title: Haemophilus parainfluenzae endocarditis in a patient with mitral valve prolapse.
abstract: Haemophilus parainfluenzae is a frequent cause of "culture-negative" endocarditis (i.e., endocarditis owing to a fastidious organism which may require longer incubation periods and/or enrichment media for detection compared to traditional pathogens). More cases will probably be identified with improvements in growth and isolation techniques. A case of H. parainfluenzae endocarditis is presented in a patient with mitral valve prolapse, which illustrates the difficulty in diagnosing endocarditis when initial blood cultures are negative. Particularly, it emphasizes the difficulty in selecting appropriate antibiotic therapy since beta-lactamase producing organisms are being isolated with increased frequency. This report is unique in that it documents successful treatment with a cephalosporin and what is, to our knowledge, the third reported case of a beta-lactamase producing H. parainfluenzae causing endocarditis. The authors believe that beta-lactamase stable second or third generation cephalosporins should constitute initial treatment of H. parainfluenzae endocarditis until sensitivity studies become available, since beta-lactamase production by this organism would nullify the effect of the previous agent of choice, ampicillin.
authors.affiliation: Department of Internal Medicine, University of South Florida College of Medicine, Tampa 33612.
authors.forename: J N
authors.initials: JN
authors.lastname: Greene
authors.forename: R L
authors.initials: RL
authors.lastname: Sandin
authors.forename: L
authors.initials: L
authors.lastname: Villanueva
authors.forename: J T
authors.initials: JT
authors.lastname: Sinnott
mesh_terms: D000328:Adult; D002435:Cefamandole / Q000627:therapeutic use; D004697:Endocarditis, Bacterial / Q000188:drug therapy / Q000382:microbiology*; D005260:Female; D006190:Haemophilus / Q000201:enzymology / Q000302:isolation & purification; D006192:Haemophilus Infections / Q000188:drug therapy / Q000382:microbiology*; D006801:Humans; D008945:Mitral Valve Prolapse / Q000382:microbiology*; D001618:beta-Lactamases / Q000096:biosynthesis
chemical_list: D002435:Cefamandole; D001618:beta-Lactamases