130/minute; respiratory rate 50/minute; and blood pressure 80/50 mmHg. He had a mass at the right preauricular area, septic arthritis of the right wrist and left knee, a generalised macular rash, and pretibial edema on physical examination. Leucocytosis, thrombocytopenia, and high acute phase reactants were detected on the laboratory studies. Blood biochemistry was normal except for low total protein and albumin levels. Echocardiography revealed a large vegetation on the tricuspid valve, but it did not cause any hemodynamic disturbance. Cardiac chambers and systolic functions were normal. These clinical and echocardiographic findings were suggestive of infective endocarditis and wide-spectrum antibiotics (vancomycin, ceftazidime, amikacin) were started. Blood and abscess cultures were positive for S. aureus. The abscess in the knee was drained surgically while the abscess on the neck drained spontaneously. Cardiac surgery was not performed for this patient as there was no clinical hemodynamic disturbance or peripheric embolization. Complete recovery was obtained after using intravenous antibiotics for 6 weeks. S. aureus bacteremia in neonates can lead to the deep tissue infections and infective endocarditis, and routine echocardiographic screening should be performed in these neonates even if there are no clinical findings

Anahtar Kelimeler

Bacteremia, Infective endocarditis, Staphylococus aeurus, Newborn

Kaynakça

• 1. Valente AM, Jain R, Scheurer M, Fowler VG, Ralph JG, Bengur AR, et al. Frequency of infective endocarditis among infants and children with staphylococcus aureus bacteremia. Pediatrics 2005;115:e15-9.
• 2. Oğuz AD. İnfektif endokardit tanısı, tedavisi ve korumasındaki yenilikler. Türkiye klinikleri J Pediatr 2010;6:31-8.
• 3. Rosenthal LB, Feja KN, Levasseur SM, Alba LR, Gersony W, Saiman L. The changing epidemiology of pediatric endocarditis at a children’s hospital over seven decades. Pediatric Cardiol 2010;31:813-20.
• 4. Sung TJ, Kim HM, Jin M. Methicillin-resistant staphylococcus aureus endocarditis in an extremely low-birth-weight infant treated with linezolid. Clin Pediatr 2008;47:504-6.
• 5. Park MK. Pediatric Cardiology for Practitioners 5th ed. San Antonio, Texas: Mosby Elsevier, 2008:351-60
• 6. O’Callaghan C, Mcdougall P. Infective endocarditis in neonates. Arch Dis Child 1988;63:53-7.
• 7. Ekici F, Varan B, Saylan-Cevik B, Ozkan M, Ok-Atılgan A, Oktay A. A large intracardiac fungus ball in a premature infant. Turk J Pediatr 2011;53:325-7.
• 8. Liu C, Bayer A, Cosgrove SE, Daum RS, Fridkin SK, Gorwitz RJ, et al. Clinical practice guidelines by the infectious diseases society of America for the treatment of methicillin resistant staphylococcus aureus infections in adults and children: Executive summary. Clin Infect Dis 2011;52:285-92.
• 9. Le Guillou S, Casalta JP, Fraisse A, Kreitmann B, Chabrol B, Dubus JC, et al. Infective endocarditis in children without underlying heart disease: a retrospective study analyzing 11 cases. Arch Pediatr 2010;17:1047-55
• 10. Wilson W, Taubert KA, Gewitz M, Lockhart PB, Baddour LM, Levison M, et al. Prevention of infective endocarditis: guidelines from the American Heart Association: a guideline from the American Heart Association Rheumatic Fever, Endocarditis, and Kawasaki Disease Committee, Council on Cardiovascular Disease in the Young, and the Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and the Quality of Care and Outcomes Research Interdisciplinary Working Group. Circulation 2007;116:1736-54.
• 11. Armstrong D, Battin MR, Knight D, Skinner J. Staphylococcus aureus endocarditis in preterm neonates. Am J Perinatology 2002;19:247-51.
• 12. Poon W, Lian W. Recurrent group B streptococcal septicemia in a very low birth weight infant with infective endocarditis and submandibular cellulitis. Ann Acad Med Sinqapore 2010;39:936-7