Zusammenfassung
Bei einem 5-jährigen, bislang herzgesunden Mädchen trat nach 14-tägiger antibiogrammgerechter Therapie (Ceftriaxon) einer Pneumokokkensepsis/-meningitis eine vorher nicht nachgewiesene endokarditische Vegetation an der Trikuspidalklappe mit embolischer Pneumonie auf. Eine durch Pneumokokken hervorgerufene, selten Kombination einer manifestierenden Pneumonie, Meningitis und Endokarditis wird auch als Austrian-Syndrom bezeichnet. Ein kultureller Keimnachweis gelangt trotz Aussetzens der Antibiotikatherapie, septischer Fieberschübe und rasch angestiegener Infektionsparameter nicht. Trotz klinischer Besserung unter erweiterter antibakterieller Behandlung (Ceftriaxon, Vancomycin, Fosfomycin) war bei unveränderten Vegetationen und progredienter Klappendestruktion eine chirurgische Sanierung der Klappe erforderlich. In dem entfernten Material konnten mittels PCR (Polymerasekettenreaktion) Pneumokokken nachgewiesen werden. Keime ließen sich jedoch nicht kultivieren.
Abstract
A 5-year-old previously healthy girl developed endocarditis of the tricuspid valve 14 days after pneumococcal sepsis for which she received ceftriaxone. She was admitted to hospital for recurrent fever. An echocardiogram showed a large vegetation on the tricuspid valve with moderate regurgitation. On chest radiography an embolic pneumonia was seen. The rare combination of pneumonia, meningitis and endocarditis caused by Streptococcus pneumoniae is also known as Austrian syndrome. Blood cultures were negative. She was treated with antibiotics (ceftriaxone, vancomycin, fosfomycin), however, progressive valve destruction occurred and surgical reconstruction of the valve and excision of the vegetation was necessary. A PCR from the recovered material detected Streptococcus pneumoniae.
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Bernitzki, S., Bennink, G., Mütze, T. et al. Trikuspidalklappenendokarditis durch Streptococcus pneumoniae bei zuvor herzgesundem Mädchen. Monatsschr Kinderheilkd 160, 165–170 (2012). https://doi.org/10.1007/s00112-011-2501-8
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DOI: https://doi.org/10.1007/s00112-011-2501-8