Acinetobacter baumannii Infective Endocarditis in a child with Down syndrome seen at Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria
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Abstract
Background: Gram negative infective endocarditis (IE) accounts for < 5% of cases of IE. Acinetobacter baumannii is a pleomorphic, emerging, opportunistic and multi-resistant organism. It is associated with delay in diagnosis and treatment failure.
Objectives: We present a case of Acinetobacter baumannii IE in a child with Patent ductus arteriosus (PDA) and features of Downs syndrome.
Case Report: A one-year-old boy presented with high grade fever for six (6) weeks. No cough convulsions, genitourinary or gastrointestinal symptoms. He had fast breathing, suck-rest-suck cycle and forehead sweating since six (6) weeks of age. He was acutely ill looking, febrile with axillary temperature of 39.3oC, in respiratory distress, with dysmorphic features and a systolic murmur at the upper left sternal border. He received intramuscular & oral antibiotics, antimalarials on out-patient basis as parents initially declined admission.
Results: Initial results were negative urine, throat, blood cultures. Echocardiogram showed reduced flow with turbulence across the PDA and pulmonary regurgitation. He was commenced on intra venous (I.V) Cefotaxime, I.V Gentimicin which was changed to I.V Ciprofloxacin, and later I.V Cefepime on account of lack of response. The diagnosis of Acinetobacter baumannii I.E was made after six (6) weeks on admission with BACTEC. He responded to I.V Amoxicillin and Ciprofloxacin based on susceptibility pattern.
Conclusion: This case highlights the rare occurrence of Acinetobacter baumannii infective endocarditis in children, particularly those with Down syndrome, a population already predisposed to infections due to immunodeficiency and unique oral microbiome characteristics.
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